Day: October 28, 2018

Emergency doctors urged to ‘Think Aorta’

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Emergency doctors are being urged to collaborate with a patient-led campaign, which aims to reduce the number of patients dying in Irish Emergency Departments (EDs) from aortic dissection.

An aortic dissection refers to a tear in the body’s largest artery that carries blood away from the heart. Unless the condition is diagnosed rapidly and the patient undergoes surgery, it can prove fatal.

However, symptoms can be similar to other heart problems, such as a heart attack, which can lead to a misdiagnosis or a delay in diagnosis.

A patient support association, Aortic Dissection Awareness (UK and Ireland), is challenging the number of unnecessary deaths that occur due to the misdiagnosis of this condition in Irish hospitals.

It is calling on the Irish Association for Emergency Medicine (IAEM) to collaborate with it and introduce changes in relation to education, awareness and policy around the condition.

The chairperson, vice-chairperson and medical advisor of this patient association are attending the IAEM’s annual scientific meeting and conference in Dublin this week to urge doctors to get involved with the ‘Think Aorta’ campaign.

This campaign was inspired by the death of Tim Fleming, who was sent home from Dublin’s Tallaght Hospital in 2015 with an incorrect diagnosis of gastritis. Mr Fleming’s daughter, Catherine Fowler, who is vice-chairperson of Aortic Dissection Awareness, is a guest speaker at the conference.

“We had no idea when dad died of how common it is for aortic dissection to be missed in the ED. Over the last three years, the picture has become very clear. Sadly, I know of many other families in Ireland who have lost their relatives to missed aortic dissection in hospitals during that time. We must do something to change the future for others,” she said.

She pointed out that as a result of the ‘Think Aorta’ campaign in the UK, the Royal College of Emergency Medicine there has accepted that this is a real issue and it is working with the association to address this.

“I will be asking the IAEM to do the same,” Ms Fowler added.

Statistics show that aortic dissection is only considered in half of the patients who present with it, and one-third of patients are actively treated for something else, such as a heart attack.

The only definitive diagnostic tool for diagnosing the condition is a CT scan, however these are often not ordered until it is too late.

“Aortic dissection is not a difficult condition to diagnose. A doctor just has to be aware enough to ‘Think Aorta’ in the first place, then once their suspicion is raised, they must request an immediate CT scan to confirm.

“Experience in the UK shows that if EDs educate staff about aortic dissection and lower the barriers to CT scanning, lives will be saved,” Ms Fowler noted.

The IAEM annual scientific meeting and conference takes place in Castleknock Hotel from October 17-19. For more information on the ‘Think Aorta’ campaign, click here

Aortic Disease Proves No Match for a Mother’s Love

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After learning she had an aortic aneurysm and dissection, a mother-to-be faced big risks. Michigan Medicine doctors worked together to keep mom and baby safe.

Last November was the start of a happy time after Monique Lowes learned she was pregnant with her first child. She had struggled for years to conceive and was thrilled at the thought of being a mother.

But her excitement soon turned to fear.

In February, the 37-year-old was advised by her primary obstetrician to undergo an echocardiogram. That screening was due to Lowes’ high blood pressure as well as her age, which put the patient in a high-risk pregnancy category.

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The test revealed a devastating and unexpected diagnosis: a thoracic aortic aneurysm and aortic dissection.

A thoracic aortic aneurysm, also referred to as a TAA, is an enlargement of the first portion of the aorta — the body’s major artery.

An aortic dissection happens when layers of the aorta pull apart and blood becomes trapped between the layers. This weakens the aorta and may cause it to rupture. People who have aortic aneurysms are at higher risk of dissection.

A difficult choice
As in Lowes’ case, the cause of aortic aneurysms isn’t always clear. Risk factors include genetic disorders such as Marfan, Loeys-Dietz or Ehlers-Danlos syndromes, arteriosclerosis (plaque buildup in artery walls) and high blood pressure.

Doctors advised Lowes of the risks that aorta repair surgery could have on her unborn child — as well as the risk she herself might face if the necessary surgery was delayed.

In the end, Lowes chose to delay the surgery.

“As a woman who has struggled with infertility, I wanted to do my best for me and my daughter,” Lowes says, noting that her pregnancy is what revealed the underlying heart condition.

“If it weren’t for her, the aneurysm would never have been discovered in time. It was a miracle that I was pregnant and that I found out about my heart condition.”

Handling with care
Lowes was admitted to Michigan Medicine, where she would spend two months on the fourth floor of the Frankel Cardiovascular Center being observed by a team of specialized providers, including cardiac surgeon Himanshu Patel, M.D., and high-risk obstetrics doctors such as Elizabeth Langen, M.D., of Von Voightlander Women’s Hospital.

“This was a very collaborative effort,” says Patel, noting that Lowes’ doctors worked hand-in-hand to monitor her condition as well as the health of her unborn baby.

SEE ALSO: Lifesaving Facts About Aortic Dissection

The goal: to get Lowes as far along in her pregnancy as possible without compromising her condition.

“The cardiac surgery and OB teams did a great job co-managing her care,” says Langen.

An incubator sat near Lowes’ hospital bed, a constant reminder that the baby might need to be delivered prematurely if the patient’s condition worsened.

But at 28 weeks pregnant, she was finally able to go home before giving birth at 32 weeks to her beautiful daughter, Graysen Faith.

The team’s detailed delivery plan included a cesarean delivery performed at the Frankel Cardiovascular Center, just in case Lowes’ aortic condition required immediate surgery.

“She was born with not a hair on her head out of place,” the proud mother says. “She’s a beautiful baby.”

“Within 24 hours, she was up and able to hold her baby and spend time with her during recovery. It was a successful outcome for her and the baby.”
Himanshu Patel, M.D.
Repair and reflection
Lowes was able to spend time with her newborn at home before returning to the Frankel Cardiovascular Center for surgery in August.

Her open-heart procedure included an incision that enabled access to the weakened area of Lowes’ aorta and dissection. The surgery required her to be put on a heart-lung machine to stop the flow of blood during repair of her aorta.

It didn’t take long, though, for mother-daughter bonding to resume.

“Within 24 hours, she was up and able to hold her baby and spend time with her during recovery,” says Patel. “It was a successful outcome for her and the baby.”

SEE ALSO: Genetic Defect Makes Cardiac Care a Family Affair

“Everyone worked so well with me,” Lowes says of her heart and obstetrics team, including the cardiac and neonatal intensive care nurses. “I fell apart a few times but then found strength to go on.”

She credits her care team as well as her sister, nephew and two nieces for keeping her strong through it all.

It was a risky choice, Lowes now admits, but she’s thankful for the outcome. “I had faith that God had a plan for me and my baby.”

As she recuperates from surgery and cares for her infant daughter, Lowes wants to spread a message of hope to moms faced with similar challenges: “Miracles do happen.”

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