Aortic dissection electrocardiogram: Difference between revisions
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==Overview== | ==Overview== | ||
[[ST elevation myocardial infarction]] ([[MI]]) due to occlusion by the dissection of the coronary artery at its ostium may be present. The [[right coronary artery]] tends to be involved more frequently than the [[left coronary artery]]. | [[ST elevation myocardial infarction]] ([[MI]]) due to occlusion by the dissection of the [[coronary artery]] at its [[ostium]] may be present. The [[right coronary artery]] tends to be involved more frequently than the [[left coronary artery]]. [[Electrical alternans]] may be present in the setting of a [[pericardial effusion]] should the dissection have extended into the [[pericardium]]. | ||
==Electrocardiogram== | ==Electrocardiogram== | ||
EKG findings in aortic dissection are usually non-specific. Possible findings include: | [[EKG]] findings in [[aortic]] dissection are usually non-specific. Possible findings include: | ||
* [[Sinus tachycardia]] | * [[Sinus tachycardia]] | ||
* Acute [[ST segment elevation]] may be seen in 1% - 2% of the patients, signifying the occurrence of [[STEMI]] due to involvement of coronary arteries by the dissection. | * [[Acute]] [[ST segment elevation]] may be seen in 1% - 2% of the patients, signifying the occurrence of [[STEMI]] due to involvement of [[coronary artery|coronary arteries]] by the dissection. | ||
* In the setting of dissection involving the [[pericardium]] causing [[pericardial effusion]], an [[electrical alterans]] may be present. | * In the setting of dissection involving the [[pericardium]] causing [[pericardial effusion]], an [[electrical alterans]] may be present. | ||
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | | colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | ||
|- | |- | ||
|bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' An [[electrocardiogram]] should be obtained on all patients who present with | |bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' An [[electrocardiogram]] should be obtained on all patients who present with [[symptom]]s that may represent [[acute]] [[thoracic aorta|thoracic]] [[aortic dissection]].<nowiki>"</nowiki> | ||
|- | |- | ||
|bgcolor="LightGreen" |<nowiki>"</nowiki>'''a.''' Given the relative infrequency of dissection-related coronary artery occlusion, the presence of [[ST-segment elevation]] suggestive of [[myocardial infarction]] should be treated as a primary cardiac event without delay for definitive aortic imaging unless the patient is at high risk for [[aortic dissection]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | |bgcolor="LightGreen" |<nowiki>"</nowiki>'''a.''' Given the relative infrequency of dissection-related [[coronary artery]] occlusion, the presence of [[ST-segment elevation]] suggestive of [[myocardial infarction]] should be treated as a primary [[cardiac]] event without delay for definitive [[aortic]] imaging unless the patient is at high risk for [[aortic dissection]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
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Revision as of 21:27, 24 January 2013
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Aortic dissection Microchapters |
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Diagnosis |
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Treatment |
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Special Scenarios |
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Case Studies |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Raviteja Guddeti, M.B.B.S. [3]
Overview
ST elevation myocardial infarction (MI) due to occlusion by the dissection of the coronary artery at its ostium may be present. The right coronary artery tends to be involved more frequently than the left coronary artery. Electrical alternans may be present in the setting of a pericardial effusion should the dissection have extended into the pericardium.
Electrocardiogram
EKG findings in aortic dissection are usually non-specific. Possible findings include:
- Sinus tachycardia
- Acute ST segment elevation may be seen in 1% - 2% of the patients, signifying the occurrence of STEMI due to involvement of coronary arteries by the dissection.
- In the setting of dissection involving the pericardium causing pericardial effusion, an electrical alterans may be present.
2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease (DO NOT EDIT)[1]
Screening Tests (DO NOT EDIT)[1]
| Class I |
| "1. An electrocardiogram should be obtained on all patients who present with symptoms that may represent acute thoracic aortic dissection." |
| "a. Given the relative infrequency of dissection-related coronary artery occlusion, the presence of ST-segment elevation suggestive of myocardial infarction should be treated as a primary cardiac event without delay for definitive aortic imaging unless the patient is at high risk for aortic dissection. (Level of Evidence: B)" |
References
- ↑ 1.0 1.1 Hiratzka LF, Bakris GL, Beckman JA; et al. (2010). "2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine". Circulation. 121 (13): e266–369. doi:10.1161/CIR.0b013e3181d4739e. PMID 20233780. Unknown parameter
|month=ignored (help)