| How is the pain associated with dissection typically characterized? | abrupt, piercing, and well localized | • Clinically, a dissection-related coronary malperfusion may present with ECG changes of primary myocardial ischemia or infarction. This may increase the likelihood of misdiagnosis and inappropriate therapeutic intervention • Before starting the treatment algorithm for myocardial ischemia, it is important to differentiate between a primary coronary event and coronary malperfusion secondary to dissection process • In dissection, pain is usually abrupt, piercing, and well localized. | 448 | definition | 1.000 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726643576_6_ctvs_all.pdf | This may increase the likelihood of misdiagnosis and inappropriate therapeutic intervention • Before starting the treatment algorithm for myocardial ischemia, it is important to differentiate between a primary coronary event and coronary malperfusion secondary to dissection process • In dissection, pain is usually abrupt, piercing, and well localized. | 1 | page=1,block=39 | 0.700 | valid |
| What defines an intramural hematoma in the aortic wall? | Hematoma within the medial layer of the aortic wall without intimal injury | Aortic Dissection (AD) Commonest and Most lethal Intramural Hematoma (IMH) Penetrating Aortic Ulcer (PAU) Formation of Entrance Tear Rupture of Vasa Vasorum Ulceration of atherosclerotic plaque Tear in the aortic intima and blood enters into the media separating the layers Hematoma within the medial layer of the aortic wall without intimal injury Ulcer-like lesion in the intima eroding through the media of the aortic wall and forming localized hematoma thereoff MYOCARDIAL INFARCTION VS ACUTE TYPE A DISSECTION DIAGNOSTIC IMAGING IN ACUTE AORTIC DISSECTION • The main purpose of imaging is the comprehensive assessment of the entire aorta and its branches with primary goals of confirmation of diagnosis, classification of dissection, assessment of branch vessels, and identification of complications (aortic rupture, aortic regurgitation, and malperfusion) • Besides these, imaging is also needed to assess myocardial and valvular function, pulmonary parenchyma, and state of kidneys IMAGING AND DIAGNOSTIC ALGORITHM • Combination of ECG, Chest X-ray, Echocardiography and ECG gated CT angiography provides desired information. | 274 | definition | 1.000 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726643576_6_ctvs_all.pdf |
| What does OPCAB stand for in the list of subsets? | Off-Pump Coronary Artery Bypass Surgery | (in the following subsets) ACS: Acute Coronary Syndrome ARB: Angiotensin Receptor Blockers ARNI: Angiotensin Receptor Neprilysin Inhibitor BMI: Body Mass Index CABG: Coronary Artery Bypass Graft CAD: Coronary Artery Disease CHF: Congestive Heart Failure CPB: Cardiopulmonary Bypass ECG: Electrocardiogram LAD: Left Anterior Descending Artery LIMA: Left Internal Mammary Artery MI: Myocardial Infarction OPCAB: Off-Pump Coronary Artery Bypass Surgery PCI: Percutaneous coronary intervention RIMA: Right Internal Mammary Artery STEMI: St Elevation Myocardial Infarction July/ 2024 This STW has been prepared by national experts of India with feasibility considerations for various levels of healthcare system in the country. These broad guidelines are advisory, and are based on expert opinions and available scientific evidence. | 410 | definition | 1.000 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726643576_6_ctvs_all.pdf | (in the following subsets) ACS: Acute Coronary Syndrome ARB: Angiotensin Receptor Blockers ARNI: Angiotensin Receptor Neprilysin Inhibitor BMI: Body Mass Index CABG: Coronary Artery Bypass Graft CAD: Coronary Artery Disease CHF: Congestive Heart Failure CPB: Cardiopulmonary Bypass ECG: Electrocardiogram LAD: Left Anterior Descending Artery LIMA: Left Internal Mammary Artery MI: Myocardial Infarction OPCAB: Off-Pump Coronary Artery Bypass Surgery PCI: Percutaneous coronary intervention RIMA: Right Internal Mammary Artery STEMI: St Elevation Myocardial Infarction July/ 2024 This STW has been |
