Linares VJA,Simó SB, Portero PMP, Ruiz AJR

Language: Spanish
References: 25
Page: 312-317
PDF size: 250.33 Kb.

ABSTRACT

Acute aortic syndrome is a pathological process with low incidence compared with acute coronary syndrome, although with a worse prognosis in the short term, which is why its early diagnosis and urgent treatment are essential to the favorable evolution of the patient.
Electrocardiographic changes suggestive of myocardial ischemia, with acute evolution, are rare in acute aortic syndrome. Even in the presence of a suggestive thoracic pain and high levels of blood pressure, an adequate differential diagnosis is of utmost importance, since the administration of anticoagulation and antiplatelet therapy in high doses can have a dramatic impact on patient outcome. Two cases are presented in which electrocardiographic changes determined the action to take in patients with acute aortic syndrome.

REFERENCES

1. Laymen M, Fein SA. Acute aortic syndromes. Emerg Med. 1999;31:87-91.

2. Evangelista A, Domínguez R, Sebastiá C, Salas A, Permanyer-Miralda G, Avegliano G, et al. Prognostic value of clinical and morphologic findings in short-term evolution of aortic intramural haematoma. Therapeutic implications. Eur Heart J. 2004; 25(1):81-7.

3. Lui RC, Menkis AH, McKenzie FN. Aortic dissection without intimal rupture: diagnosis and management. Ann Thorac Surg. 1992;53(5):886-8.

4. Robbins RC, McManus RP, Mitchell RS, Latter DR, Moon MR, Olinger GN, et al. Management of patients with intramural hematoma of the thoracic aorta. Circulation. 1993;88(5 Pt 2):II1-10.

5. Nienaber CA, Von Kodolitsch Y, Petersen B, Loose R, Helmchen U, Haverich A, et al. Intramural hemorrhage of the thoracic aorta: diagnostic and therapeutic implications. Circulation. 1995;92(6): 1465-72.

6. Marti V, Paniagua P, Ginel A. Severe coronary luminal narrowing ascribed to aortic intramural haematoma after valve surgery. Heart. 2007;93(11):1405.

7. Vilacosta I, San Román JA, Ferreirós J, Aragoncillo P, Méndez R, Castillo JA, et al. Natural history and serial morphology of aortic intramural hematoma: a novel variant of aortic dissection. Am Heart J. 1997; 134(3):495-507.

8. Evangelista A, Mukherjee D, Mehta RH, O'Gara PT, Fattori R, Cooper JV, et al; International Registry of Aortic Dissection (IRAD) Investigators. Acute intramural hematoma of the aorta: a mystery in evolution. Circulation. 2005;111(8):1063-70.

9. Evangelista A, Domínguez R, Sebastia C, Salas A, Permanyer-Miralda G, Avegliano G, et al. Long-term follow-up of aortic intramural hematoma: predictors of outcome. Circulation. 2003;108(5):583-9.

10. Cañadas MV, Vilacosta I, Ferreirós J, Bustos A, Díaz-Mediavilla J, Rodríguez E. Intramural Aortic Hematoma and Anticoagulation. Rev Esp Cardiol. 2007;60:201-4.

11. Meszaros I, Morocz J, Szlavi J, Schmidt J, Tornoci L, Nagy L, et al. Epidemiology and clinicopathology of aortic dissection. Chest. 2000;117:1271-8.

12. Hirst AE, Johns VJ, Kime SW. Dissecting aneurysm of the aorta: a review of 505 cases. Medicine. 1958; 37(3):217-79.

13. Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000; 283(7):897-903.

14. Roberts CS, Roberts WC. Aortic dissection with the entrance tear in the descending thoracic aorta: analysis of 40 necropsy patients. Ann Surg. 1991;213: 356-68.

15. Nienaber CA, von Kodolitsch Y, Nicolas V, Siglow V, Piepho A, Brockhoff C, et al. The diagnosis of thoracic aortic dissection by non-invasive imaging procedures. N Engl J Med. 1993;328(1):1-9.

16. Bansal RC, Chandrasekaran K, Ayala K, Smith D. Frequency and explanation of false negative diagnosis of aortic dissection by aortography and transesophageal echocardiography. J Am Coll Cardiol. 1995;25(6):1393-401.

17. Suzuki T, Distante A, Zizza A, Trimarchi S, Villani M, Salerno Uriarte JA, et al; IRAD-Bio Investigators. Diagnosis of acute aortic dissection by D-dimer: the International Registry of Acute Aortic Dissection Substudy on Biomarkers (IRAD-Bio) experience. Circulation. 2009;119(20):2702-7.

18. Tsai TT, Evangelista A, Nienaber CA, Trimarchi S, Sechtem U, Fattori R, Myrmel T, Pape L, Cooper JV, Smith DE, Fang J, Isselbacher E, Eagle KA; International Registry of Acute Aortic Dissection (IRAD). Long-term survival in patients presenting with type A acute aortic dissection: insights from the International Registry of Acute Aortic Dissection (IRAD). Circulation. 2006;114(1 Suppl):I350-6.

19. Erbel R, Alfonso F, Boileau C, Dirsch O, Eber B, Haverich A, et al. Diagnosis and management of aortic dissection. Eur Heart J. 2001;22(18):1642-81.

20. Nallamothu BK, Mehta RH, Saint S, Llovet A, Bossone E, Cooper JV, et al. Syncope in acute aortic dissection: diagnostic, prognostic, and clinical implications. Am J Med. 2002;113:468-71.

21. Mehta RH, Suzuki T, Hagan PG, Bossone E, Gilon D, Llovet A, et al. Predicting death in patients with acute type A aortic dissection. Circulation. 2002; 105:200-6.

22. Spittell PC, Spittell JA, Joyce JW, Tajik AJ, Edwards WD, Schaff HV, et al. Clinical features and differrential diagnosis of aortic dissection. Mayo Clin Proc. 1993;68(7):642-51.

23. Courand PY, Dauphin R, Roussel E, Besnard C, Lantelme P. An uncommon presentation of acute type A aortic dissection: left main coronary artery obstruction. J Cardiovasc Med (Hagerstown). 2011 Jun 10. 10 [Epub ahead of print] doi: 10.2459/JCM.0b013e328348c390.

24. Ravandi A, Penny WF. Percutaneous intervention of an acute left main coronary occlusion due to dissection of the aortic root. JACC Cardiovasc Interv. 2011 Jun;4(6):713-5.

25. Kamp TJ, Goldschmidt-Clermont PJ, Brinker JA, Resar JR. Myocardial infarction, aortic dissection and thrombolytic therapy. Am Heart J. 1994;128(6 Pt 1):1234-7.