Aortic Dissection: The Daily PANCE Blueprint

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Aortic Dissection: The Daily PANCE Blueprint

A 70-year-old woman comes to the emergency department due to sudden-onset chest pain followed by shortness of breath. The pain started 2 hours ago, and she experienced an episode of syncope lasting about 1 minute shortly after the pain began. She has a history of untreated hypertension and hyperlipidemia. She has no history of heart disease or smoking. Blood pressure is 180/95 mm Hg in both arms; pulse is 110/min and irregular; and respirations are 22/min. Pulses are symmetric and equal in all extremities. There is an S4 gallop. ECG shows atrial fibrillation with rapid ventricular response. Serum troponin is elevated. Chest x-ray shows an enlarged cardiac silhouette, and a CT scan of the chest is shown below. Which of the following is the best next step in management of this patient?

Descending (Type B Stanford) Aortic Dissection

A. Administration of aspirin and nitroglycerin
B. Immediate thrombolytic therapy
C. Initiation of anticoagulation with heparin
D. Emergency pericardiocentesis
E. Emergent surgical repair

Answer and topic summary

The answer is E. Emergent aortic repair surgery

This patient’s presentation is highly suggestive of an acute aortic dissection, as indicated by the sudden-onset chest pain, syncope, hypertensive crisis, and the findings on the CT scan. The presence of an enlarged cardiac silhouette on the chest x-ray and the symptoms align with the diagnosis of aortic dissection. Emergent aortic repair surgery is the most appropriate intervention to prevent further complications such as aortic rupture or end-organ damage.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Cardiology ⇒ Vascular Disease ⇒ Aortic aneurysm/dissection

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