Acute aortic syndrome: Difference between revisions

Jump to navigation Jump to search
(/* 2014 ESC Guidelines on the Diagnosis and Treatment of Aortic Diseases (DO NOT EDIT){{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...)
Line 35: Line 35:
! colspan="4"  align="left" |History and clinical assessment
! colspan="4"  align="left" |History and clinical assessment
|-
|-
! style="padding: 5px 5px; background: #FFFFE0; "  align="left" |In all patients with suspected AAS, pre-test probability assessment is recommended, according to the patient’s condition, symptoms, and clinical features.
! style="padding: 5px 5px; background: #FFFFE0; "  align="left" |<nowiki>"</nowiki>In all patients with suspected AAS, pre-test probability assessment is recommended, according to the patient’s condition, symptoms, and clinical features.<nowiki>"</nowiki>
| style="padding: 5px 5px; background: #90EE90;" align="center" |'''I'''
| style="padding: 5px 5px; background: #90EE90;" align="center" |'''I'''
| style="padding: 5px 5px; background: #0000CD;" align="center" |{{fontcolor|#FFF|B}}
| style="padding: 5px 5px; background: #0000CD;" align="center" |{{fontcolor|#FFF|B}}
Line 42: Line 42:
! colspan="4"  align="left" | Laboratory testing
! colspan="4"  align="left" | Laboratory testing
|-
|-
! style="padding: 5px 5px; background: #FFFFE0; " align="left" |In case of suspicion of AAS, the interpretation of biomarkers should always be considered along with the pretest clinical probability.
! style="padding: 5px 5px; background: #FFFFE0; " align="left" |<nowiki>"</nowiki>In case of suspicion of AAS, the interpretation of biomarkers should always be considered along with the pretest clinical probability.<nowiki>"</nowiki>
| style="padding: 5px 5px; background: #FFA500;" align="center" |'''IIa'''
| style="padding: 5px 5px; background: #FFA500;" align="center" |'''IIa'''
| style="padding: 5px 5px; background: #0000CD;" align="center" |{{fontcolor|#FFF|B}}
| style="padding: 5px 5px; background: #0000CD;" align="center" |{{fontcolor|#FFF|B}}
|
|
|-
|-
! style="padding: 5px 5px; "  align="left" |In case of low clinical probability of AAS, negative D-dimer levels should be considered as ruling out the diagnosis.
! style="padding: 5px 5px; "  align="left" |<nowiki>"</nowiki>In case of low clinical probability of AAS, negative D-dimer levels should be considered as ruling out the diagnosis.<nowiki>"</nowiki>
| style="padding: 5px 5px; background: #FFA500;" align="center" |'''IIa'''
| style="padding: 5px 5px; background: #FFA500;" align="center" |'''IIa'''
| style="padding: 5px 5px; background: #6495ED;" align="center" |{{fontcolor|#FFF|C}}
| style="padding: 5px 5px; background: #6495ED;" align="center" |{{fontcolor|#FFF|C}}