| What does the letter 'A' represent in the ABCDE approach to emergency care? | Airway maintenance with cervical spine control | Primary survey (ABCDEs) aims at recognition and management of immediate life-threatening injuries largely based on clinical examination. ABCDE • Airway maintenance with cervical spine control • Breathing and ventilation • Circulation with haemorrhage control • Disability (brief neurological assessment) • Exposure/Environmental control: Prevent Hypothermia OTHER VITALS • Blood pressure • All peripheral pulses • Altered/Muffled Heart Sounds ALSO LOOK FOR • Neurological deficits • Tenderness over chest, first rib fracture • Subcutaneous emphysema • Surgery DIAGNOSIS • Suspected on Chest x-ray Confirmation on CT angiography chest MANAGEMENT • Stenting/open surgery | 145 | definition | 1.000 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726643576_6_ctvs_all.pdf | ABCDE • Airway maintenance with cervical spine control • Breathing and ventilation • Circulation with haemorrhage control • Disability (brief neurological assessment) • Exposure/Environmental control: Prevent Hypothermia OTHER VITALS • Blood pressure • All peripheral pulses • Altered/Muffled Heart Sounds ALSO LOOK FOR • Neurological deficits • Tenderness over chest, first rib fracture • Subcutaneous emphysema • Surgery DIAGNOSIS • Suspected on Chest x-ray Confirmation on CT angiography chest MANAGEMENT • Stenting/open surgery |
| What does acute aortic syndrome refer to? | a constellation of life - threatening aortic diseases that have similar presentation, but appear to have distinct demographic, clinical, pathological and survival characteristics | Acute aortic syndrome (AAS) is a term used to describe a constellation of life - threatening aortic diseases that have similar presentation, but appear to have distinct demographic, clinical, pathological and survival characteristics • Blood enters through the intimal tear and separates the intima from the media and or adventitia. | 55 | definition | 0.980 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726643576_6_ctvs_all.pdf | Acute aortic syndrome (AAS) is a term used to describe a constellation of life - threatening aortic diseases that have similar presentation, but appear to have distinct demographic, clinical, pathological and survival characteristics • Blood enters through the intimal tear and separates the intima from the media and or adventitia. | 1 | page=1,block=25 | 0.700 | valid |
| What is a penetrating aortic ulcer? | Ulcer-like lesion in the intima eroding through the media of the aortic wall and forming localized hematoma thereoff | Aortic Dissection (AD) Commonest and Most lethal Intramural Hematoma (IMH) Penetrating Aortic Ulcer (PAU) Formation of Entrance Tear Rupture of Vasa Vasorum Ulceration of atherosclerotic plaque Tear in the aortic intima and blood enters into the media separating the layers Hematoma within the medial layer of the aortic wall without intimal injury Ulcer-like lesion in the intima eroding through the media of the aortic wall and forming localized hematoma thereoff MYOCARDIAL INFARCTION VS ACUTE TYPE A DISSECTION DIAGNOSTIC IMAGING IN ACUTE AORTIC DISSECTION • The main purpose of imaging is the comprehensive assessment of the entire aorta and its branches with primary goals of confirmation of diagnosis, classification of dissection, assessment of branch vessels, and identification of complications (aortic rupture, aortic regurgitation, and malperfusion) • Besides these, imaging is also needed to assess myocardial and valvular function, pulmonary parenchyma, and state of kidneys IMAGING AND DIAGNOSTIC ALGORITHM • Combination of ECG, Chest X-ray, Echocardiography and ECG gated CT angiography provides desired information. | 349 | definition | 0.980 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726643576_6_ctvs_all.pdf |
| What symptoms are associated with claudication? | Pain/cramp in calf/foot/ thigh/buttock with walking that is relieved with rest | • Claudication: Pain/cramp in calf/foot/ thigh/buttock with walking that is relieved with rest • Duration and progress of symptoms • Onset, duration and progress of ulcer/ gangrene, if any • Rest pain • Identifying risk factors: Diabetes, hypertension, smoking, ischemic heart disease, family history, dyslipidaemia • Syncope/blackout/stroke/mesenteric ischemia • History suggestive of cardiac disorder (angina/palpitations, shortness of breath/ loss of consciousness) EXAMINATION • Blood Pressure (Including ankle-brachial index, toe-brachial index in diabetes, elderly, renal insufficiency) • All peripheral pulses • Condition of the limb: temperature, colour, hair loss, atrophy, nail bed capillary filling, sensation and motor power, gangrene/pre-gangrene • Wound inspection (if any) • Comorbidity evaluation: CVS, Renal Diabetes mellitus, CNS, neuropathy • Evaluation for possible venous conduits Annual follow up CLLI is a manifestation of objectively proven Peripheral Arterial Disease (PAD) defined by ankle brachial index of <0.90. | 16 | definition | 0.980 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726643576_6_ctvs_all.pdf | • Claudication: Pain/cramp in calf/foot/ thigh/buttock with walking that is relieved with rest • Duration and progress of symptoms • Onset, duration and progress of ulcer/ gangrene, if any • Rest pain • Identifying risk factors: Diabetes, hypertension, smoking, ischemic heart disease, family history, dyslipidaemia • Syncope/blackout/stroke/mesenteric ischemia • History suggestive of cardiac disorder (angina/palpitations, shortness of breath/ loss of consciousness) EXAMINATION • Blood Pressure (Including ankle-brachial index, toe-brachial index in diabetes, elderly, renal insufficiency) • All |
