Aortic dissection history and symptoms: Difference between revisions

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Revision as of 14:35, 29 October 2012

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 of sudden onset.

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. 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).

Onset

Sudden onset

Intensity

Severe

Location

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.

Nature

Sharp chest pain
Tearing or stabbing in nature.
A pleuritic pain suggests acute pericarditis associated with hemorrhage into the pericardial sac.

Infrequent Symptoms

Abdominal pain due to mesenteric ischemia
Cardiac arrest occurs in 4% of patients
Claudication due to iliac artery occlusion
Congestive heart failure may be observed due to aortic root dilatation leading to aortic insufficiency
Dysphagia due to compression of the esophagus
Hemoptysis due to compression of and erosion into the bronchus
Horner syndrome due to compression of the superior cervical ganglia
Oliguria/ Anuria due to involvement of the renal arteries causing pre-renal azotemia.^[1] ^[2] ^[3] ^[4]
Paraplegia, paralysis from involvement of one of the cerebral or spinal arteries
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
Syncope may occur and in 50% of cases, the etiology of the syncope is hemorrhage into the pericardial sac causing pericardial tamponade
Upper gastrointestinal (UGI) bleed
Vocal cord paralysis and hoarseness (compression of the recurrent laryngeal nerve)

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

↑ Saner, H.E., et al., Aortic dissection presenting as Pericarditis. Chest, 1987. 91(1): p. 71-4. PMID 3792088
↑ Rosman, H.S., et al., Quality of history taking in patients with aortic dissection. Chest, 1998. 114(3): p. 793-5. PMID 9743168
↑ 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
↑ 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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[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

[1]

[2]

[3]

[4]

@@ Line 23: / Line 23: @@
 ==Infrequent Symptoms==
-* [[Abdominal pain]] due to mesentric ischemia
+* [[Abdominal pain]] due to mesenteric ischemia
 * [[Cardiac arrest]] occurs in 4% of patients
 * Claudication due to [[iliac artery]] occlusion
@@ Line 29: / Line 29: @@
 *[[Dysphagia]] due to compression of the [[esophagus]]
 *[[Hemoptysis]] due to compression of and erosion into the [[bronchus]]
-* Hoarseness
+*[[Horner syndrome]] due to compression of the [[superior cervical ganglia]]
-*[[Horner syndrome]] (compression of the [[superior cervical ganglia]])
+* [[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>
-* [[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>
+* [[Paraplegia]], [[paralysis]] from involvement of one of the cerebral or spinal arteries
-* [[Paraplegia]], [[paralysis]]: from involvement of one of the cerebral arteries
+*[[Stridor]] and [[wheezing]] due to compression of the airway
-*[[Stridor]] and [[wheezing]] (compression of the airway)
+*Swelling of the neck and face due to compression of the superior vena cava or [[Superior vena cava syndrome]]
-* Superior vena cava (SVC) syndrome
+* [[Syncope]] may occur and in 50% of cases, the etiology of the syncope is hemorrhage into the pericardial sac causing [[pericardial tamponade]]
-*Swelling of the neck and face (compression of the superior vena cava or [[Superior vena cava syndrome]])
-* [[Syncope]]: 50% of the times, the etiology of syncope is hemorrhage into the pericardial sac causing [[pericardial tamponade]]
-* Upper airway obstruction
 * Upper gastrointestinal (UGI) bleed
 *[[Vocal cord paralysis]] and [[hoarseness]] (compression of the [[recurrent laryngeal nerve]])