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Dissecting Aortic Aneurysm

Posted

Hi,

Why is it that in a patient with a suspected dissected aortic aneurysm, blood pressure should be checked in both arms.

Thankyou.

lsyorke, RN

Specializes in Med-Surg, Wound Care.

A patient with that diagnosis should be in the OR...FAST!!!

Yep. There are new procedures now to treat this but not widely done. My kids dad was saved last year after a car wreck- his aorta had actually dissected and DETACHED from his heart!! Evidently there was a tiny membrane layer keeping him from bleeding out. He now has a stent graft in place from his left subclavain all the way to his celiac and has had 10 surgeries since. has to be on BP meds forever and watched closely for occlusion. He was the first person ever to survive this type of injury accoring to the surgeons at Dartmouth. They had also not done a stent graft that big before but they had nothing to lose and everything to gain in trying. He is very lucky to be here still.

dianah, ADN

Specializes in Cath Lab/Radiology. Has 45 years experience.

i found the following sentence in an emergency medicine article (cited after the quote):

because branch vessels may be occluded by the false lumen or by emboli, blood pressure differences between arms of 15-20 mm hg may be present and should be sought.

http://www.em-news.com/pt/re/emmednews/fulltext.00132981-200307000-00016.htm;jsessionid=hvcjxfvkmwvlprbgjj2h2qg0dgjp62s9rswgy87qjsyqs2txffbj!1219373867!181195629!8091!-1

kukukajoo, glad your kids' dad survived, against the odds! what a story!

UM Review RN, ASN, RN

Specializes in Utilization Management.

I only had one patient with this. It was so awfully sad. :(((

We had different BP readings in both arms and Pt c/o "tearing" posterior shoulder pain.

I knew in my gut what it was at that point and called the doc, but there was nothing that could be done to save the patient.

DeLana_RN, BSN, RN

Has 22 years experience.

This killed my brother... he was 41. Sadly, he was far from any medical help, alone in his apartment.

We were told that the odds would have been poor in any case, unless he had been close to an OR when it happened.

DeLana

A thoracic aneurysm can affect blood supply to the left subclavian artery, the large branch that leads to the left arm.

ok, i'm still confused.

"because branch vessels may be occluded by the false lumen or by emboli, blood pressure differences between arms of 15-20 mm hg may be present and should be sought"

and

"a thoracic aneurysm can affect blood supply to the left subclavian artery, the large branch that leads to the left arm"

so does that mean because the emboli is big, the blood pressure is different? or blocked? i'm a literal girl, i need to understand the pathophysiology of why this happens, and can't find it on the web anywhere.

grantz

Specializes in Operating Room Nurse. Has 1 years experience.

ok, i'm still confused.

"because branch vessels may be occluded by the false lumen or by emboli, blood pressure differences between arms of 15-20 mm hg may be present and should be sought"

and

"a thoracic aneurysm can affect blood supply to the left subclavian artery, the large branch that leads to the left arm"

so does that mean because the emboli is big, the blood pressure is different? or blocked? i'm a literal girl, i need to understand the pathophysiology of why this happens, and can't find it on the web anywhere.

first of all know the flow of blood in the heart:

first it enters the vena cava then right atrium down to right ventricles and the rv pumps the blood to the lungs through pulmonary artery then it goes back to heart from the lungs and it is now oxygenated. it enters the heart via pulmonary veins in the left atrium and then down to the left ventricles, the lv pumps the blood to aorta.

aneurysm = a sac and maybe ruptured if too much pressure is put..

aorta = largest artery

in short aortic aneurysm is a sac in the aorta which can be ruptured and cause internal bleeding may cause decrease amount of blood circulating the vascular space so the person will have a fvd and therefore a low bp and high hr as compensatory mechanism which can lead to shock and if not treated promptly will result to death..

p.s. if you think i miss something or its incorrectly stated pls do some reply. i'd be happy to receive some comments. thank you and i hope that helps you alwayslearningrn

Edited by grantz

highlandlass1592, BSN, RN

Specializes in Critical Care. Has 13 years experience.

First of all know the flow of blood in the heart:

First it enters the vena cava then right atrium down to right ventricles and the RV pumps the blood to the lungs through pulmonary artery then it goes back to heart from the lungs and it is now oxygenated. It enters the heart via pulmonary veins in the left atrium and then down to the left ventricles, the LV pumps the blood to aorta.

aneurysm = a sac and maybe ruptured if too much pressure is put..

Aorta = largest artery

in short Aortic Aneurysm is a sac in the Aorta which can be ruptured and cause internal bleeding may cause decrease amount of blood circulating the vascular space so the person will have a FVD and therefore a low BP and high HR as compensatory mechanism which can lead to shock and if not treated promptly will result to death..

P.S. if you think I miss something or its incorrectly stated pls do some reply. I'd be happy to receive some comments. thank you and I hope that helps you AlwaysLearningRN

The post is referring to an aortic dissection not an aneurysm, different ball game.

grantz

Specializes in Operating Room Nurse. Has 1 years experience.

The post is referring to an aortic dissection not an aneurysm, different ball game.

Dissecting Aortic Aneurysm :cool:

highlandlass1592, BSN, RN

Specializes in Critical Care. Has 13 years experience.

Lost my other link for you. Anyways, here is one link:

http://www.iradonline.org/treatment.html

We are a specialty center for management, treatment & repair of both dissections & aneurysms, see these all the time. You have a difference in blood pressure due to the tear & where circulation is compromised. (Basically a dissection will lead to 2 lumens in the aorta instead of one. The false lumen, where the clot is located can not give adequate perfusion to the affected areas of the body. You also have a catecholamine release with a tear which will affect pressures.)

If you want to research further, do a lit search in AJN, they had an article on dissections from a couple of years ago (has a great cross-section picture of the aorta which will give you a great visual of what's going on). Circulations, journal of AHA, also had an excellent article. My computer is down (where I have the articles saved) otherwise I'd give you the specific citations. (on my iPad now) I use both of those articles when teaching nurses about dissections. Hope it helps

highlandlass1592, BSN, RN

Specializes in Critical Care. Has 13 years experience.

Apologies. Top of my screen was cut off so I didn't see title, only one post

grantz

Specializes in Operating Room Nurse. Has 1 years experience.

Apologies. Top of my screen was cut off so I didn't see title, only one post

No problem highlandlass1592. We are just human. :)

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