Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3793_Библиотеки_им_академика_М_И_Перельмана

but cases of congestive heart failure due to rupture of the dissecting process into the right or left atrium or right ventricle have also been reported.

The initial treatment objectives in suspected aortic dissection are to control pain and provide anti-impulse therapy to reduce systemic blood pressure, lower the rate of change of pressure development (dP/dT) to decrease aortic shear stress, and limit propagation of the dissection. In hypertensive patients, treatment consists of an intravenous (IV) β-adrenergic blocking agent, often in combination with IV sodium nitroprusside. β-Blockade before nitroprusside therapy is essential because the latter increases the velocity of left ventricular ejection, increases aortic shear stress, and may promote propagation of the dissection. venous labetalol in place of a β-blocker and sodium nitroprusside is an alternative, but it has the potential for hepatotoxicity with long-term therapy.87 In normotensive patients, an IV β-adrenergic blocking agent may be used alone. Intravenous verapamil or diltiazem is an alternative in patients who cannot tolerate β-blockers. To assist in monitoring blood pressure and renal perfusion, an intraarterial cannula and indwelling bladder catheter are advisable. Following initial patient stabilization, expedited noninvasive aortic imaging is pursued (as discussed in the previous section). If the patient continues to require close monitoring and support, an emergency bedside TEE is the test of choice.