| align="center" |<ref name="EggebrechtMehta2008">{{cite journal|last1=Eggebrecht|first1=Holger|last2=Mehta|first2=Rajendra H.|last3=Metozounve|first3=Huguette|last4=Huptas|first4=Sebastian|last5=Herold|first5=Ulf|last6=Jakob|first6=Heinz G.|last7=Erbel|first7=Raimund|title=Clinical Implications of Systemic Inflammatory Response Syndrome Following Thoracic Aortic Stent-Graft Placement|journal=Journal of Endovascular Therapy|volume=15|issue=2|year=2008|pages=135–143|issn=1526-6028|doi=10.1583/07-2284.1}}</ref><ref name="SutherlandEscano2008">{{cite journal|last1=Sutherland|first1=Alexander|last2=Escano|first2=Jude|last3=Coon|first3=Troy P.|title=D-dimer as the Sole Screening Test for Acute Aortic Dissection: A Review of the Literature|journal=Annals of Emergency Medicine|volume=52|issue=4|year=2008|pages=339–343|issn=01960644|doi=10.1016/j.annemergmed.2007.12.026}}</ref><ref name="SuzukiBossone2013">{{cite journal|last1=Suzuki|first1=Toru|last2=Bossone|first2=Eduardo|last3=Sawaki|first3=Daigo|last4=Jánosi|first4=Rolf Alexander|last5=Erbel|first5=Raimund|last6=Eagle|first6=Kim|last7=Nagai|first7=Ryozo|title=Biomarkers of aortic diseases|journal=American Heart Journal|volume=165|issue=1|year=2013|pages=15–25|issn=00028703|doi=10.1016/j.ahj.2012.10.006}}</ref><ref name="TaylorIyer2013">{{cite journal|last1=Taylor|first1=R. Andrew|last2=Iyer|first2=Neel S.|title=A decision analysis to determine a testing threshold for computed tomographic angiography and d-dimer in the evaluation of aortic dissection|journal=The American Journal of Emergency Medicine|volume=31|issue=7|year=2013|pages=1047–1055|issn=07356757|doi=10.1016/j.ajem.2013.03.039}}</ref>
| align="center" |<ref name="EggebrechtMehta2008">{{cite journal|last1=Eggebrecht|first1=Holger|last2=Mehta|first2=Rajendra H.|last3=Metozounve|first3=Huguette|last4=Huptas|first4=Sebastian|last5=Herold|first5=Ulf|last6=Jakob|first6=Heinz G.|last7=Erbel|first7=Raimund|title=Clinical Implications of Systemic Inflammatory Response Syndrome Following Thoracic Aortic Stent-Graft Placement|journal=Journal of Endovascular Therapy|volume=15|issue=2|year=2008|pages=135–143|issn=1526-6028|doi=10.1583/07-2284.1}}</ref><ref name="SutherlandEscano2008">{{cite journal|last1=Sutherland|first1=Alexander|last2=Escano|first2=Jude|last3=Coon|first3=Troy P.|title=D-dimer as the Sole Screening Test for Acute Aortic Dissection: A Review of the Literature|journal=Annals of Emergency Medicine|volume=52|issue=4|year=2008|pages=339–343|issn=01960644|doi=10.1016/j.annemergmed.2007.12.026}}</ref><ref name="SuzukiBossone2013">{{cite journal|last1=Suzuki|first1=Toru|last2=Bossone|first2=Eduardo|last3=Sawaki|first3=Daigo|last4=Jánosi|first4=Rolf Alexander|last5=Erbel|first5=Raimund|last6=Eagle|first6=Kim|last7=Nagai|first7=Ryozo|title=Biomarkers of aortic diseases|journal=American Heart Journal|volume=165|issue=1|year=2013|pages=15–25|issn=00028703|doi=10.1016/j.ahj.2012.10.006}}</ref><ref name="TaylorIyer2013">{{cite journal|last1=Taylor|first1=R. Andrew|last2=Iyer|first2=Neel S.|title=A decision analysis to determine a testing threshold for computed tomographic angiography and d-dimer in the evaluation of aortic dissection|journal=The American Journal of Emergency Medicine|volume=31|issue=7|year=2013|pages=1047–1055|issn=07356757|doi=10.1016/j.ajem.2013.03.039}}</ref>
|-
|-
! style="padding: 5px 5px; background: #FFFFE0; "  align="left" |In case of intermediate clinical probability of AAS with a positive (point-of-care) D-dimer test, further imaging tests should be considered.
