Category: Vascular
Keywords: Hypertension (PubMed Search)
Posted: 12/17/2007 by Rob Rogers, MD
(Updated: 8/14/2024)
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Secondary Causes of Hypertension
Although not that common, consider the following (with accompanying history and/or physical examination findings) in patients with hypertension:
Although most of the time the patient will end up having essential hypertension, these entities should at the very least be considered.
Journal of Hypertension 2007
Category: Vascular
Keywords: subarachnoid hemorrhage (PubMed Search)
Posted: 12/10/2007 by Rob Rogers, MD
(Updated: 8/14/2024)
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Subarachnoid hemorrhage: Unilateral or bilateral headache?
Pretty good evidence exists that most patients with subarachnoid hemorrhage will have a bilateral headache.
In fact, unilateral headache is helpful in the history in ruling out SAH in most cases. Presence of an unruptured aneurysm, however can be present with a unilateral headache.
J NeuroSurg 2006
Category: Vascular
Keywords: ECG, Aortic Dissection (PubMed Search)
Posted: 12/4/2007 by Rob Rogers, MD
(Updated: 8/14/2024)
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ECG gating CTs for aortic dissection/aneurysm rule out
AJR 2007
Category: Vascular
Keywords: Aortic Dissection (PubMed Search)
Posted: 11/26/2007 by Rob Rogers, MD
(Updated: 8/14/2024)
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A few pearls regarding Acute Aortic Dissection...
Elefteriades. Acute Aortic Disorders. 2007
Category: Vascular
Keywords: Aortic Dissection (PubMed Search)
Posted: 11/19/2007 by Rob Rogers, MD
(Updated: 8/14/2024)
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Patients with aortic dissection (Type A or B) who develop intestinal/renal, etc. ischemia should be considered for aortic fenestration-a procedure in which holes are literally created in the aortic lumen to connect the true and false lumen-this allows perfusion of the involved vessel to occur from true lumen into the false lumen into the involved vessel.
Patients with large vessel malperfusion have a VERY HIGH mortality rate, AND most CT surgeons will not operate even on a Type A unless the involved vessels have been opened up.
This procedure is useful when major vessels (SMA as an example) branch from the aortic false lumen.
So, when to consider this procedure:
Who do you call?
Category: Vascular
Keywords: Pulmonary Embolism, Pneumonia (PubMed Search)
Posted: 11/13/2007 by Rob Rogers, MD
(Updated: 8/14/2024)
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Category: Vascular
Keywords: Aneurysm (PubMed Search)
Posted: 11/5/2007 by Rob Rogers, MD
(Updated: 8/14/2024)
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Splenic Artery Aneurysm
Who cares, you ask?
Category: Vascular
Keywords: D-Dimer, Pulmonary Embolism (PubMed Search)
Posted: 10/30/2007 by Rob Rogers, MD
(Updated: 8/14/2024)
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Degree of D-Dimer elevation and Mortality Rates
Evidence now exists that links the degree of D-Dimer elevation with mortality rate. The higher the D-Dimer, the higher the PE mortality rate.
Consider this when risk stratifying patients with PE. This adds to our use of biomarkers for risk stratification. Elevation of BNP, D-Dimer, and Troponins have been shown to predict mortality.
Category: Vascular
Posted: 10/22/2007 by Rob Rogers, MD
(Updated: 8/14/2024)
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Blue Toe Syndrome
This syndrome refers to acute digital ischemia caused by athero-microembolism and is associated with cool, painful, cyanotic toes in the presence of palpable distal pulses.
Presence of this syndrome should prompt the Emergency Physician to search for the proximal source. Failure to identify the source and aggressively treat may lead to limb loss.
Common etiologies include:
Category: Vascular
Keywords: Hypertension (PubMed Search)
Posted: 10/16/2007 by Rob Rogers, MD
(Updated: 8/14/2024)
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There is no good evidence for what type of workup an asymptomatic hypertensive patient should get in the ED. An ECG is likely to show LVH, a cxr will be normal in most cases, and many patients will have some degree of proteinuria.
So, what is a safe and reasonable strategy to workup these patients?
American College of Emergency Physicians 2006 Guidelines on the evaluation of asymptomatic HTN.
Category: Vascular
Keywords: Aorta, Enteric, Fistula (PubMed Search)
Posted: 10/8/2007 by Rob Rogers, MD
(Emailed: 10/9/2007)
(Updated: 8/14/2024)
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Suspect an aortoenteric fistula in patients who present with an upper GI bleed if they have ever had a AAA repair. This occurs when a fistula forms between the abdominal aorta and the GI tract (most commonly the duodenum). Patients may present stable or may present critically-ill. Unstable patients with an upper GI bleed and a history of AAA repair should proceed to the OR for laparotomy.
Stable patient may undergo CT scanning and/or endoscopy. Bottom line: If a patient with a history of AAA repair presents with an upper GI bleed, rally your troops (GI, Surgery, etc) ASAP and don't mess around. If you are wrong, and the patient doesn't have a fistula, no big deal. If you are wrong, and the patient does have a fistula, the patient may very well die on you as you struggle to get a regular ICU bed.
Category: Vascular
Keywords: aneurysm (PubMed Search)
Posted: 10/1/2007 by Rob Rogers, MD
(Updated: 8/14/2024)
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Category: Vascular
Keywords: IVC, inferior vena cava, Indications (PubMed Search)
Posted: 9/24/2007 by Rob Rogers, MD
(Updated: 8/14/2024)
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Category: Vascular
Keywords: Hypertension, Encephalopathy (PubMed Search)
Posted: 9/17/2007 by Rob Rogers, MD
(Updated: 8/14/2024)
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Category: Vascular
Keywords: Hypertension (PubMed Search)
Posted: 9/11/2007 by Rob Rogers, MD
(Updated: 8/14/2024)
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Category: Vascular
Keywords: Pulmonary Embolism, CT (PubMed Search)
Posted: 9/3/2007 by Rob Rogers, MD
(Updated: 8/14/2024)
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Category: Vascular
Keywords: Thoracic, Aortic Aneurysm (PubMed Search)
Posted: 8/27/2007 by Rob Rogers, MD
(Updated: 8/14/2024)
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Category: Vascular
Keywords: Aortic Dissection, Neurologic (PubMed Search)
Posted: 8/20/2007 by Rob Rogers, MD
(Updated: 8/14/2024)
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Category: Vascular
Keywords: mesenteric ischemia, elderly, geriatric, abdominal pain (PubMed Search)
Posted: 8/12/2007 by Amal Mattu, MD
(Updated: 8/14/2024)
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Category: Vascular
Keywords: Aortic, Cauda Equina Syndrome (PubMed Search)
Posted: 8/6/2007 by Rob Rogers, MD
(Updated: 8/14/2024)
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