Aortic dissection history and symptoms: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
m (Bot: Adding CME Category::Cardiology)
No edit summary
Line 4: Line 4:
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}
==Overview==
==Overview==
67% of patients with [[aortic]] dissection present with [[acute]] [[symptom]]s (<2 weeks), and 33% with [[chronic]] [[symptom]]s (>= 2 weeks). 74% of patients who survive the initial tear typically present with the sudden onset of severe tearing [[pain]].


==History==
==History==
The presence of [[syndrome]]s/ diseases or procedures that place the patient at high risk of dissection should be ascertained:
History of patients with aortic dissection may include the following factors:
* [[Marfan's syndrome]]
* [[Marfan's syndrome]]
* [[Connective tissue disease]]
* [[Connective tissue disease]]
* Family history of [[aortic]] disease
* Family history of the [[aortic]] disease
* Known [[aortic valve]] disease such as [[bicuspid aortic valve]] disease
* Known [[aortic valve]] disease such as [[bicuspid aortic valve]] disease
* Recent [[heart surgery]] or [[aortic]] manipulation
* Recent [[heart surgery]] or [[aortic]] manipulation
* Known [[thoracic aortic aneurysm]]
* Known [[thoracic aortic aneurysm]]
==Common Symptoms==
==Common Symptoms==
===Chest Pain===
Common symptoms of aortic dissection include:<ref name="HaganNienaber2000">{{cite journal|last1=Hagan|first1=Peter G.|last2=Nienaber|first2=Christoph A.|last3=Isselbacher|first3=Eric M.|last4=Bruckman|first4=David|last5=Karavite|first5=Dean J.|last6=Russman|first6=Pamela L.|last7=Evangelista|first7=Arturo|last8=Fattori|first8=Rossella|last9=Suzuki|first9=Toru|last10=Oh|first10=Jae K.|last11=Moore|first11=Andrew G.|last12=Malouf|first12=Joseph F.|last13=Pape|first13=Linda A.|last14=Gaca|first14=Charlene|last15=Sechtem|first15=Udo|last16=Lenferink|first16=Suzanne|last17=Deutsch|first17=Hans Josef|last18=Diedrichs|first18=Holger|last19=Marcos y Robles|first19=Jose|last20=Llovet|first20=Alfredo|last21=Gilon|first21=Dan|last22=Das|first22=Sugata K.|last23=Armstrong|first23=William F.|last24=Deeb|first24=G. Michael|last25=Eagle|first25=Kim A.|title=The International Registry of Acute Aortic Dissection (IRAD)|journal=JAMA|volume=283|issue=7|year=2000|pages=897|issn=0098-7484|doi=10.1001/jama.283.7.897}}</ref><ref>{{cite journal|title=Correspondence|journal=The Annals of Thoracic Surgery|volume=67|issue=2|year=1999|pages=593|issn=00034975|doi=10.1016/S0003-4975(99)00037-5}}</ref><ref name="pmid22456637">{{cite journal |vauthors=Trimarchi S, Tolenaar JL, Tsai TT, Froehlich J, Pegorer M, Upchurch GR, Fattori R, Sundt TM, Isselbacher EM, Nienaber CA, Rampoldi V, Eagle KA |title=Influence of clinical presentation on the outcome of acute B aortic dissection: evidences from IRAD |journal=J Cardiovasc Surg (Torino) |volume=53 |issue=2 |pages=161–8 |date=April 2012 |pmid=22456637 |doi= |url=}}</ref><ref name="pmid11980527">{{cite journal |vauthors=Klompas M |title=Does this patient have an acute thoracic aortic dissection? |journal=JAMA |volume=287 |issue=17 |pages=2262–72 |date=May 2002 |pmid=11980527 |doi=10.1001/jama.287.17.2262 |url=}}</ref>
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. In 17% patients, the [[pain]] migrates as dissection extends down the [[aorta]].
*Chest pain (especially migrating pain)
 
**Sudden onset of pain is the most common symptom.
===Neck, Throat, and Jaw Pain===
**The quality of pain is different from other causes of chest pain. it may be sharp, ripping, tearing, knife-like.
Neck, throat, jaw, and [[unilateral]] face [[pain]] are also seen more commonly in those with type I or type II dissection.
**The most common site of pain in order of frequency is chest (80%), back (40%), and abdomen (25%).
 