! style="padding: 5px 5px; background: #FFFFE0; "  align="left" |<nowiki>"</nowiki>In case of intermediate clinical probability of AAS with a positive (point-of-care) D-dimer test, further imaging tests should be considered.<nowiki>"</nowiki>
| style="padding: 5px 5px; background: #FFA500;" align="center" |'''IIa'''
| style="padding: 5px 5px; background: #FFA500;" align="center" |'''IIa'''
| style="padding: 5px 5px; background: #0000CD;" align="center" |{{fontcolor|#FFF|B}}
| style="padding: 5px 5px; background: #0000CD;" align="center" |{{fontcolor|#FFF|B}}
| align="center" |<ref name="EggebrechtMehta2008">{{cite journal|last1=Eggebrecht|first1=Holger|last2=Mehta|first2=Rajendra H.|last3=Metozounve|first3=Huguette|last4=Huptas|first4=Sebastian|last5=Herold|first5=Ulf|last6=Jakob|first6=Heinz G.|last7=Erbel|first7=Raimund|title=Clinical Implications of Systemic Inflammatory Response Syndrome Following Thoracic Aortic Stent-Graft Placement|journal=Journal of Endovascular Therapy|volume=15|issue=2|year=2008|pages=135–143|issn=1526-6028|doi=10.1583/07-2284.1}}</ref><ref name="SutherlandEscano2008">{{cite journal|last1=Sutherland|first1=Alexander|last2=Escano|first2=Jude|last3=Coon|first3=Troy P.|title=D-dimer as the Sole Screening Test for Acute Aortic Dissection: A Review of the Literature|journal=Annals of Emergency Medicine|volume=52|issue=4|year=2008|pages=339–343|issn=01960644|doi=10.1016/j.annemergmed.2007.12.026}}</ref>
| align="center" |<ref name="EggebrechtMehta2008">{{cite journal|last1=Eggebrecht|first1=Holger|last2=Mehta|first2=Rajendra H.|last3=Metozounve|first3=Huguette|last4=Huptas|first4=Sebastian|last5=Herold|first5=Ulf|last6=Jakob|first6=Heinz G.|last7=Erbel|first7=Raimund|title=Clinical Implications of Systemic Inflammatory Response Syndrome Following Thoracic Aortic Stent-Graft Placement|journal=Journal of Endovascular Therapy|volume=15|issue=2|year=2008|pages=135–143|issn=1526-6028|doi=10.1583/07-2284.1}}</ref><ref name="SutherlandEscano2008">{{cite journal|last1=Sutherland|first1=Alexander|last2=Escano|first2=Jude|last3=Coon|first3=Troy P.|title=D-dimer as the Sole Screening Test for Acute Aortic Dissection: A Review of the Literature|journal=Annals of Emergency Medicine|volume=52|issue=4|year=2008|pages=339–343|issn=01960644|doi=10.1016/j.annemergmed.2007.12.026}}</ref>
|-
|-
! style="padding: 5px 5px;"  align="left" |In patients with high probability (risk score 2 or 3) of AD, testing of D-dimers is not recommended.
! style="padding: 5px 5px;"  align="left" |<nowiki>"</nowiki>In patients with high probability (risk score 2 or 3) of AD, testing of D-dimers is not recommended.<nowiki>"</nowiki>
| style="padding: 5px 5px; background: #F08080;" align="center" |'''III'''
| style="padding: 5px 5px; background: #F08080;" align="center" |'''III'''
| style="padding: 5px 5px; background: #6495ED;" align="center" |{{fontcolor|#FFF|C}}
| style="padding: 5px 5px; background: #6495ED;" align="center" |{{fontcolor|#FFF|C}}
Line 64: Line 64:
! colspan="4" align="left" |Imaging
! colspan="4" align="left" |Imaging
|-
|-
! style="padding: 5px 5px; background: #FFFFE0; "  align="left" |TTE is recommended as an initial imaging investigation.
! style="padding: 5px 5px; background: #FFFFE0; "  align="left" |<nowiki>"</nowiki>TTE is recommended as an initial imaging investigation.<nowiki>"</nowiki>
| style="padding: 5px 5px; background: #90EE90;" align="center" |'''I'''
| style="padding: 5px 5px; background: #90EE90;" align="center" |'''I'''
| style="padding: 5px 5px; background: #6495ED;" align="center" |{{fontcolor|#FFF|C}}
| style="padding: 5px 5px; background: #6495ED;" align="center" |{{fontcolor|#FFF|C}}
!
