Acute Aortic Disease PDF

Preface

Over 100 years ago, the great physician Sir William Osler observed "there is no condition more conducive to clinical humility than aneurysm of the aorta." The lithograph in Figure 1 illustrates the "electroshock therapy" applied in that era for the treatment of large aortic aneurysms. Although we have made great progress since that era, Osler's observation regarding the challenge posed by aortic diseases remains true to this day. The powerful potential for aortic aneurysm and related disorders to injure or kill patients is expressed through a variety of acute aortic conditions. It is on these conditions that this volume is focused.

Acute aortic disease has affected so many individuals of great intelligence, creativity, and physical prowess (Fig. 2) that some authors have even speculated that the propensity for aortic aneurysm or dissection is genetically associated with intellectual or physical brilliance.

This volume is intended for cardiologists, emergency physicians, and cardiac surgeons. Of course, this book is also appropriate for trainees in those disciplines. We anticipate that it will also prove useful to a wide variety of other professionals, including internists, vascular surgeons, radiologists, physician associates, nurses, and students and residents in these various disciplines. The book provides basic information for the novice as well as cutting-edge insight for the expert.

This book takes up four perspectives to understanding aortic diseases: we explore the underlying biology of aortic disease, the imaging of aortic aneurysms and dissections, the appropriate means for diagnosis of these entities, and, of course, the treatment, both medical and surgical, of acute aortic conditions. Via these investigations, we will "read the playbook" of this virulent opponent that constitutes the acute aortic condition. By reading the playbook, we aim to render the professional better able to do battle with these conditions.

We make liberal use of illustrations of all types, including line drawings, x-rays, and operative photographs, in order to emphasize the narrative observations made in the text.

Some distinguishing features of this book, intended to engage the reader in an almost interactive exchange with the author experts, include the Editor's Counterpoint (in which comments on the material are presented by each chapter author) and the inclusion of a question and answer section at the end of most chapters (Questions for the Author).

The aorta, we are finding, is "much more than a tube." It is not simply a passive conduit for carrying blood to important organs. Rather, it is an active organ in its own right, even assisting the heart itself in propelling blood via its elastic properties in the "game of catch" it plays with the left ventricle. These organ-type functions of the aorta are explored in this book.

We place special emphasis on the difficult problem of diagnosing acute aortic conditions on the front lines-in the office, in the emergency room, or in the coronary care unit. Aside from their inherent virulence and complexity, these conditions pose special challenges by virtue of their relative infrequency and myriad clinical presentations. In many ways, for the internist, cardiologist, or emergency physician on the front lines, looking for aortic dissections is like trying to find a needle in a haystack. In fact, for every 100 patients presenting with chest pain, 99 will have some cause other than aortic aneurysm and dissection. Also, aortic dissection has been called "the great masquerader" because it can mimic such a broad spectrum of diseases. Dissection can present with chest pain, back pain, neck pain, abdominal distress, stroke-like symptoms, paraplegia, and vascular insufficiency of the extremities. Our intent is that readers of this book will always maintain an index of suspicion for aortic conditions and become better prepared to recognize affected individuals among the vast number of disparate patients they are called to evaluate.

The challenges of diagnosis and treatment in acute aortic conditions are such that litigation abounds in this arena. In this book, we pay special attention to the nature of lawsuits in aortic diseases and make special recommendations regarding measures for their prevention. An entire chapter is devoted to this topic.

The biologic, radiologic, and medical and surgical sciences have indeed made great strides since the observations of Osler regarding the challenge posed by aortic diseases. This book intends to present those strides to the reader, so as to better equip medical professionals to recognize and treat these disorders.

Through scientific advances, the balance of power is slowly changing vis-àvis aortic diseases, with a better outlook than ever before, for both physicians and for the patients with whom they are entrusted, and progressively less danger from the inherent aortic disease.