Aortic dissection history and symptoms: Difference between revisions

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** [[Abdominal pain]]: from mesentric ischemia
** [[Abdominal pain]]: from mesentric ischemia
** [[Oliguria]]/ [[Anuria]]: Involvement of renal arteries causing pre-renal failure.<ref>Saner, H.E., et al., Aortic dissection presenting as Pericarditis. Chest, 1987. 91(1): p. 71-4. PMID 3792088</ref> <ref>Rosman, H.S., et al., Quality of history taking in patients with aortic dissection. Chest, 1998. 114(3): p. 793-5. PMID 9743168</ref> <ref>Hagan, P.G., et al., The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA, 2000. 283(7): p. 897-903. PMID 10685714</ref> <ref>von Kodolitsch, Y., A.G. Schwartz, and C.A. Nienaber, Clinical prediction of acute aortic dissection. Arch Intern Med, 2000. 160(19): p. 2977-82. PMID 11041906</ref>
** [[Oliguria]]/ [[Anuria]]: Involvement of renal arteries causing pre-renal failure.<ref>Saner, H.E., et al., Aortic dissection presenting as Pericarditis. Chest, 1987. 91(1): p. 71-4. PMID 3792088</ref> <ref>Rosman, H.S., et al., Quality of history taking in patients with aortic dissection. Chest, 1998. 114(3): p. 793-5. PMID 9743168</ref> <ref>Hagan, P.G., et al., The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA, 2000. 283(7): p. 897-903. PMID 10685714</ref> <ref>von Kodolitsch, Y., A.G. Schwartz, and C.A. Nienaber, Clinical prediction of acute aortic dissection. Arch Intern Med, 2000. 160(19): p. 2977-82. PMID 11041906</ref>
====Blood pressure changes====
While many patients with an aortic dissection have a history of [[arterial hypertension|hypertension]], the blood pressure is quite variable at presentation with acute aortic dissection, and tends to be higher in individuals with a distal dissection.  In individuals with a proximal aortic dissection, 36% present with [[arterial hypertension|hypertension]], while 25% present with [[hypotension]].  In those that present with distal aortic dissections, 70% present with hypertension while 4% present with hypotension.
Severe hypotension at presentation is a grave prognostic indicator.  It is usually associated with [[pericardial tamponade]], severe [[aortic insufficiency]], or rupture of the aorta.  Accurate measurement of the blood pressure is important.  ''Pseudohypotension'' (falsely low blood pressure measurement) may occur due to involvement of the [[brachiocephalic artery]] (supplying the right arm) or the [[left subclavian artery]] (supplying the left arm).


* 74% of patients who survive the initial tear typically present with the sudden onset of severe tearing pain.  92% of patients with anterior chest pain as their major source of pain have either type I or type II dissections, and only 8% have type III.  Neck, throat, jaw, and unilateral face pain are also seen more commonly in those with type I or type II dissection.  52% of patients with type III dissection have the majority of their pain in the back, and 67% of these patients have some degree of back pain.  
* 74% of patients who survive the initial tear typically present with the sudden onset of severe tearing pain.  92% of patients with anterior chest pain as their major source of pain have either type I or type II dissections, and only 8% have type III.  Neck, throat, jaw, and unilateral face pain are also seen more commonly in those with type I or type II dissection.  52% of patients with type III dissection have the majority of their pain in the back, and 67% of these patients have some degree of back pain.  

Revision as of 00:50, 29 October 2012

Aortic dissection Microchapters

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Case Studies

Case #1


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

67% of patients with aortic dissection present with acute symptoms (<2 weeks), and 33% with chronic symptoms (>= 2 weeks). About 96% of individuals present with severe pain that had a sudden onset.

History

Symptoms

  • Pain:
    • Sudden onset, sharp, severe chest pain.
    • Tearing or stabbing in nature. A pleuritic pain suggests acute pericarditis associated with hemorrahge into the pericardial sac.
    • Location:
      • Depends on the site of dissection - Anterior chest pain is associated with dissections of the ascending aorta, whereas back pain (interscapular) indicates dissection of the descending aorta.
      • In 17% patients, the pain migrates as dissection extends down the aorta.
  • Less common symptoms include -
  • 74% of patients who survive the initial tear typically present with the sudden onset of severe tearing pain. 92% of patients with anterior chest pain as their major source of pain have either type I or type II dissections, and only 8% have type III. Neck, throat, jaw, and unilateral face pain are also seen more commonly in those with type I or type II dissection. 52% of patients with type III dissection have the majority of their pain in the back, and 67% of these patients have some degree of back pain.
  • Up to 15 – 55 % of patients can have painless dissection. Dissection should therefore be included in the differential in patients with unexplained syncope, stroke or congestive heart failure (CHF).
  • 4% of patients present with out of hospital cardiac arrest.
  • Unusual symptoms include:
  • Hoarseness
  • Hemoptysis
  • Claudication
  • Superior vena cava (SVC) syndrome
  • Upper gastrointestinal (UGI) bleed
  • Upper airway obstruction.

ACC/ AHA Guidelines - Recommendations for History and Physical Examination for Thoracic aortic disease (DO NOT EDIT)

Class I
1. For patients presenting with a history of acute cardiac and noncardiac symptoms associated with a significant likelihood of thoracic aortic disease, the clinician should perform a focused physical examination, including a careful and complete search for arterial perfusion differentials in both upper and lower extremities, evidence of visceral ischemia, focal neurological deficits, a murmur of aortic regurgitation, bruits, and findings compatible with possible cardiac tamponade (Level of Evidence: C)

References

  1. ↑ Saner, H.E., et al., Aortic dissection presenting as Pericarditis. Chest, 1987. 91(1): p. 71-4. PMID 3792088
  2. ↑ Rosman, H.S., et al., Quality of history taking in patients with aortic dissection. Chest, 1998. 114(3): p. 793-5. PMID 9743168
  3. ↑ Hagan, P.G., et al., The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA, 2000. 283(7): p. 897-903. PMID 10685714
  4. ↑ von Kodolitsch, Y., A.G. Schwartz, and C.A. Nienaber, Clinical prediction of acute aortic dissection. Arch Intern Med, 2000. 160(19): p. 2977-82. PMID 11041906


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