Protocol de abordare a durerii toracice in urgenta - Cursul national ...
Protocol de abordare a durerii toracice in urgenta - Cursul national ...
Protocol de abordare a durerii toracice in urgenta - Cursul national ...
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46. Diagnosticul disectiei se confirma utilizand explorari imagistice (ClasaI, Nivel C) (12): angiografia tomografica computerizata / ecocardiografiatransesofagiana / rezonanta magnetica daca pacientul este stabil si asimptomatic.- Angiografia tomografica computerizata este <strong>in</strong> general cel mai rapid simai usor accesibil test diagnostic.- Ecocardiografia transesofagiana este un test diagnostic echivalent sipreferabil <strong>in</strong> cazul pacientilor cu <strong>in</strong>suficienta renala sau alergie la substanta<strong>de</strong> contrast.- Rezonanta magnetica nucleara ramane cel mai exact test, dar necesitaun pacient stabil. Ea trebuie evitata daca se suspecteaza o disectie aortica<strong>de</strong> tip A.609Tabel 5. Diagnosticul imagistic <strong>in</strong> disectia acuta <strong>de</strong> aorta (12).Recomandari I IIa IIb III1. Ecografia transtoracica urmata <strong>de</strong> ecocardiografia transesofagiana2. Tomografia computerizata• daca este cruciala <strong>de</strong>tectia rupturilor3. Angiografia <strong>de</strong> contrast• pentru <strong>de</strong>f<strong>in</strong>irea anatomica a cauzei hipoperfuziei viscerale• pentru ghidarea <strong>in</strong>terventiei percutane• la pacientii stabili hemod<strong>in</strong>amic• coronarografie preoperatorie <strong>de</strong> rut<strong>in</strong>a• la pacientii <strong>in</strong>stabili hemod<strong>in</strong>amic4. MRI• la pacientii <strong>in</strong>stabili hemod<strong>in</strong>amic5. Ecografia <strong>in</strong>travasculara• *pentru ghidarea <strong>in</strong>terventiilor percutaneNivel <strong>de</strong>evi<strong>de</strong>nta47. Precizarea diagnosticului <strong>de</strong> disectie <strong>de</strong> aorta sau anevrism simptomatic:Electrocardiograma efectuata la pacientul cu durere toracica si suspiciune<strong>de</strong> disectie <strong>de</strong> aorta se va <strong>in</strong>soti <strong>de</strong> modificari electrocardiografice <strong>de</strong> <strong>in</strong>farctmiocardic acut la aproximativ 20 % d<strong>in</strong> pacientii cu disectie <strong>de</strong> tip A, <strong>de</strong>un<strong>de</strong> riscul <strong>de</strong> a adm<strong>in</strong>istra terapie trombolitica cu efecte nocive la acestipacienti (12). Acesti pacienti cu suspiciune <strong>de</strong> disectie aortica si semne ECG<strong>de</strong> ischemie trebuie supusi unei explorari imagistice <strong>in</strong>a<strong>in</strong>te <strong>de</strong> adm<strong>in</strong>istrareatratamentului trombolitic (Clasa II, Nivel C). Procedura imagistica trebuie sa+++++++++++CCCCCCCCCCCTimisoara 2009
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