Thoracic aortic aneurysm medical therapy
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Differentiating Thoracic Aortic Aneurysm from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]
Overview
Medical therapy for patients with a thoracic aortic aneurysm includes aggressive blood pressure control, smoking cessation, and aggressive lipid management.
Medical Therapy
- 2 Large bore IV needles
- Adequate airway and breathing
- Urinary output monitoring
Emergency care
- Aggressive blood pressure control
- Aggressive fluid resuscitation
- Immediate cardiac surgery consultation
Medications
Follow up
2010 ACCF/AHA Guideline Recommendations: General Medical Treatment and Risk Factor Management (DO NOT EDIT) [1]
Medical treatment of patients with Thoracic aortic diseases (DO NOT EDIT)[1]
| Class I |
| "1. Stringent control of hypertension, lipid profile optimization, smoking cessation, and other atherosclerosis risk-reduction measures should be instituted for patients with small aneurysms not requiring surgery, as well as for patients who are not considered surgical or stent graft candidates (Level of Evidence: A)" |
Blood pressure control (DO NOT EDIT)[1]
| Class I |
| "1. Antihypertensive therapy should be administered to hypertensive patients with thoracic aortic diseases to achieve a goal of less than 140/90 mm Hg (patients without diabetes) or less than 130/80 mm Hg (patients with diabetes or chronic renal disease) to reduce the risk of stroke, myocardial infarction, heart failure, and cardiovascular death. (Level of Evidence: B)" |
| "2. Beta adrenergic–blocking drugs should be administered to all patients with Marfan syndrome and aortic aneurysm to reduce the rate of aortic dilatation unless contraindicated. (Level of Evidence: B)" |
| Class IIa |
| "1.For patients with thoracic aortic aneurysm, it is reasonable to reduce blood pressure with beta blockers and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers to the lowest point patients can tolerate without adverse effects. (Level of Evidence:B)" |
| "2.An angiotensin receptor blocker (losartan) is reasonable for patients with Marfan syndrome, to reduce the rate of aortic dilatation unless contraindicated. (Level of Evidence:B)" |
Dyslipidemia Treatment (DO NOT EDIT)[1]
| Class IIa |
| "1. Treatment with a statin to achieve a target LDL cholesterol of less than 70 mg/dL is reasonable for patients with a coronary heart disease risk equivalent such as noncoronary atherosclerotic disease, atherosclerotic aortic aneurysm, and coexistent coronary heart disease at high risk for coronary ischemic events (Level of Evidence:A)" |
Smoking Cessation (DO NOT EDIT)[1]
| Class I |
| "1. Smoking cessation and avoidance of exposure to environmental tobacco smoke at work and home are recommended. Follow-up, referral to special programs, and/or pharmacotherapy (including nicotine replacement, buproprion, or varenicline) is useful, as is adopting a stepwise strategy aimed at smoking cessation (the 5 As are Ask, Advise, Assess, Assist, and Arrange) (Level of Evidence: B)" |
Takayasu's Arteritis and Giant Cell Arteritis (DO NOT EDIT)[1]
| Class I |
| "1. Initial therapy for active Takayasu arteritis and active giant cell arteritis should be corticosteroids at a high dose (prednisone 40 to 60 mg daily at initiation or its equivalent) to reduce the active inflammatory state. (Level of Evidence: B)" |
| "2. The success of treatment of patients with Takayasu arteritis and giant cell arteritis should be periodically evaluated to determine disease activity by repeated physical examination and either an erythrocyte sedimentation rate or C-reactive protein level. (Level of Evidence: B)" |
| "3. Elective revascularization of patients with Takayasu arteritis and giant cell arteritis should be delayed until the acute inflammatory state is treated and quiescent. (Level of Evidence: B)" |
| Class IIa |
| "1. It is reasonable to treat patients with Takayasu arteritis receiving corticosteroids with an additional anti-inflammatory agent if there is evidence of progression of vascular disease, recurrence of constitutional symptoms, or re-elevation of inflammatory marker. (Level of Evidence:C)" |
Aortic Arch and Thoracic Aortic Atheroma and Atheroembolic Disease (DO NOT EDIT)[1]
| Class IIa |
| "1. Treatment with a statin is a reasonable option for patients with aortic arch atheroma to reduce the risk of stroke. (Level of Evidence: C)" |
| Class IIb |
| "1. Oral anticoagulation therapy with warfarin (INR 2.0 to 3.0) or antiplatelet therapy may be considered in stroke patients with aortic arch atheroma 4.0 mm or greater to prevent recurrent stroke. (Level of Evidence: C)" |
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE; 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.