This document discusses aortic dissection, its symptoms, risk factors, screening recommendations, mortality rates, and treatment options. It begins with definitions of angina and discusses its causes. It then reviews studies on the prevalence and causes of emergency room visits for chest pain. Risk factors for aortic dissection are described. The document outlines complications, mortality rates, and reintervention rates for different types and treatments of aortic dissection. Both open and endovascular surgical options are presented, along with their complications. Management recommendations for suspected aortic dissection are provided. The conclusion emphasizes the importance of considering aortic dissection for any chest pain and promptly consulting cardiothoracic surgery.

1. Revisiting
"Chest Pain" a.k.a "Angina"
Dicky A.Wartono ,drSpBTKV(K)
Cardiothoracic & Vascular Surgeon Siloam Hospital
2016

2. Disclosures
• Consultant for
– Terumo Medical CV group for Aortic Graft
– Medtronic Aortic Stent
– Sing Biotech Endo Stent
• Grant fo Reseach for
– Terumo Stent Graft Frozen ET
– Terumo Combine Composite –Branched Graft

3. • an·gi·na.... Latin : angere ("to strangle")
• 1. a condition marked by severe pain in the chest, often also
spreading to the shoulders, arms, and neck, caused by an
inadequate blood supply to the heart.
• 2. any of a number of disorders in which there is an intense
localized pain. "Ludwig's angina"
Rose GA, Blackburn H, Gillum RF, Prineas RJ.
Cardiovascular Survey Methods (2nd edn). Geneva: WHO, 2012
Blacklock SM. The symptom of chest pain in Family Practice.
J Fam Pract 2013

4. Blacklock SM. The symptom of chest pain in Family Practice.
J Fam Pract 2013

11. • 280 medical ER Dept (Gen Hpts) across US
• 2013 - 2014
Reasons for Emergency Room Use Among U.S. Adults
Aged 18–64: National Health Interview Survey, 2013 and 2014
by Renee M. Gindi, Ph.D., M.P.H.; Lindsey I. Black, M.P.H.; and Robin A. Cohen, Ph.D.,
Division of Health Interview Statistics

12. Rose GA, Blackburn H, Gillum RF, Prineas RJ.
Cardiovascular Survey Methods (2nd edn). Geneva: WHO, 2012

14. Aortic dissection
a tear in the inside of the aorta causes blood
to flow between the layers of the wall of the aorta,
forcing the layers apart
Criado FJ (2011)

15. • Aortic were the primary cause of 9,863 deaths in
2014 and a contributing cause in more than
17,215 deaths in the United States in 2012.
• About two-thirds of people who have an aortic
dissection are male.
• The U.S. Preventive Services Task Force
recommends that men aged 65–75 years who
have ever smoked should get an ultrasound
screening aortic diseases, even if they have no
symptoms
Centers for Disease Control and Prevention. Underlying Cause of Death 1999-2013 on CDC WONDER
Online Database, released 2015. Data are from the Multiple Cause of Death Files, 1999-2013, as
compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics
Cooperative Program

21. • No clinical relevances
• Mortality 1% perhour
• 10 % turned to subacute AoD
• >50% complicated AoD  50-100% mortality
• 22% ACS  Type A AoD req urgent surgery
• 77% AoD  treat as ACS  30% mortality
• Type A AoD konservatif  90% mortality
Aortic dissection: a 25-year perspective.
Tex Heart Inst J. 38 (6): 694–700

25. Mod Bentall Proc : AoValve + Ao root relacement + Coro reimplant

31. TEVAR
Thoracic Endovascular Aortic Repair

33. Hybrid AO Arch
Debranching
Total arch relacement
+/- Endostent

34. EVAR
Endovascular Aortic Repair

42. Complication
Access Problems
Stent Migration
Stent Fractures
Ao Rupture
Post Implnt Syndr
Endoleak (1st 3 mo)
- Morbidity remain
- Mortality 80%
- Reintervension 50%
Hagan PG, Nienaber CA, Isselbacher EM, et al. The International
Registry of Acute Aortic Dissection (IRAD): new insights into an old
disease. JAMA. 2000

43. Harapan Kita
National Cardiovascular Centre
Reg 2012 - 2015
• Mean/year : 90 AoD  33 req EMG surgery
• Mortality :
• Konserv : St A (98%), St B (50%)
• T/Evar : 4%
• Surgery : 8%
• Morbidity : ACS (2%), NeuroCog(2%), paraplegia
(0.4%), CRF (8%), oth(1%)

47. Management
Immediate cardiothoracic
referral
Invasif monitoring if possible
Central Line access.
Control PR (aim for PR 60-80)
& BP (100-120 SBP) - use IV B-
blocker
Opiate analgesia.

49. Conclusion
• Chest Pain !!!  remember Aortic Dissection
– TKV consult, contrass CT, ICU OR/cath
• Aortic dissections are “High” :
• High Cost, High Mortality & High Tech
• Many Option for Managing excpt Type A AoD

50. Thank You
http://www.slideshare.net/dickyawartono
https://www.facebook.com/dickyawartono
drdickyaw@yahoo.com