Aortic dissection in parturients
Aortic dissection in parturients
• Rare and potentially lethal
• Symptoms — crushing chest pain, abdominal pain radiating to back and lumbar area
• Usually occurs during 3rd trimester, often around 32 weeks
• Average patient age is 30
• Diagnosis made with angiography, transesophageal echocardiography (TEE), magnetic resonance imaging (MRI)
• Immediate therapy – hemodynamic control, decrease ventricular ejection velocity and mean arterial pressure (MAP) with labetalol, nicardipine, and hydralazine
• Predisposing conditions — Marfans’ syndrome, Ehler-Danlos syndrome, hypertension, diabetes, bicuspid aortic valve. Note: Ehlers-Danlos syndrome affects connective tissue, primarily the skin, joints, and blood vessel walls. Symptoms include overly flexible joints that can dislocate, and skin that’s translucent, elastic, and bruises easily. In some cases, there may be dilation and even rupture of major blood vessels. Treatment helps manage symptoms and monitor for complications. Options include drugs, physical therapy, and sometimes surgery.
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