!
|-
|-
! style="padding: 5px 5px; "  align="left" |In unstabled patients with a suspicion of AAS, the following imaging modalities are recommended according to local availability and expertise:
! style="padding: 5px 5px; "  align="left" |<nowiki>"</nowiki>In unstabled patients with a suspicion of AAS, the following imaging modalities are recommended according to local availability and expertise:
!
!
!
!
!
!
|-
|-
! style="padding: 5px 5px; background: #FFFFE0; "  align="center" |TOE
! style="padding: 5px 5px; background: #FFFFE0; "  align="center" |TOE<nowiki>"</nowiki>
| style="padding: 5px 5px; background: #90EE90;" align="center" |'''I'''
| style="padding: 5px 5px; background: #90EE90;" align="center" |'''I'''
| style="padding: 5px 5px; background: #6495ED;" align="center" |{{fontcolor|#FFF|C}}
| style="padding: 5px 5px; background: #6495ED;" align="center" |{{fontcolor|#FFF|C}}
Line 84: Line 84:
!
!
|-
|-
! style="padding: 5px 5px; background: #FFFFE0; "  align="left" |In stable patients with a suspicion of AAS, the following imaging modalities are recommended (or should be considered) according to local availability and expertise:
! style="padding: 5px 5px; background: #FFFFE0; "  align="left" |<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:
!
!
!
!
Line 99: Line 99:
!
!
|-
|-
!TOE
!TOE<nowiki>"</nowiki>
| style="padding: 5px 5px; background: #FFA500;" align="center" |'''IIa'''
| style="padding: 5px 5px; background: #FFA500;" align="center" |'''IIa'''
| style="padding: 5px 5px; background: #6495ED;" align="center" |{{fontcolor|#FFF|C}}
| style="padding: 5px 5px; background: #6495ED;" align="center" |{{fontcolor|#FFF|C}}
!
!
|-
|-
! style="padding: 5px 5px; background: #FFFFE0; "  align="left" |In case of initially negative imaging with the persistence of suspicion of AAS, repetitive imaging (CT or MRI) is recommended.
! style="padding: 5px 5px; background: #FFFFE0; "  align="left" |<nowiki>"</nowiki>In case of initially negative imaging with the persistence of suspicion of AAS, repetitive imaging (CT or MRI) is recommended.<nowiki>"</nowiki>
| style="padding: 5px 5px; background: #90EE90;" align="center" |'''I'''
| style="padding: 5px 5px; background: #90EE90;" align="center" |'''I'''
| style="padding: 5px 5px; background: #6495ED;" align="center" |{{fontcolor|#FFF|C}}
| style="padding: 5px 5px; background: #6495ED;" align="center" |{{fontcolor|#FFF|C}}
!
!
|-
|-
! style="padding: 5px 5px;"  align="left" |Chest X-ray maybe considered in cases of low clinical probability of AAS.
! style="padding: 5px 5px;"  align="left" |<nowiki>"</nowiki>Chest X-ray maybe considered in cases of low clinical probability of AAS.<nowiki>"</nowiki>
| style="padding: 5px 5px; background: #FFA500;" align="center" |'''IIb'''
| style="padding: 5px 5px; background: #FFA500;" align="center" |'''IIb'''
| style="padding: 5px 5px; background: #6495ED;" align="center" |{{fontcolor|#FFF|C}}
| style="padding: 5px 5px; background: #6495ED;" align="center" |{{fontcolor|#FFF|C}}
!
!
|-
|-
! style="padding: 5px 5px;  background: #FFFFE0;"  align="left" |In case of uncomplicated Type B AD treated medically, repeated imaging (CT or MRI)e during the first days is recommended.
