38-year-old
Maori woman normally
fit and well. Presents
day 6 post-vaginal delivery with:
–chest
pain (since delivery)
–shortness
of breath
–nausea
–lightheadedness
Vaginal delivery difficult – episiotomy, Ventouse-assisted, PPH 600 mL Hypertensive in pregnancy
Vaginal delivery difficult – episiotomy, Ventouse-assisted, PPH 600 mL Hypertensive in pregnancy
CTPA:
no PE, but pericardial effusion, ascites,
and R pleural effusion of unclear cause
Echo:
marked dilatation of ascending aorta, mild-mod aortic insufficiency,
pericardial effusion
CTA:
Aortic intimal flaps (red arrows) initially reported as “ulceration” After rediscussion with radiology, diagnosed as type A dissection involving ascending aorta
Aortic intimal flaps (red arrows) initially reported as “ulceration” After rediscussion with radiology, diagnosed as type A dissection involving ascending aorta
Pregnancy
alone is independent risk factor for dissection
•Hypertension
•Hyperdynamic,
hypervolaemic
state
•Hormonal
effects on vasculature
•Gravid
uterus compressing descending aorta and iliac arteries -> increased
stress/pressures in upper aorta
Dissections
occur in third trimester or in peripartum
period
Mortality if untreated in a dissection of the ascending aorta.
–33%
of patients die within the first 24 hours
–50%
die within 48 hours
–Undiagnosed
ascending aortic
dissection has
two-week
mortality
of 75%
One of the great saves of my career as a clinical cardiologist! Kia Ora from the land of the long white cloud.
