Aortic Dissection – ABC CARDIOL

ABCIC

Review Article

Assessment of Acute Chest Pain in the Emergency Department: How Point-of-Care Ultrasound Can Assist the Cardiologist

Alexandre de Matos Soeiro et al. Lucas Lentini Herling de Oliveira Rômulo Fonseca de Moraes Tatiana de Carvalho Andreucci Torres Leal

Abstract

The use of point-of-care ultrasound (POCUS) in emergency settings is now well established as part of the initial assessment of critically ill patients. In cases of acute chest pain, POCUS plays a significant role in differential diagnosis, helping to reduce diagnostic errors and, most importantly, preventing the discharge of patients with potentially life-threatening conditions. In this context, the main diagnostic considerations include acute coronary syndrome (ACS), pericarditis, pulmonary thromboembolism (PTE), and acute aortic syndromes (AAS). POCUS has proven effective in all of these scenarios and can be widely applied with proper training, both by novice physicians and experienced echocardiographers. This article aims to discuss the key ways in which POCUS can specifically aid in the differential diagnosis of chest pain.

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ABC

Letter to the Editor

Analysis of Factors Affecting False Lumen Thrombosis in Type B Aortic Dissection

Beatriz Vitória Carvalho Lordêlo et al. Álvaro Eduardo Santos Oliveira Henri Jun Iti Okubo Luana Macedo da Silva Nascimento … Luiz Henrique Cardoso da Silva Pedro Pereira Tenório

Dear editor,

The study published by Tang et al., entitled “Factors Affecting False Lumen Thrombosis in Type B Aortic Dissection,” highlighted the influence of morphological aspects of type B aortic dissection (TBAD), according to the Stanford classification, on false lumen thrombosis prior to treatment with endovascular repair of the thoracic aorta. It has been shown that false lumen thrombosis occurs significantly less frequently in patients with TBAD and renal failure, when compared with those with TBAD and normal renal function.

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IJCS

Case Report

Spontaneous Multivessel Coronary Artery Dissection: Case Report

Ana Paula Schonarth et al. Ottávia Zainho Helbok Caroline de Oliveira Fischer Bacca Arieli Carini Michels

Abstract

Spontaneous coronary artery dissection (SCAD) is a rare condition that can cause acute myocardial infarction (AMI), especially in young women without risk factors for coronary artery disease. Diagnosis is made by cardiac catheterization, and treatment varies from conservative to surgical approaches, depending on the severity. We report the case of a woman with a history of AMI who underwent initial catheterization without requiring percutaneous coronary intervention due to the absence of an obstructive lesion. Subsequently, the patient presented episodes of angina, and a new catheterization was performed, which revealed dissection in the left anterior descending and right coronary arteries. Given the lack of spontaneous resolution of the dissection, which was initially unilateral and progressed to bilateral, the patient underwent myocardial revascularization with mammary artery and saphenous vein bypass grafts. The objective of this study is to document a case of SCAD and to describe its characteristics, diagnosis, and therapeutic management.

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ABC

Original Article

Factors Affecting False Lumen Thrombosis In Type B Aortic Dissection

Qian-hui Tang et al. Jing Chen Han Yang Zhong Qin … Qiu-ning Lin Xiao Qin

Abstract

Background

Complete thrombosis of the false lumen facilitates remodeling of type B aortic dissection (TBAD). Morphological characteristics affect thrombosis in the false lumen.

Objectives

Discuss the factors present before admission that influence false lumen thrombosis in patients with TBAD.

Methods

We studied 282 patients diagnosed with TBAD in our hospital between January 2008 and December 2017. We divided the subjects into a thrombotic group and a non-thrombotic group based on whether any thrombus was detectable in the false lumen. We analyzed the differences between the two groups with respect to clinical data, the vertical length of the dissection, and the diameter of the aorta. P values < 0.05 were considered statistically significantly different.

Results

Significant differences between the thrombotic group and non-thrombotic group were found with respect to age (53.92 ± 11.40 vs. 50.36 ± 10.71, p = 0.009) and proportion of patients with renal insufficiency (7.83% vs. 16.38%, p = 0.026). In zones 3–9, the true lumen diameter of the thrombotic group was significantly larger than in the non-thrombotic group (p < 0.05). Binary logistic regression analysis showed that true lumen diameter in zone 5 and renal insufficiency were independent predictors of false lumen thrombosis.

Conclusions

Age and renal function were associated with thrombosis in the false lumen. Potentially, the difference between the diameter of the true lumen diameter and that of the false lumen may influence the thrombosis of the false lumen.

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ABCIC

Image

A Deceiving Aorta

Helder Santos et al. Hugo Miranda Inês Almeida Mariana Santos … Samuel Almeida Lurdes Almeida

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ABC

Anatomopathological Session

Case 3/2016 – 58 Year-Old Hypertensive Male with End-Stage Renal Disease, Aortic Dissection, Fever and Hemoptysis

Desiderio Favarato et al. Paulo Sampaio Gutierrez

Clinical aspects

The patient had a previous diagnosis of arterial hypertension and chronic renal disease, with renal failure, being on renal replacement therapy via hemodialysis. He had chest pain and dyspnea. His clinical and laboratory assessments revealed coronary artery disease and chronic aortic dissection.

Chronic renal disease significantly progresses as age and cardiovascular disease advance, culminating with renal function worsening. The ARIC Study reports an increase in cardiovascular disease prevalence from 18% to 40% before the age of 65 years, from normal renal function to a glomerular filtration rate drop of 15 mL/min/1.73m², while, over the age of 65 years, that prevalence increases from 20% to 50%, with progressive renal function worsening.

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ABC

Case Report

Acute aortic dissection during pregnancy

Walkiria Samuel Avila et al. Ricardo Dias Renato Takeshi Yamada Adriano Armelin

Acute aortic dissection is one of the most dreaded clinical conditions during pregnancy. Difficulties in establishing a diagnosis and limitations regarding invasive studies increase mortality rates associated with the disease. The limited experience reported in the literature does not allow the determination of guidelines for clinical and/or surgical management of aortic dissection in pregnancy. The authors present a case of acute aortic dissection in a woman in her 33rd week of gestation and discuss the diagnostic approach considering the peculiarities of the disease’s manifestation.

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