Acute aortic syndrome: Difference between revisions

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==Overview==
==Overview==
'''Acute aortic syndrome''' ('''AAS''') describes a constellation of emergency conditions with a similar clinical feature that involves the [[aorta]].<ref name="pmid16679467">{{cite journal |author=Ahmad F, Cheshire N, Hamady M |title=Acute aortic syndrome: pathology and therapeutic strategies |journal=Postgrad Med J |volume=82 |issue=967 |pages=305–12 |date=May 2006 |pmid=16679467 |doi=10.1136/pgmj.2005.043083 |url=http://pmj.bmjjournals.com/cgi/pmidlookup?view=long&pmid=16679467 |pmc=2563796}}</ref> These include [[aortic dissection]], intramural [[thrombus]], and [[penetrating atherosclerotic ulcer|penetrating atherosclerotic aortic ulcer]].<ref name="Macura">{{cite journal | last=Macura | first=KJ |author2=Corl FM|author3=Fishman EK|author4=Bluemke DA | title=Pathogenesis in acute aortic syndromes: aortic dissection, intramural hematoma, and penetrating atherosclerotic aortic ulcer | journal=American Journal of Roentgenology | volume=181 | issue=2 | pages=309–316 | date=1 August 2003 | pmid=12876003 | url=http://www.ajronline.org/cgi/content/full/181/2/309 | accessdate=2008-05-28 | doi=10.2214/ajr.181.2.1810309}}</ref>  It is possible for AAS to lead to [[acute coronary syndrome]].<ref name="pmid16291307">{{cite journal |author=Manghat NE, Morgan-Hughes GJ, Roobottom CA |title=Multi-detector row computed tomography: imaging in acute aortic syndrome |journal=Clin Radiol |volume=60 |issue=12 |pages=1256–67 |date=December 2005 |pmid=16291307 |doi=10.1016/j.crad.2005.06.011 |url=}}</ref>  The term was introduced in 2001.<ref name="pmid12860875">{{cite journal |author=van der Loo B, Jenni R |title=Acute aortic syndrome: proposal for a novel classification |journal=Heart |volume=89 |issue=8 |pages=928 |date=August 2003 |pmid=12860875 |doi= 10.1136/heart.89.8.928|url=http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=12860875 |pmc=1767786}}</ref><ref name="pmid11250953">{{cite journal |author=Vilacosta I, Román JA |title=Acute aortic syndrome |journal=Heart |volume=85 |issue=4 |pages=365–8 |date=April 2001 |pmid=11250953 |doi= 10.1136/heart.85.4.365|url=http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=11250953 |pmc=1729697}}</ref>
'''Acute aortic syndrome''' ('''AAS''') describes a constellation of emergency conditions with a similar clinical feature that involves the [[aorta]]. These include [[aortic dissection]], intramural [[thrombus]], and [[penetrating atherosclerotic ulcer|penetrating atherosclerotic aortic ulcer]]. It is possible for AAS to lead to [[acute coronary syndrome]]. The term was introduced in 2001.
 
