Cardiology>>>>>Aorta And Hypertension
Question 8#

You see a 60-year-old musician in the outpatient clinic who discharged himself 2 weeks previously following admission with a confirmed type B dissection of the aorta. He tells you that he doesn’t want to take any medication as he prefers natural healing methods. His blood pressure is 180/90 mmHg. He asks you what the future holds for him off medication.

What can you tell him that the data suggest if he has no treatment?

A. Approximately 1/6 (16%) are dead within a year and 1/5 (20%) die within 5 years
B. Approximately 1/20 (5%) are dead within a year and 1/10 (10%) die within 5 years
C. Approximately a third (33%) are dead within a year and half (50%) die within 5 years
D. The type of tear in his aorta is not as serious as other types of tear and the herbal remedy Echinacea has been used successfully for this condition for hundreds of years in the Amazon delta
E. None of the above are true

Correct Answer is A

Comment:

Whilst type B dissections are not as lethal as type A dissections, they are associated with significant mortality if not treated appropriately. Mortality with no treatment is 11% at 1 month, 16% at 1 year, and 20% at 5 years. Approximately a third of survivors of acute dissection experience further dissection or rupture or will require surgery for aneurysm within 5 years. High-risk groups include the elderly, those with poorly controlled hypertension, the presence of a false lumen, larger aortic size, and Marfan syndrome. At presentation, aggressive control of blood pressure to a target of 110 mmHg with IV beta-blockers and sodium nitroprusside infusions is recommended initially, and combinations of beta-blockers, ACE inhibitors, and other antihypertensive medications as outpatients with a less aggressive target of 135/80 mmHg. Maintaining a heart rate of <60 bpm has been shown to be beneficial in preventing complications in type B dissection. Follow-up imaging, usually with CT or MRI, is recommended at 1, 3, 6, 9, and 12 months