Manajemen Syok Kardiogenik pada Diseksi Aorta

Authors

  • Bagus Fitriadi Kurnia Putra Departemen/SMF Kardiologi dan Kedokteran Vaskular, Fakultas Kedokteran Universitas Airlangga/RSUD Dr. Soetomo, Surabaya, Indonesia
  • Muhammad Aminuddin Departemen/SMF Kardiologi dan Kedokteran Vaskular, Fakultas Kedokteran Universitas Airlangga/RSUD Dr. Soetomo, Surabaya, Indonesia

DOI:

https://doi.org/10.55175/cdk.v47i8.581

Keywords:

Diseksi aorta, syok kardiogenik, tatalaksana

Abstract

Pendahuluan: Diseksi aorta merupakan kegawatdaruratan akibat robekan tunika intima aorta yang menyebabkan perdarahan ke dalam tunika media. Komplikasi syok terjadi pada lebih dari 20% kasus dan akan meningkatkan mortalitas. Kasus: Wanita 72 tahun dirujuk ke IGD dengan keluhan nyeri dada dan rasa tidak nyaman di perut dan punggung, disertai lemas, gelisah, dan klinis syok. Pada foto toraks didapatkan kesan aneurisma aorta. CT scan menunjukkan diseksi aorta asenden, arkus aorta, aorta desenden, aorta abdominalis, berlanjut sampai ke arteri iliaka eksterna, dan trombus di arkus aorta. Pasien dan keluarga menolak tindakan operasi; pasien diterapi secara konservatif.

Introduction: Aortic dissection is the result of aortic intima tear that leads to bleeding within the tunica media. Shock occurs in up to 20% patients and is associated with increased mortality. Case: A 72-year-old woman was referred to ED with chest pain and discomfort in the stomach and back, accompanied by weakness, anxiety, and clinical presentation of shock. Chest X-ray examination gave an impression of aortic aneurysm. CT scan showed dissection of the aorta ascendens, arcus aorta, aorta descendens, abdominal aorta, continues until the external iliac artery, and thrombus in the aortic arch. Patient and families reject surgical management; the patient was treated conservatively

Downloads

Download data is not yet available.

References

Clouse WD, Hallett JW, Jr, Schaff HV, Spittell PC, Rowland CM, Ilstrup DM, et al. Acute aortic dissection: Population-based incidence compared with degenerative aortic aneurysm rupture. Mayo Clin Proc. 2004;79:176–80

Olsson C, Thelin S, Stahle E, Ekbom A, Granath F. Thoracic-aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002. Circulation. 2006;114:2611–8

Shirakabe A, Hata N, Yokoyama S, Shinada T, Suzuki Y, Kobayashi N, et al. Diagnostic score to differentiate acute aortic dissection in the emergency room. Circ J. 2008;72:986–90

Mehta RH, Suzuki T, Hagan PG, Bossone E, Gilon D, Llovet A, et al. Predicting death in patients with type A aortic dissection. Circulation 2002;105:200-6

Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35:2873–926.

DeBakey ME, Henly WS, Cooley DA, Morris GC, Crawford ES, Beall AC. Surgical management of dissecting aneurysms of the aorta. J Thorac Cardiovasc Surg. 1965;49:130–49

Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, et al. The International registry of acute aortic dissection (IRAD): new insights into an old disease. JAMA. 2000;283:897–903.

Klompas M. Does this patient have an acute thoracic aortic dissection? JAMA. 2002;287:2262–72

Jex RK, Schaff HV, Piehler JM, Orszulak TA, Puga FJ, King RM, et al. Repair of ascending aortic dissection. Influence of associated aortic valve insufficiency on early and late results. J Thorac Cardiovasc Surg. 1987;93:375–84

Di Eusanio M, Trimarchi S, Patel HJ, Hutchison S, Suzuki T, Peterson MD, et al. Clinical presentation, management, and short-term outcome of patients with type A acute dissection complicated by mesenteric malperfusion. J Thorac Cardiovasc Surg.2013;145:385–90

Bossone E, Pyeritz RE, Braverman AC, Peterson MD, Ehrlich M, O’Gara P, et al. Shock complicating type A acute aortic dissection: Clinical correlates, management, and outcomes. Am Heart J. 2016;176:93-9

Strayer R, Shearer PL, Hermann LK. Screening, evaluation, and early management of acute aortic dissection in the ED. Curr Cardiol Rev. 2012;8:152-7

Isselbacher EM, Cigarroa JE, Eagle KA. Cardiac tamponade complicating proximal aortic dissection. Is pericardiocentesis harmful? Circulation 1994;90:2375-8

Cruz I, Stuart B, Caldeira D, Morgado G, Gomes AC, Almeida AR, et al. Controlled pericardiocentesis in patients with cardiac tamponade complicating aortic dissection: Experience in a centre without cardiothoracic surgery. Eur Heart J Acute Cardiovasc Care 2015;4:124-8

Hiratzaka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, et al. 2010 ACCF/AHA/AATS/ACR/ASA/ SCA/ SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. Circulation 2010;121:266-369.

Ianuzzi JL, Isselbacher EM. Medical therapy and acute surveillance. In: Baliga R, Nienaber C, Isselbacher EM, Eagle KA. Aortic dissection and related syndromes. New York: Springer Science & Business Media; 2007 .p. 145-52.

Downloads

Published

01-10-2020

How to Cite

Kurnia Putra, B. F., & Aminuddin, M. (2020). Manajemen Syok Kardiogenik pada Diseksi Aorta. Cermin Dunia Kedokteran, 47(8), 607–610. https://doi.org/10.55175/cdk.v47i8.581