الفهرس 
ANATOMY OF CARDIOVASCULAR SYSTEMOnly 14 pages are availabe for public view
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Abstract
P
atients with chest pain are the most common patients who seek emergency department (ED) care. The etiologies for this symptom range from minor disease processes to life-threatening conditions. The most frequently fatal condition in the spectrum of these patients is acute aortic syndrome (AAS).
The term acute aortic syndrome (AAS), coined several years ago is now widely recognized. AAS includes a heterogeneous group of patients with a similar clinical profile presenting one of the following acute aortic pathologies: penetrating aortic ulcer (PAU), intramural aortic hematoma (IAH), classic aortic dissection (CD) or incomplete dissection (ID). The classic presenting symptom of these patients is sudden onset of severe, sharp chest pain termed as aortic pain.
A high index of clinical suspicion is required, to distinguish AAS from other causes of chest pain. Any delay in diagnosis and treatment of AAS leads to an increase in morbidity and mortality so early diagnosis and management of AAS may be considered the difference between life and death for the affected patient.
Risk factors for AAS include both acquired and genetic conditions and from these risk factors hypertension is the most common for AAS.
All components of AAS may progress to an aortic rupture. Although these acute aortic pathologies appear mostly separate but in some patients one may precede the other and, in others, they just coexist. All previous facts strongly suggest the existence of a link between them.
All these components can be distinguished in terms of their pathology and radiological appearance. They also share a common classification system, the Stanford classification that was originally applied to aortic dissection. This defines aortic disease according to site that broadly correlates with management.
Imaging plays a vital role in diagnosing AAS. Echocardiography (Transthoracic/transoesophageal), contrast enhanced CT, MRI and aortography are currently used to confirm the diagnosis. Multidetector computer tomography MDCT is preferred at many institutions for the evaluation of acute aortic syndrome.
The initial management of AAS involves placement of the patient in an intensive care unit (ICU) or immediate transfer of the patient to the operating room; blood pressure and heart rate should be intensively managed and urine output and cardiac rhythm closely observed.
Early surgery is advocated for patients with an AAS type A. Medical treatment for patients with type B AAS is the currently accepted treatment when the lesion is stable. While type B lesions that are unstable or complicated (persistent pain, lesion progression on serial imaging, signs of imminent rupture or end organ ischemia) should be managed either with surgery or endovascular aortic repair (stenting).
A new type of critical care center has been established at the Methodist Hospital in Houston, Texas: the acute aortic treatment center (AATC). The focus of this center is rapid transportation, diagnosis, and introduction of therapy for patients with acute aortic syndromes.
After the operation, the patient should be transported directly from the operating room into the ICU. The most critical aspect of postoperative care in the intensive care unit (and with medical therapy generally) is blood pressure control using β-blockers. Also attention to ongoing blood loss, correction of hypothermia, treatment of coagulopathy and early detection of postoperative complications are all of great importance.