ILearnEM

Vascular Emergencies

Vascular Emergencies

 

There are many vascular-related events that present to the emergency department ranging from high blood pressure to dissection of major vessels. Examples of these events are listed here:

 

Systemic Hypertension:1

  • Hypertensive EMERGENCY is an acute elevation of blood pressure (≥180/120 mmHg) associated with end organ damage, specifically, acute effects on the brain, heart, aorta, kidneys, and/or eyes.
  • Hypertensive URGENCY is a clinical presentation associated with severe elevations in blood pressure without progressive target organ dysfunction.
  • Asymptomatic hypertension is also a frequent encounter in the ED.

 

Acute Aortic Syndromes:2 

  • Acute aortic syndromes encompass a number of life-threatening aortic emergencies.
    • These include aortic dissection, penetrating atherosclerotic ulcer, intramural hematoma, and aortic aneurysmal leakage or ruptured abdominal aortic aneurysm.
    • All mechanisms involve weakening of the medial layer and intimal wall stress. 
  • Aortic Dissection:
    • Aortic dissection occurs after a violation of the intima allows blood to enter the media and dissect between the intimal and adventitial layers.
    • Risk stratification for aortic dissection

 

Aneurysms of the Aorta and Major Arteries:3 

  • An aneurysm is dilation of the arterial wall to >1.5 times its normal diameter. Aneurysms have been classically distinguished as true aneurysms, pseudoaneurysms, and mycotic aneurysms.
    • The wall of the true aneurysm consists of all layers of the vessel wall.
    • The wall of the pseudoaneurysm consists partially of the vessel wall and partially of fibrous or other surrounding tissue.
    • A mycotic aneurysm is an aneurysm that develops as a result of infection in the vessel wall.
  • Abdominal Aortic Aneurysm
  • Thoracic Aortic Aneurysms

 

Occlusive Arterial Disease:4 

  • Acute limb ischemia secondary to thrombosis or embolism is a true medical emergency requiring immediate therapy for limb salvage.
  • The term critical limb ischemia is used when chronic progressive peripheral arterial disease results in ischemic pain at rest, ulcercation, or gangrene.

 

 

Click HERE for a list of all mentioned FOAM resources.

 

  1. Cline, D., Machado, A., Chapter 61, “Systemic and Pulmonary Hypertension”. Tintinalli’s Emergency Medicine – A Comprehensive Study Guide. J Tintinalli. 7th ed. McGraw-Hill Education, 2010.
  2. Johnson, G., Prince, L. Chapter 59, “Aortic Dissection and Related Aortic Syndromes”. Tintinalli’s Emergency Medicine – A Comprehensive Study Guide. J Tintinalli. 8th ed. McGraw-Hill Education, 2016.
  3. Prince, L., Johnson, G., Chapter 63, “Aneurysms of the Aorta and Major Arteries”. Tintinalli’s Emergency Medicine – A Comprehensive Study Guide. J Tintinalli. 7th ed. McGraw-Hill Education, 2010.
  4. Chopra, A., Carr, D., Chapter 64, “Occlusive Arterial Disease”. Tintinalli’s Emergency Medicine – A Comprehensive Study Guide. J Tintinalli. 7th ed. McGraw-Hill Education, 2010.

 

Prepared by Alex Mungham PGY1 FM – University of Ottawa