Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

26/10/2023 THORACIC AORTA DISSECTION & VALVULAR DISEASE By Catherine Oliver 1 THORACIC AORTA DISSECTION • Tear in the intimal lining • 50-60y/o Tunica intima • Males > Females CONGENITA ACQUIRE IATROGENI Connective tissue • Hypertension • Aortic/mitral valve disorders • Smoking surgery • Marfans syndrome • Pregnancy • CABG • Biscuspid aortic • Atherosclerosis• Percutaneous valve • Aortic aneurysm cardiac catheter • Coarctation of the • Family history placement aorta 2 26/10/2023 THORACIC AORTA DISSECTION brachiocephalic trunk Anterograde Forward Descending Aorta RBackwarde Left Ventricle 3 CLASSIFICATION Debakey based upon the site of dissection origin “BAD” Stanford based upon the proximity to the LSA B A D 4 26/10/2023 PRESENTATION S Chest/Back/Abdo O Acute C Sharp/Ripping R Chest/Back/Abdo A Syncope/Weakness/Sensory loss T Getting worse E n/a S Severe 5 INVESTIGATIONS Physical • PerfExamn deficit • Auscultation ⚬ Radial ⚬ Aortic regurgitation ￭ Brachiocephalic (both) (early diastolic) ￭ Subclavian (LHS) ⚬ Systolic BP ￭ >20mmHg difference • Reduced GCS ⚬ Focal neurological deficit • Left pleural effusion ￭ Paraesthesia ￭ Weakness ￭ Paraplegia 6 26/10/2023 INVESTIGATIONS B ECG, baseline observations L Blood tests (FBC, U&E, LFT’s, D-dimer, Troponin, G&S, CRP, VBG/ABG) I CXR, Transthoracic echocardiography (TTE), *CT* S - S Senior support, Cardiothoracics 7 THE MANAGEMENT Stanford Aims Control pain A B • Morphine HR <60 Surgery SysBP 100-120mmHg • Beta-blockers • Di-hydropyridine Complicated Un-Complicated CCB’s Medical therapy 8 26/10/2023 Quick breather 5 mins 9 VALVULAR DISEASE STENOSIS REGURGITATION Too stiff/thick ∴ Congestion Aortic Poor seal ∴ Congestion • *Calcification* (>70y/o) Aortic • *Bicuspid valve* (<70y/o) • Rheumatic fever • Rheumatic fever • Marfan’s • Infective endocarditis Mitral • *R• Congenitaler* Mitral • Rheumatic fever • Infective endocarditis • Papillary muscle rupture Primary; Problem w/ valve apparatus Secondary; Stretch of the annulus 10 26/10/2023 MITRAL Stenosis Regurgitation Dyspnoea Angina Dyspnoea HF Fatigue IE/HF Malar flush Tapping apex Displaced apex AF “Pan-systolic” Burrrrr “Mid-diastolic” LUB-de-Durrrr 5ICS MCL 5ICS MCL Radiates - axilla LHS on expiration LHS on expiration 11 MITRAL Stenosis Regurgitation Dyspnoea Fatigue IE/HF Displaced apex “Pan-systolic” Burrrrr 5ICS MCL Radiates - axilla LHS on expiration 12 26/10/2023 MITRAL Stenosis Regurgitation Dyspnoea Angina HF Malar flush Tapping apex AF “Mid-diastolic” LUB-de-Durrrr 5ICS MCL LHS on expiration 13 AORTIC Stenosis Regurgitation Syncope Angina Dyspnoea DysHFoea Slow rising pulse Angina “Ejection systolic” Lub-woosh-Dub Collapsing pulse 2 ICS RHS Radiates - Carotids “Early Diastolic” Lub-Durrrr Sit forward on expiration 3 ICS LHS “Erb’s Point” 14 26/10/2023 AORTIC Stenosis Regurgitation Dyspnoea HF Angina Collapsing pulse “Early Diastolic” Lub-Durrrr 3 ICS LHS “Erb’s Point” 15 AORTIC Stenosis Regurgitation Syncope Angina Dyspnoea Signs Slow rising pulse Corrigan’s - distension and collapse of carotids “Ejection systolic” Lub-woosh-Dub 2 ICS RHS De Musset’s - head bobbing Radiates - Carotids Sit forward on expiration Quincke’s - nail bed pulse Muller’s - uvula pulse 16 26/10/2023 AORTIC Stenosis Regurgitation Syncope Angina Dyspnoea Slow rising pulse “Ejection 2 ICS RHS Lub-woosh-Dub Radiates - Carotids Sit forward on expiration 17 LOCATIONS & MANEUVRES Expiration Expiration 18 26/10/2023 INVESTIGATION & MANAGEMENT AS AR MS M R ECG; LVH ECG; LVH ECG; baseline ECG; baseline CXR; pulmonary CXR; pulmonary CXR; baseline OR ECHO; TTE then TOE congestion congestion enlarged atrium, ECHO; TTE then TOE ECHO; TTE then TOE pulmonary HTN ECHO; TTE then TOE Replacement/Repair Valvuloplasty or Monoror Monitor Replacement Replacement/Repair or Valvotomy 19 INVESTIGATION & MANAGEMENT AS AR MS M R 20 26/10/2023 RESOURCES EUREKA; CARDIOVASCULAR MEDICINE GEEKY MEDICS NINJA NERD/ZERO TO FINALS/RADIOPAEDIA 21 THANK YOU ANY QUESTIONS? 22 26/10/2023 RESOURCE page 23 THE MANAGEMENT Lorem ipsum dolor sit amet, consectetur adipiscing elit. Etiam euismod id sem quis accumsan. Sed tempus placerat velit a placerat. Cras suscipit est at mauris. Etiam euismod id sem quis accumsan. Sed tempuscing elit. 01 placerat velit a placerat. Cras suscipit est at mauris. Lorem ipsum dolor sit amet, consectetur adipiscing elit. 02 placerat velit a placerat. Cras suscipit est at mauris. Etiam euismod id sem quis accumsan. Sed tempuscing elit. 03 placerat velit a placerat. Cras suscipit est at mauris. Lorem ipsum dolor sit amet, consectetur adipiscing elit. 04 placerat velit a placerat. Cras suscipit est at mauris. 24