Aneurysm and Dissection

Definition/Etiology:

Aneurysm – abnormal bulging, stretching, or thinning of the wall of an artery
Dissection – aortic wall layer separation

Risk factors:

• Hypertension, atherosclerosis
• >60 yoa
• Cardiac surgery
• Connective tissue disease
• Cocaine use
• Smoking
• Congenital defects
• Trauma

Pathophysiology:

Aneurysm – pressure of blood passing through weakened artery wall = bulge (forming balloon)

Dissection – aortic wall separation due to inner layer aortic wall tear, blood enters through the tear = wall separation

Types:

• Ascending (most common, lethal)
• Descending
• Descending into Ascending
• Abdominal

Clinical Presentation:

Dissection/ Ruptured Aneurysm
Sudden pain to chest, back, flank, shoulders

• Tearing, ripping, sharp, stabbing
• Not relieved by analgesics

Difference of 20 mm Hg in systolic blood pressure between arms

Ascending:

• s/s stroke, AMI
• Altered

Descending:

• Renal failure, paraplegia, no distal pulses

Collaborative Management:

Dissection or Ruptured Aneurysm (life threatening)

• Chest x ray, EKG, echo, CT/MRI, angiography
• ABCs (rapid deterioration), O2, PIV stat
• Type and cross match
• Control BP! (sBP100-120mmHg)
  • Get PRN orders from provider
• Continuous cardiac monitoring
• Pain control
• Prepare for surgery

Evaluation | Patient Monitoring | Education:

Monitor:

• Level of consciousness
• Hemodynamic status
• Breath sounds/pulse ox
• Cardiac rate and rhythm
• Periphery – paresthesia, decreased strength, tingling
• Pain

Linchpins: (Key Points)

• Aneurysm – all layers/ whole wall is weak
• Dissection – tear=hole; hole=blood fill; blood fill=Separation of wall layers
• Aortic rupture or dissection = life threatening = immediate intervention = surgery asap