Aortic dissection progressing to intramural hematoma: A multiple case study

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Filipino Multidisciplinary Research Journal in Education


Advances in tomographic imaging have made aortic dissection, known as intramural hematoma (IMH), more common in acute aortic syndrome. Unpredictable IMH development to dissection or rupture, or acute aortic (pain) syndrome, may indicate underlying illness. Independent observational data show that after 30 days in the hospital, the IMH either fades or progresses to a dissection, restricted rupture, or aneurysm. Type A ascending aortic IMH has a significant risk of early development and requires prompt surgery. Recurrent pain or pleural effusion indicate disease progression. Large PAU may be a common denominator of development and bad outcome, but no PAU does not suggest stable IMH. 75% of individuals with proximal IMH died or had surgery. Validating an earlier concept, IMH of the descending aorta may demand careful waiting. A recent meta-analysis explains IMH and aortic ulcers. Natural course of 168 cases of typical IMH led to overt aortic dissection in 25% of ascending aortic IMH and in 13% of descending IMH, aortic rupture in 28% and 9%, or stabilization in 28% and 76%; 30-day mortality was 18% with surgical repair of proximal IMH and 33% with surgery to distal IMH compared to 60% and 8% with medical treatment of proximal and distal IMH. Aortic rupture, imminent aortic rupture, or clinical deterioration suggest TEVAR is needed. Type B IMH treatment involves monitoring vital signs (systolic 120) and treating pain. They have CT scans often (repeated with worsening or new-onset pain or concerns about end-organ ischemia). TEVAR may be an option for people who haven't responded to hypertension medicines, have persistent pain, or have IMA enlargement (IMH). In type B IMH patients, beta-blockers lower heart rate and blood pressure. Calcium channel blockers and sodium nitroprusside are options. To avoid reflex tachycardia, use these drugs alongside beta-blockers. Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers may assist aortic remodeling and blood pressure regulation. Ascending aortic IMH has a bad short-term prognosis, although surgery improves outcomes. When IMH of the descending aorta is restricted or the aortic diameter is less than 50 mm, the prognosis is better. Location, aortic width, and risk variables are inconsistent predictors of late progression for IMH. Good blocking may improve prognosis even if surgery fails.

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