M&M - Dr. Allen
SPONTANEOUS CORONARY ARTERY DISSECTION
• SCAD is a rare cause of ACS-type chest pain, more often seen in younger, female, post-partum patients. Consider in cocaine and caffeine induced chest pain.
• PCI and thrombolytics less successful in SCAD, suffering from higher failure and complication rates, respectively. Medical management with beta blockers is mainstay of treatment.
SUPERIOR MESENTERIC ARTERY SYDROME
• SMA syndrome presents with recurrent post-prandial emesis and abdominal pain, usually in the setting of increased catabolic state, internal or external abdominal compression.
• Consider SMA syndrome in post-scoliosis patients given the relative lengthening of the spinal column that results in a decrease in the SMA/aorta angle, causing compression of the duodenum.
THORACIC AORTIC ANEURSYM DISSECTION
• Thoracic aortic aneurysm dissection/rupture is the deadliest complication of thoracic aortic aneurysmal disease. Operative decisions for aneurysms depends on clinical scenario, but generally adopted at ~5.5cm.
• Intubation in the critically ill patient should be done by the most experienced operator, with consideration for use of video laryngoscopy, given higher 1st pass success rates despite difficult airway characteristics.
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