Aortic Dissection (cont.)
What is the treatment for aortic dissection?
The ABCs of resuscitation are always a priority.
In the emergency department, intravenous lines will be placed, monitors for
heart rate and rhythm will be attached, and supplemental oxygen provided.
Treatment and diagnostic testing usually occur at the same time until the final
diagnosis is established.
The initial medications used are directed at lowering the blood pressure to
prevent further tearing or damage to the aorta.
Beta blocker medications [for
example, esmolol (Brevibloc), labetalol (Normodyne, Trandate), metoprolol
(Lopressor, Toprol XL)] decrease the adrenaline action on the heart and blood
vessels. Nitroglycerin dilates blood vessels to decrease blood pressure. Specific
medication combinations will depend upon the patient's needs.
Ultimately, type A aortic dissections of the ascending aorta require surgery
as the treatment of choice. The area of aorta that is damaged is replaced with
an artificial graft. If the aortic valve has been damaged, it too may need
replacement or repair.
Medical management (non-surgical) is preferred for Type B dissection of the
descending aorta, but again, each patient needs to be assessed individually as
to the specific treatment suggested. Medications are prescribed to aggressively
control high blood pressure to prevent further dissection and aortic injury.
What is the prognosis for aortic dissection?
For aortic rupture, in which all three layers of the aorta are disrupted, the
mortality (death) rate is up to 80% of patients. Fifty percent of these patients
die before reaching a hospital.
For Type A aortic dissection, the mortality rate remains high, with up to a
30% death rate after surgery.
Type B aortic dissections, treated medically, have an initial death rate of
10%. This compares to a 30% mortality when treated surgically.
Overall, for both types of aortic dissection, the ten year survival rate is
more than 60%
Next: Can aortic dissection be prevented? »
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