Aortic dissection history and symptoms: Difference between revisions
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | | colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | ||
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|bgcolor="LightGreen" | '''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, | |bgcolor="LightGreen" | '''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]], [[bruit]]s, and findings compatible with possible [[cardiac tamponade]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' | ||
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Revision as of 22:06, 29 October 2012
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Aortic dissection Microchapters |
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Diagnosis |
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Treatment |
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Special Scenarios |
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Case Studies |
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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). 74% of patients who survive the initial tear typically present with the sudden onset of severe tearing pain.
Pain
Chest 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. In 17% patients, the pain migrates as dissection extends down the aorta.
Neck, Throat, and Jaw Pain
Neck, throat, jaw, and unilateral face pain are also seen more commonly in those with type I or type II dissection.
Back 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.
Pleuritic Pain
Pleuritic pain suggests acute pericarditis associated with hemorrhage into the pericardial sac.
Painless Dissection
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).
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