Specific Arterial Disease
Wilmer W Nichols, Michael F O'Rourke, Elazer R Edelman, Charalambos Vlachopoulos in McDonald's Blood Flow in Arteries, 2022
Aortic dissection is a medical emergency, requiring prompt and aggressive reduction in disruptive forces within the aorta, complemented by surgery when the ascending aorta is involved (with the threat of aortic valve incompetence and rupture into the pericardial sac) (Nienaber and Eagle, 2003a, 2003b; Isselbacher, 2007). Studies of aortic dissection have emphasized the importance of pulsatile phenomena and the rate of rise (dP/dt) of aortic pressure in the initiation and progression of dissection (Beller et al., 2004). Nevertheless, the contribution of shear stress at the aortic wall and of blood flow acceleration (dV/dt) has been challenged. Yin et al. (1989) (using appropriate high-fidelity manometry and flow measurement) found this dV/dt not to be reduced by β-blocking agents or by nitroprusside in patients with Marfan syndrome, although such therapy did reduce mean, pulsatile and maximal tensile stress in the wall.
Valvular heart disease
Ian Mann, Christopher Critoph, Caroline Coats, Peter Collins in The Junior Doctor’s Guide to Cardiology, 2017
This is likely to vary significantly. In the acute setting, the main symptoms are as follows: aortic dissection: — sudden tearing inter-scapular pain— pain maximal at onset— may be accompanied by vagal or syncopal symptoms— possible neurological features with hemiparesis if dissection involves the origin of the carotid arteryendocarditis: — fevers— drenching night sweats— weight loss.
Cardiothoracic surgery
Philip Stather, Helen Cheshire in Cases for Surgical Finals, 2012
A 60-year-old man presents to A&E due to a tearing pain in his chest. You suspect he has an aortic dissection. Give three other symptoms of aortic dissection. (3 marks)Give three causes of aortic dissection. (3 marks)What characteristic signs may you see on chest X-ray? (1 mark)What is the mortality rate for this condition? (1 mark)Give two reasons why this patient may develop a pleural effusion. (2 marks)
Numerical simulation of two-phase non-Newtonian blood flow with fluid-structure interaction in aortic dissection
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
Yonghui Qiao, Yujie Zeng, Ying Ding, Jianren Fan, Kun Luo, Ting Zhu
Aortic dissection is a serious hazardous cardiovascular disease in which blood enters the middle layer of the aortic wall through an entrance tear. This causes the layer to split, forming a “true lumen” (TL) and a “false lumen” (FL) (Wan Ab Naim et al. 2014). Currently, there is a lack of sufficient understanding of the pathogenesis and pathophysiological changes involved in aortic dissection. Detailed knowledge of flow-related variables such as wall pressure and wall shear stress (WSS) can provide better insight into the progression of aortic dissection, aid clinicians in tailoring treatment to individual patients, and optimize management of the disease. In the last several decades, many researchers have applied numerical approaches to obtain the hemodynamic parameters of aortic dissection (Sun & Chaichana 2016). Khanafer and Berguer (2009) found that the highest shear stress occurs in the medial layer, and this may contribute to the dissection. Tse et al. (2011) investigated blood flow in a pre-aneurismal aorta model and inferred that elevated TAWSS would extend the tear. Ab Naim et al. (2016) reported vortical structure in the FL and its interaction with WSS to predict thrombus formation.
Exercise parameters for the chronic type B aortic dissection patient: a literature review and case report
Published in Postgraduate Medicine, 2021
Donald C. DeFabio, Christopher J. DeFabio
The patient’s report of onset of symptoms is consistent with aortic dissection. He recalls experiencing a sharp and sudden pain between his shoulders while paddling. The intensity of pain, as the patient states, was ‘like I never had before.’ The patient was rushed to an emergency department shortly after, where an initial diagnosis of an uncomplicated TBD, from just distal of the subclavian artery for approximately 6 cm with a closed lumen, was provided. After 2 weeks in cardiac intensive care (CIC) the patient was transitioned from intravenous anti-hypertensive therapy to oral medication. Soon after, a spontaneous elevation of his blood pressure caused the dissection to expand to the common iliac arteries bilaterally with a now patent lumen, as confirmed by computed tomography (CT) scan. After an additional two weeks in CIC his blood pressure was considered under control with oral medication and he was released from the hospital to home.
Prevalence and development of aortic dilation and dissection in women with Turner syndrome: a systematic review and meta-analysis
Published in Expert Review of Cardiovascular Therapy, 2023
F. Meccanici, J.W.C. de Bruijn, J.S. Dommisse, J.J.M. Takkenberg, A.E. van den Bosch, J. W. Roos-Hesselink
The data were analyzed using the Metafor package [24] in statistical and computing program R (R foundation for Statistical Computing, Vienna, Austria, Version 4.2.1). Patient characteristics were described as reported in the individual study and pooled using an inverse-variance weighted approach. Studies reporting on aortic dissection incidence alone were not included in the pooling of patient characteristics, yet the characteristics of aortic dissection cases were described. Normally distributed numerical data were presented as mean ± standard deviation (SD) and non-normally distributed numerical data as median and range or interquartile range (IQR). Categorical data were presented as proportion (%). For the primary outcomes, the range of the included studies was shown and pooled estimates were calculated. Pooled categorical data were shown as percentages, numerical data as mean and dissection incidence as cases per 100.000 patient-years, all with accompanying 95% confidence interval (CI).
Related Knowledge Centers
- Acute Aortic Syndrome
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- Arterial Dissections
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