**Type A aortic dissection more commonly presents with chest pain, whereas type B tends to manifest with back/abdominal pain.
===Back Pain===
*Neck, throat, and jaw pain
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]].
*Back pain
 
*Pleuretic pain (maybe suggestive of acute pericarditis due to [[hemorrhage]] into the [[pericardial sac]].
===Pleuritic Pain===
It worths mentioning that the presence of pain is not necessary for the diagnosis of aortic dissection. Patients may present with [[syncope]], [[stroke]] or symptoms suggestive of [[congestive heart failure|congestive heart failure (CHF)]].
[[Pleuritic pain]] suggests acute [[pericarditis]] associated with [[hemorrhage]] into the [[pericardial sac]].
 
===Painless Dissection===
Up to 15 – 55 % of patients can have [[pain]]less dissection. Dissection should therefore be included in the differential in patients with unexplained [[syncope]], [[stroke]] or [[congestive heart failure|congestive heart failure (CHF)]].
 
==Less Common Symptoms==
==Less Common Symptoms==
* [[Abdominal pain]] due to [[mesenteric ischemia]]
Less common symptoms od aortic dissection include:
* [[Cardiac arrest]] occurs in 4% of patients
* [[Abdominal pain]] following [[mesenteric ischemia]]
* [[Claudication]] due to [[iliac artery]] occlusion
* [[Cardiac arrest]] (rarely)
* [[Congestive heart failure]] may be observed due to [[aortic root]] [[dilatation]] leading to [[aortic insufficiency]]
* [[Claudication]] due to [[iliac artery]] involvement
*[[Dysphagia]] due to compression of the [[esophagus]]
* Symptoms of [[congestive heart failure]] may be observed due to [[aortic root]] [[dilatation]] leading to [[aortic insufficiency]]
*[[Hemoptysis]] due to compression of and erosion into the [[bronchus]]
* [[Dysphagia]] due to compression of the [[esophagus]]
*[[Horner syndrome]] due to compression of the [[superior cervical ganglia]]
* [[Hemoptysis]] due to compression of and erosion into the [[bronchus]]
* [[Oliguria]]/ [[Anuria]] due to involvement of the [[renal arteries]] causing pre-[[renal]] [[azotemia]].<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>
* [[Horner syndrome]] due to compression of the [[superior cervical ganglia]]
* [[Oliguria]]/ [[Anuria]] due to involvement of the [[renal arteries]] causing pre-[[renal]] [[azotemia]].
* [[Paraplegia]], [[paralysis]] from involvement of one of the [[cerebral artery|cerebral]] or [[spinal cord|spinal]] [[artery|arteries]]
* [[Paraplegia]], [[paralysis]] from involvement of one of the [[cerebral artery|cerebral]] or [[spinal cord|spinal]] [[artery|arteries]]
*[[Stridor]] and [[wheezing]] due to compression of the airway
* [[Stridor]] and [[wheezing]] due to compression of the airway
*[[Swelling]] of the neck and face due to compression of the [[superior vena cava]] or [[Superior vena cava syndrome]]
* [[Swelling]] of the neck and face due to compression of the [[superior vena cava]] or [[Superior vena cava syndrome]]
* [[Syncope]] may occur and in 50% of cases, the [[etiology]] of the [[syncope]] is [[hemorrhage]] into the [[pericardial sac]] causing [[pericardial tamponade]]
* [[Syncope]]  
* [[Upper gastrointestinal bleed|Upper gastrointestinal (UGI) bleed]]  
* [[Upper gastrointestinal bleed|Upper gastrointestinal (UGI) bleed]]  
*[[Vocal cord paralysis]] and [[hoarseness]] (compression of the [[recurrent laryngeal nerve]])
* [[hoarseness]] (compression of the [[recurrent laryngeal nerve]])


