Acute Type A aortic dissection is associated with malperfusion of one or more vascular beds. The extent, severity and duration of the malperfusion can negatively impact the patient.
Vascular Bed
Manifestations
coronary
elevated troponin, elevated ST segment, regional wall motion abnormalities on echocardiography
cerebral and/or spinal cord
stroke, paraplegia or paraparesis, transient ischemic attack
extremity
limb ischemia, elevated CK, loss of peripheral pulses
mesenteric
bowel paralysis, abdominal tenderness
other visceral
acute kidney injury, elevated pancreatic enzymes
If ischemia is severe then expect:
(1) organ failure or infarction
(2) elevated serum lactate concentration
Involvement of multiple vascular beds is associated with shock and multi-organ failure.
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