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Nursing Assessment:Nursing management of acute coronary syndrome (ACS) involves taking the patient's history, focusing on primary complaints such as chest pain, dyspnea, and excessive sweating (diaphoresis), as well as other symptoms like back or jaw pain, nausea, vomiting, palpitations, dizziness, and fatigue. The nurse also reviews the patient's history of cardiac events, risk factors such as hypertension, diabetes, smoking, family history, and current medications.In the objective assessment,...
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Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
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A nurse managing a patient with aortic regurgitation begins with a comprehensive assessment, including a review of the patient's medical history, family history, and lifestyle factors. During the cardiac examination, the nurse listens for heart sounds and checks for signs of valve abnormalities. The nurse also observes for symptoms such as dyspnea, orthopnea, and paroxysmal nocturnal dyspnea and assesses the patient's endurance and daily activity tolerance.Based on the findings, the nurse...
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Managed successfully: Iatrogenic aortic dissection during primary percutaneous coronary intervention.

Muhammad Hashim Kalwar1, Jawaid Akbar Sial1, Tahir Saghir1

  • 1National Institute of Cardiovascular Disease Karachi Pakistan.

JPMA. the Journal of the Pakistan Medical Association
|May 30, 2018
PubMed
Summary

Iatrogenic aortic dissection from percutaneous coronary intervention (PCI) is rare but serious. This case shows conservative management and monitoring led to complete resolution of aortic dissection.

Keywords:
Aortic dissection, Percutaneous coronary intervention

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Iatrogenic aortic dissection is a rare, life-threatening complication of primary percutaneous coronary intervention (PCI).
  • Prompt recognition and management are crucial for patient outcomes.
  • This case highlights a specific instance of dissection during PCI for myocardial infarction.

Observation:

  • A 70-year-old female developed an aortic dissection during primary PCI for a left anterior descending artery myocardial infarction.
  • The dissection was attributed to manipulation of the extra backup (EBU) guiding catheter.
  • The patient experienced a transient cerebrovascular accident on post-procedure day 3.

Findings:

  • Conservative management with strict monitoring in the coronary care unit (CCU) was initiated.
  • Serial computed tomography angiography (CTA) demonstrated complete resolution of the ascending aortic dissection.
  • The patient recovered fully from the cerebrovascular accident.

Implications:

  • Conservative management can be effective for select cases of iatrogenic aortic dissection post-PCI.
  • Non-invasive imaging like CTA is vital for monitoring dissection resolution.
  • This case underscores the importance of careful catheter manipulation during complex PCI procedures.