Aortic dissection history and symptoms
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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). 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
- Aortic root dilatation may lead to symptoms of CHF
- Syncope: 50% of the times, the etiology of syncope is hemorrhage into the pericardial sac causing pericardial tamponade
- Paraplegia, paralysis: from involvement of one of the cerebral arteries
- Cardiac arrest occurs in 4% of patients
- Abdominal pain: from mesentric ischemia
- Oliguria/ Anuria: Involvement of renal arteries causing pre-renal failure.[1] [2] [3] [4]
- 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
- ↑ 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