S1E9: Aortic Dissection in rural Liberia - Global Health
This month, TheCase.Report is going global!
Callum and Jimmy join Mohammed to discuss a fascinating case with some broad differentials to consider. Callum takes us through the first successful management of Type A Aortic Dissection in the country. Callum has published this as a case report in the BMJ so you can check it out here.
Our Adult in the Room Dr. Jean O'Sullivan weighs in with her take on the case.
Jimmy and Callum catch up with Hessou, an incredibly impressive friend and colleague of theirs from JFK Hospital in Monrovia, Liberia. Mohammed digs into Jimmy and Niamh's experiences of out of programme humanitarian work while Callum catches up again with Dr. Jean O'Sullivan about her experience of working in LMICs.
Lots to cover this month.
Let's get to it!
Aortic Dissection
Presentation
Examination
History
Hypotension (hypovolaemic, cardiac failure or neurogenic)
Haemopericardium (pulsus paradoxus, faint or absent heart sounds, distended neck veins, shock)
>20mmHg difference in blood pressure between arms
Central “tearing/ ripping” chest pain
Sometimes intrascapular pain
Back pain
Migration of pain depending on direction of tear
Risk Factors: Marfan’s Syndrome, Hypertension,
Syncope
Stroke
Investigations
Chest X-ray
ECG:
Widened mediastinum
Small left pleural effusion
Double shadow on aortic knuckle
Intimal calcification separated more than 6mm from the edge
Cardiomegaly (pericardial effusion)
Non-specific ST and T-wave changes
Ischaemic changes
May be normal
Echo… There’s always a role for the probe
Dilated aortic
Aortic regurgitation
Aortic dissection flap
Pericardial effusion