==2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients with Thoracic Aortic Disease (DO NOT EDIT)<ref name="pmid20233780">{{cite journal| author=Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE et al.| title=2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. | journal=Circulation | year= 2010 | volume= 121 | issue= 13 | pages= e266-369 | pmid=20233780 | doi=10.1161/CIR.0b013e3181d4739e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20233780  }} </ref>==
==2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients with Thoracic Aortic Disease (DO NOT EDIT)<ref name="pmid20233780">{{cite journal| author=Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE et al.| title=2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. | journal=Circulation | year= 2010 | volume= 121 | issue= 13 | pages= e266-369 | pmid=20233780 | doi=10.1161/CIR.0b013e3181d4739e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20233780  }} </ref>==

Revision as of 22:27, 9 December 2019

Aortic dissection Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Aortic dissection from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Special Scenarios

Management during Pregnancy

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

History

History of patients with aortic dissection may include the following factors:

Common Symptoms

Common symptoms of aortic dissection include:[1][2][3][4]

  • Chest pain (especially migrating pain)
    • Sudden onset of pain is the most common symptom.
    • The quality of pain is different from other causes of chest pain. it may be sharp, ripping, tearing, knife-like.
    • The most common site of pain in order of frequency is chest (80%), back (40%), and abdomen (25%).
    • Type A aortic dissection more commonly presents with chest pain, whereas type B tends to manifest with back/abdominal pain.
  • Neck, throat, and jaw pain
  • Back pain
  • Pleuretic pain (maybe suggestive of acute pericarditis due to hemorrhage into the pericardial sac.

It worths mentioning that the presence of pain is not necessary for the diagnosis of aortic dissection. Patients may present with syncope, stroke or symptoms suggestive of congestive heart failure (CHF).

Less Common Symptoms

Less common symptoms od aortic dissection include:

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients with Thoracic Aortic Disease (DO NOT EDIT)[5]

History and Physical Examination for Thoracic Aortic Disease (DO NOT EDIT)[5]

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.[6][7][8] (Level of Evidence: C)"

References

  1. ↑ Hagan, Peter G.; Nienaber, Christoph A.; Isselbacher, Eric M.; Bruckman, David; Karavite, Dean J.; Russman, Pamela L.; Evangelista, Arturo; Fattori, Rossella; Suzuki, Toru; Oh, Jae K.; Moore, Andrew G.; Malouf, Joseph F.; Pape, Linda A.; Gaca, Charlene; Sechtem, Udo; Lenferink, Suzanne; Deutsch, Hans Josef; Diedrichs, Holger; Marcos y Robles, Jose; Llovet, Alfredo; Gilon, Dan; Das, Sugata K.; Armstrong, William F.; Deeb, G. Michael; Eagle, Kim A. (2000). "The International Registry of Acute Aortic Dissection (IRAD)". JAMA. 283 (7): 897. doi:10.1001/jama.283.7.897. ISSN 0098-7484.
  2. ↑ "Correspondence". The Annals of Thoracic Surgery. 67 (2): 593. 1999. doi:10.1016/S0003-4975(99)00037-5. ISSN 0003-4975.
  3. ↑ Trimarchi S, Tolenaar JL, Tsai TT, Froehlich J, Pegorer M, Upchurch GR, Fattori R, Sundt TM, Isselbacher EM, Nienaber CA, Rampoldi V, Eagle KA (April 2012). "Influence of clinical presentation on the outcome of acute B aortic dissection: evidences from IRAD". J Cardiovasc Surg (Torino). 53 (2): 161–8. PMID 22456637.
  4. ↑ Klompas M (May 2002). "Does this patient have an acute thoracic aortic dissection?". JAMA. 287 (17): 2262–72. doi:10.1001/jama.287.17.2262. PMID 11980527.
  5. ↑ 5.0 5.1 Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE; et al. (2010). "2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine". Circulation. 121 (13): e266–369. doi:10.1161/CIR.0b013e3181d4739e. PMID 20233780.
  6. ↑ Townsend CM, Beauchamp RD, Evers BM, et al. Sabiston Textbook of Surgery. 18th ed. Philadelphia: Elsevier Health Sciences, 2008.
  7. ↑ Libby P, Bonow RO, Mann DL, et al. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia: 2007.
  8. ↑ Isselbacher E. Cecil Medicine. 23rd ed. Philadelphia: Elsevier Health Sciences, 2008.

Template:WH Template:WS CME Category::Cardiology

Retrieved from "https://www.wikidoc.org/index.php?title=Aortic_dissection_history_and_symptoms&oldid=1591103"