| What are the potential consequences of severe acute aortic regurgitation? | heart failure and pulmonary edema | Presence of diastolic murmur of aortic regurgitation, unequal pulses, limb ischemia or neurological complications favor the diagnosis of acute dissection • If dissection is diagnosed with myocardial ischemia it should be managed on the line of dissection and thrombolytic therapy should NOT be initiated COMPLICATION CAUSATIVE MECHANISM PRESENTATION Aortic Regurgitation Loss of support and distortion of aortic valve Diastolic murmur, Severe acute regurgitation can cause heart failure and pulmonary edema Myocardial Ischemia Dissection process involves one or more coronary ostia Chest pain and ECG suggestive of myocardial infarction. | 473 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726643576_6_ctvs_all.pdf | Presence of diastolic murmur of aortic regurgitation, unequal pulses, limb ischemia or neurological complications favor the diagnosis of acute dissection • If dissection is diagnosed with myocardial ischemia it should be managed on the line of dissection and thrombolytic therapy should NOT be initiated COMPLICATION CAUSATIVE MECHANISM PRESENTATION Aortic Regurgitation Loss of support and distortion of aortic valve Diastolic murmur, Severe acute regurgitation can cause heart failure and pulmonary edema Myocardial Ischemia Dissection process involves one or more coronary ostia Chest pain and |
| What distinction needs to be made before treating myocardial ischemia? | between a primary coronary event and coronary malperfusion secondary to dissection process | • Clinically, a dissection-related coronary malperfusion may present with ECG changes of primary myocardial ischemia or infarction. This may increase the likelihood of misdiagnosis and inappropriate therapeutic intervention • Before starting the treatment algorithm for myocardial ischemia, it is important to differentiate between a primary coronary event and coronary malperfusion secondary to dissection process • In dissection, pain is usually abrupt, piercing, and well localized. | 324 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726643576_6_ctvs_all.pdf | This may increase the likelihood of misdiagnosis and inappropriate therapeutic intervention • Before starting the treatment algorithm for myocardial ischemia, it is important to differentiate between a primary coronary event and coronary malperfusion secondary to dissection process • In dissection, pain is usually abrupt, piercing, and well localized. | 1 | page=1,block=39 | 0.700 | valid |
| What does a tear in the aortic intima lead to in aortic dissection? | blood enters into the media separating the layers | Aortic Dissection (AD) Commonest and Most lethal Intramural Hematoma (IMH) Penetrating Aortic Ulcer (PAU) Formation of Entrance Tear Rupture of Vasa Vasorum Ulceration of atherosclerotic plaque Tear in the aortic intima and blood enters into the media separating the layers Hematoma within the medial layer of the aortic wall without intimal injury Ulcer-like lesion in the intima eroding through the media of the aortic wall and forming localized hematoma thereoff MYOCARDIAL INFARCTION VS ACUTE TYPE A DISSECTION DIAGNOSTIC IMAGING IN ACUTE AORTIC DISSECTION • The main purpose of imaging is the comprehensive assessment of the entire aorta and its branches with primary goals of confirmation of diagnosis, classification of dissection, assessment of branch vessels, and identification of complications (aortic rupture, aortic regurgitation, and malperfusion) • Besides these, imaging is also needed to assess myocardial and valvular function, pulmonary parenchyma, and state of kidneys IMAGING AND DIAGNOSTIC ALGORITHM • Combination of ECG, Chest X-ray, Echocardiography and ECG gated CT angiography provides desired information. | 224 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726643576_6_ctvs_all.pdf |