Aortic dissection history and symptoms: Difference between revisions
| Line 17: | Line 17: | ||
==Pain== | ==Pain== | ||
===Chest 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. | 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, and Jaw Pain=== | ||
Revision as of 20:46, 24 January 2013
|
Aortic dissection Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Special Scenarios |
|
Case Studies |
|
|
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.
History
The presence of syndromes /diseases or procedures that place the patient at high risk of dissection should be ascertained:
- Marfan's syndrome
- Connective tissue disease
- Family history of aortic disease
- Known aortic valve disease such as bicuspid aortic valve disease
- Recent heart surgery or aortic manipulation
- Known thoracic aortic aneurysm
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)
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
- ↑ 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
- ↑ 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.
- ↑ Townsend CM, Beauchamp RD, Evers BM, et al. Sabiston Textbook of Surgery. 18th ed. Philadelphia: Elsevier Health Sciences, 2008.
- ↑ Libby P, Bonow RO, Mann DL, et al. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia: 2007.
- ↑ Isselbacher E. Cecil Medicine. 23rd ed. Philadelphia: Elsevier Health Sciences, 2008.