==Classification==
==Classification==
Acute aortic syndromes is classified into 5 entities as follows:<ref name="Erbel2001">{{cite journal|last1=Erbel|first1=R|title=Diagnosis and management of aortic dissection Task Force on Aortic Dissection, European Society of Cardiology|journal=European Heart Journal|volume=22|issue=18|year=2001|pages=1642–1681|issn=0195668X|doi=10.1053/euhj.2001.2782}}</ref><ref>{{cite journal|title=2014 ESC Guidelines on the diagnosis and treatment of aortic diseases|journal=European Heart Journal|volume=35|issue=41|year=2014|pages=2873–2926|issn=0195-668X|doi=10.1093/eurheartj/ehu281}}</ref>
Acute aortic syndromes is classified into 5 entities as follows:<ref name="Erbel2001">{{cite journal|last1=Erbel|first1=R|title=Diagnosis and management of aortic dissection Task Force on Aortic Dissection, European Society of Cardiology|journal=European Heart Journal|volume=22|issue=18|year=2001|pages=1642–1681|issn=0195668X|doi=10.1053/euhj.2001.2782}}</ref><ref>{{cite journal|title=2014 ESC Guidelines on the diagnosis and treatment of aortic diseases|journal=European Heart Journal|volume=35|issue=41|year=2014|pages=2873–2926|issn=0195-668X|doi=10.1093/eurheartj/ehu281}}</ref>
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==Guidelines==
==Guidelines==
==2014 ESC Guidelines on the Diagnosis and Treatment of Aortic Diseases (DO NOT EDIT)<ref name="pmid25173340">{{cite journal |vauthors=Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwöger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RS, Vrints CJ |title=2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC) |journal=Eur. Heart J. |volume=35 |issue=41 |pages=2873–926 |date=November 2014 |pmid=25173340 |doi=10.1093/eurheartj/ehu281 |url=}}</ref>==
==2014 ESC Guidelines on the Diagnosis and Treatment of Aortic Diseases (DO NOT EDIT)<ref name="pmid25173340">{{cite journal |vauthors=Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwöger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RS, Vrints CJ |title=2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC) |journal=Eur. Heart J. |volume=35 |issue=41 |pages=2873–926 |date=November 2014 |pmid=25173340 |doi=10.1093/eurheartj/ehu281 |url=}}</ref>==
===Clinical Assessment of Patients Suspicious of Aortic Dissection===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ESC guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|bgcolor="LightGreen" |<nowiki>"</nowiki>In all patients with suspected AAS, pre-test probability assessment is recommended, according to the patient’s condition, symptoms, and clinical features.<ref name="EvangelistaIsselbacher2018">{{cite journal|last1=Evangelista|first1=Arturo|last2=Isselbacher|first2=Eric M.|last3=Bossone|first3=Eduardo|last4=Gleason|first4=Thomas G.|last5=Eusanio|first5=Marco Di|last6=Sechtem|first6=Udo|last7=Ehrlich|first7=Marek P.|last8=Trimarchi|first8=Santi|last9=Braverman|first9=Alan C.|last10=Myrmel|first10=Truls|last11=Harris|first11=Kevin M.|last12=Hutchinson|first12=Stuart|last13=O’Gara|first13=Patrick|last14=Suzuki|first14=Toru|last15=Nienaber|first15=Christoph A.|last16=Eagle|first16=Kim A.|title=Insights From the International Registry of Acute Aortic Dissection|journal=Circulation|volume=137|issue=17|year=2018|pages=1846–1860|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.117.031264}}</ref>''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LemonChiffon"| [[ESC guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki> Chest X-ray may be considered in cases of low clinical probability of AAS. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> 
|}
===Diagnostic Work-up of Patients Suspicious of Acute Aortic Syndrome===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ESC guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|bgcolor="LightGreen" |<nowiki>"</nowiki>''In unstabled patients with a suspicion of AAS, the following imaging modalities are recommended according to local availability and expertise:transoesophageal echocardiography; CT scan.([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LightGreen" |<nowiki>"</nowiki>''In stable patients with a suspicion of AAS, the following imaging modalities are recommended (or should be considered) according to local availability and expertise:CT scan; MRI.([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
===Diagnostic Value of Echocardiography in the Diagnosis of Aortic Dissection===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ESC guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|bgcolor="LightGreen" |<nowiki>"</nowiki>''Initial recommended [[imaging]] study for the [[diagnosis]] of [[acute aortic syndrome]] is [[transthoracic echocardiography]]. ([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ESC guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon" |<nowiki>"</nowiki>''In stable [[patients]], [[transoesophageal echocardiography]] is the recommended [[imaging]] study. ([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
===Follow-up Imaging study===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ESC guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|bgcolor="LightGreen" |<nowiki>"</nowiki>''In case of initially negative imaging with persistence of suspicion of AAS, repetitive imaging (CT or MRI) is recommended.([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LightGreen" |<nowiki>"</nowiki>''In case of uncomplicated Type B AD treated medically, repeated imaging (CT or MRI) during the first days is recommended. ([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 03:02, 25 December 2019

Acute aortic syndrome Microchapters

Home

Patient Information

Overview

Classification

Aortic dissection
Aortic intramural hematoma
Penetrating atherosclerotic aortic ulcer

Differentiating Acute Aortic Syndrome from other Diseases

Causes

Guidelines

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2]

Overview

Acute aortic syndrome (AAS) describes a constellation of emergency conditions with a similar clinical feature that involves the aorta. These include aortic dissection, intramural thrombus, and penetrating atherosclerotic aortic ulcer. It is possible for AAS to lead to acute coronary syndrome. The term was introduced in 2001.

Classification

Acute aortic syndromes is classified into 5 entities as follows:[1][2]

  • Type I: classic aortic dissection involving an intimal layer between the true and false lumen (with no communication between the two lumen)
  • Type II: aortic dissection with medial rupture and the subsequent intramural hematoma formation
  • Type III: subtle aortic dissection with bulging of the aortic wall
  • Type IV: aortic dissection due to plaque rupture and subsequent ulceration
  • Type V: iatrogenic/traumatic dissection

Differentiating Acute Aortic Syndrome from other Diseases

Causes

Guidelines

2014 ESC Guidelines on the Diagnosis and Treatment of Aortic Diseases (DO NOT EDIT)[5]

References

  1. Erbel, R (2001). "Diagnosis and management of aortic dissection Task Force on Aortic Dissection, European Society of Cardiology". European Heart Journal. 22 (18): 1642–1681. doi:10.1053/euhj.2001.2782. ISSN 0195-668X.
  2. "2014 ESC Guidelines on the diagnosis and treatment of aortic diseases". European Heart Journal. 35 (41): 2873–2926. 2014. doi:10.1093/eurheartj/ehu281. ISSN 0195-668X.
  3. Smith AD, Schoenhagen P (January 2008). "CT imaging for acute aortic syndrome". Cleve Clin J Med. 75 (1): 7–9, 12, 15–7 passim. doi:10.3949/ccjm.75.1.7. PMID 18236724.
  4. Evangelista Masip A (April 2007). "[Progress in the acute aortic syndrome]". Rev Esp Cardiol (in Spanish; Castilian). 60 (4): 428–39. doi:10.1157/13101646. PMID 17521551.
  5. Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwöger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RS, Vrints CJ (November 2014). "2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC)". Eur. Heart J. 35 (41): 2873–926. doi:10.1093/eurheartj/ehu281. PMID 25173340.


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