A 65-year-old hypeensive male presented to the ER with sudden onset of pain in the back of the chest more so in the interscapular region. He described it as very severe and tearing in nature along with dyspnea, hemiplegia and hemianesthesia. Patient also complained of frequent episodes of syncope in the past 2 days. O/E: - Hypotension Feeble pulses in B/L radial aeries Wide pulse pressure Diastolic murmur heard which was radiating towards the right sternal border. X-RAY CHEST ECG CECT CHEST All of the following are true about the condition except: -
This is a case of aoic dissection. Chest x-ray findings: - Prominent aoic arch and descending thoracic aoa Marked widening of the mediastinum CECT chest findings: -Aoic dissection with intimal flap noted in the thoracic aoa ECG is normal and hence it rules out STEMI. It occurs when blood separates the laminar planes of the media to form a blood-filled channel within the aoic wall. Occurs in 3 groups of patients. Male (40-60 years) with hypeension Connective tissue disorder in young patients. Iatrogenic 6th and 7th decade* Male > female Most frequent pre-existing histologically detectable lesion is cystic medial degeneration Inflammation is characteristically absent Beta-blockers are given to lower Hea rate.
The most frequent pre-existing histologically detectable lesion is cystic medial degeneration
Inflammation is usually present.
Similar condition in a young patient would have pointed towards a diagnosis of a connective tissue disorder.
Beta-blockers unless contraindicated can be given in the above condition.
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