! style="padding: 5px 5px;  background: #FFFFE0;"  align="left" |<nowiki>"</nowiki>In case of uncomplicated Type B AD treated medically, repeated imaging (CT or MRI)e during the first days is recommended.<nowiki>"</nowiki>
| style="padding: 5px 5px; background: #90EE90;" align="center" |'''I'''
| style="padding: 5px 5px; background: #90EE90;" align="center" |'''I'''
| style="padding: 5px 5px; background: #6495ED;" align="center" |{{fontcolor|#FFF|C}}
| style="padding: 5px 5px; background: #6495ED;" align="center" |{{fontcolor|#FFF|C}}

Revision as of 03:40, 29 December 2019

Schematic view of acute aortic syndrome by Sahar

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]

Recomendacations Class Level References
History and clinical assessment
"In all patients with suspected AAS, pre-test probability assessment is recommended, according to the patient’s condition, symptoms, and clinical features." I B [6]
Laboratory testing
"In case of suspicion of AAS, the interpretation of biomarkers should always be considered along with the pretest clinical probability." IIa B
"In case of low clinical probability of AAS, negative D-dimer levels should be considered as ruling out the diagnosis." IIa C [7][8][9][10]
"In case of intermediate clinical probability of AAS with a positive (point-of-care) D-dimer test, further imaging tests should be considered." IIa B [7][8]
"In patients with high probability (risk score 2 or 3) of AD, testing of D-dimers is not recommended." III C
Imaging
"TTE is recommended as an initial imaging investigation." I C
"In unstabled patients with a suspicion of AAS, the following imaging modalities are recommended according to local availability and expertise:
TOE" I C
CT I C
"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 I C
MRI I C
TOE" IIa C
"In case of initially negative imaging with the persistence of suspicion of AAS, repetitive imaging (CT or MRI) is recommended." I C
"Chest X-ray maybe considered in cases of low clinical probability of AAS." IIb C
"In case of uncomplicated Type B AD treated medically, repeated imaging (CT or MRI)e during the first days is recommended." I C

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.
  6. Evangelista, Arturo; Isselbacher, Eric M.; Bossone, Eduardo; Gleason, Thomas G.; Eusanio, Marco Di; Sechtem, Udo; Ehrlich, Marek P.; Trimarchi, Santi; Braverman, Alan C.; Myrmel, Truls; Harris, Kevin M.; Hutchinson, Stuart; O’Gara, Patrick; Suzuki, Toru; Nienaber, Christoph A.; Eagle, Kim A. (2018). "Insights From the International Registry of Acute Aortic Dissection". Circulation. 137 (17): 1846–1860. doi:10.1161/CIRCULATIONAHA.117.031264. ISSN 0009-7322.
  7. 7.0 7.1 Eggebrecht, Holger; Mehta, Rajendra H.; Metozounve, Huguette; Huptas, Sebastian; Herold, Ulf; Jakob, Heinz G.; Erbel, Raimund (2008). "Clinical Implications of Systemic Inflammatory Response Syndrome Following Thoracic Aortic Stent-Graft Placement". Journal of Endovascular Therapy. 15 (2): 135–143. doi:10.1583/07-2284.1. ISSN 1526-6028.
  8. 8.0 8.1 Sutherland, Alexander; Escano, Jude; Coon, Troy P. (2008). "D-dimer as the Sole Screening Test for Acute Aortic Dissection: A Review of the Literature". Annals of Emergency Medicine. 52 (4): 339–343. doi:10.1016/j.annemergmed.2007.12.026. ISSN 0196-0644.
  9. Suzuki, Toru; Bossone, Eduardo; Sawaki, Daigo; Jánosi, Rolf Alexander; Erbel, Raimund; Eagle, Kim; Nagai, Ryozo (2013). "Biomarkers of aortic diseases". American Heart Journal. 165 (1): 15–25. doi:10.1016/j.ahj.2012.10.006. ISSN 0002-8703.
  10. Taylor, R. Andrew; Iyer, Neel S. (2013). "A decision analysis to determine a testing threshold for computed tomographic angiography and d-dimer in the evaluation of aortic dissection". The American Journal of Emergency Medicine. 31 (7): 1047–1055. doi:10.1016/j.ajem.2013.03.039. ISSN 0735-6757.


Template:Vascular diseases