Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast Episode 87: Aortic Dissection with Tom Metkus
Jul 11, 2018
Tom Metkus, cardiologist and intensivist who treats acute aortic syndromes, walks through what aortic dissection is and why it threatens organs. He explains Type A versus Type B urgency, red flags and misleading presentations. Discussions cover imaging limits, surgical versus medical decision making, blood-pressure and heart-rate control, TEVAR, postoperative complications, and long-term surveillance.
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Always Consider Dissection With Thunderclap Chest Pain
- If you see a patient with sudden, severe chest pain or chest pain plus another symptom, consider aortic dissection early.
- Early suspicion drives timely imaging and prevents dangerous treatment delays.
Type A Is Time-Sensitive And Surgical
- Type A dissections (ascending) are surgical emergencies due to rapid expansion, rupture, and end-organ malperfusion.
- Delay to definitive surgery increases mortality substantially, often estimated around 1% per hour.
Dissection Presents As A Clinical Chameleon
- Dissection causes two main problems: aortic rupture and organ malperfusion depending on which branch vessels are involved.
- Presentations therefore vary widely from chest pain to stroke, limb ischemia, or abdominal pain.