Block 2 Case 9 Answers - IHD

A 65 year old man with a history 40pack-year history of smoking presents to the ER with severe chest/back pain. He thinks he is having a heart attack but all of the tests come back negative.

1. What are you concerned he has? Aortic dissection - this occurs when there is an intimal tear which allows blood to flow between layers of the media.  Note the compression of the lumen from the blood within the inner wall of the aorta. The blood can ascend to the heart and fill the pericardial sac and result in tamponade and sudden death. 

2. Name 3 risk factors for this condition

• HTN (90%)
• marfans - medial degeneration
• pregnancy

3. Discuss the classification system for this disease:

Debakey	Stanford	prognosis
Type 1 asc/desc	A	poor
Type II asc only	A	Poor
Type III desc only	B	better

4. His HTN and smoking history are risk factors for an AAA: where is the most likely location of an AAA?

• between renal arteries and iliacs