In summary, acute aortic aneurysm dissection is a life-threatening cardiovascular emergency that requires prompt recognition and management. Clinical pharmacists play a critical role in the management of this condition by ensuring appropriate pharmacotherapy, monitoring for potential drug interactions or adverse effects, and providing patient education.
Acute aortic aneurysm dissection presents with sudden-onset severe chest or back pain, often described as tearing or ripping. The clinical presentation includes hypertension, pulse deficits, and symptoms suggestive of organ malperfusion. Risk factors for aortic dissection include hypertension, connective tissue disorders, bicuspid aortic valve, family history, aging, atherosclerosis, and trauma or prior cardiac surgery.
The management of acute aortic aneurysm dissection involves a multidisciplinary approach. Immediate goals include blood pressure control, pain management, and preventing further propagation of the dissection. Surgical intervention is often required for type A dissections, while medical management is the mainstay for type B dissections. Long-term management includes surveillance, lifestyle modifications, and regular follow-up to monitor disease progression and prevent complications.
Clinical pharmacists with a strong understanding of the clinical presentation, diagnostic approach, pharmacotherapy, and key guidelines can contribute significantly to optimizing patient care and improving outcomes in acute aortic aneurysm dissection.
References
- Ledrle FA, Powell JT, Nienaber CA: Does intensive medical treatment improve outcomes in aortic dissection? BMJ 349:g5288, 2014.
- Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet. 2015 Feb 28;385(9970):800-11. doi: 10.1016/S0140-6736(14)61005-9. Epub 2015 Feb 6. PMID: 25662791.
- Gudbjartsson T, Ahlsson A, Geirsson A, Gunn J, Hjortdal V, Jeppsson A, Mennander A, Zindovic I, Olsson C. Acute type A aortic dissection – a review. Scand Cardiovasc J. 2020 Feb;54(1):1-13. doi: 10.1080/14017431.2019.1660401. Epub 2019 Sep 23. PMID: 31542960.
- Siegal EM. Acute aortic dissection. J Hosp Med. 2006 Mar;1(2):94-105. doi: 10.1002/jhm.69. PMID: 17219479.
- Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. J Am Coll Cardiol. 2010;55(14):e27-e129.doi:10.1016/j.jacc.2010.02.015
- Erbel R, Aboyans V, Boileau C, et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases. Eur Heart J. 2014;35(41):2873-2926. doi:10.1093/eurheartj/ehu281
- Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD). JAMA. 2000;283(7):897–903. doi:10.1001/jama.283.7.897
- Tsai TT, Fattori R, Trimarchi S, et al. Long-term survival in patients presenting with type B acute aortic dissection: insights from the International Registry of Acute Aortic Dissection. Circulation. 2006;114(21):2226-2231. doi:10.1161/CIRCULATIONAHA.106.622340
- Trimarchi S, Tolenaar JL, Tsai TT, et al. Influence of clinical presentation on the outcome of acute B aortic dissection: evidences from IRAD. J Cardiovasc Surg (Torino). 2012;53(2):161-168.
- Wheatley GH 3rd, Gurbuz AT, Rodriguez-Lopez JA, Ramaiah VG, Olsen D, Williams J, Diethrich EB. Midterm outcome in 158 consecutive Gore TAG thoracic endoprostheses: single center experience. Ann Thorac Surg. 2006;81(5):1570-1577. doi:10.1016/j.athoracsur.2005.11.003
- Fattori R, Montgomery D, Lovato L, et al. Survival after endovascular therapy in patients with type B aortic dissection: a report from the International Registry of Acute Aortic Dissection (IRAD). JACC Cardiovasc Interv. 2013;6(8):876-882. doi:10.1016/j.jcin.2013.03.013
- Nienaber CA, Rousseau H, Eggebrecht H, et al. Randomized comparison of strategies for type B aortic dissection: the INvestigation of STEnt Grafts in Aortic Dissection (INSTEAD) trial. Circulation. 2009;120(25):2519-2528. doi:10.1161/CIRCULATIONAHA.109.886408
- Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE. Management of acute aortic dissections. Ann Thorac Surg. 1970;10(3):237-247. doi:10.1016/s0003-4975(10)65594-4