Aortic dissection - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Aortic dissection typically presents in men older than 50 years of age, with sudden onset of severe ripping or tearing substernal or interscapular pain. Patients typically describe the pain as severe "sharp" or "stabbing", maximal at onset.
May present with syncope, heart/renal failure, or mesenteric or limb ischemia; oxygen/advanced life support protocol and hemodynamic support should be instituted without delay when the condition is suspected.
Diagnostic modalities include computed tomography scan, magnetic resonance imaging, or transthoracic/transesophageal echocardiography.
Involvement of the ascending aorta and/or arch warrants urgent surgical repair. Dissections of the descending aorta are managed medically with beta blockade; surgery in this group is reserved for those with end-organ malperfusion, persistent pain, rapid aneurysmal degeneration, or rupture.
Lifelong surveillance is needed with regular imaging to detect delayed aneurysmal degeneration of the remaining aorta, which may later require surgery.

Quick Reference

History & Exam
- Key Factors
- Other Factors
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Proximal dissection
3D CT, distal dissection
CT of a 71-year-old man showing type II dissecting aneurysm of the ascending aorta. Hematoma around the proximal segment of the ascending aorta (panels A-D) compressed the right pulmonary artery, almost occluding its patency and limiting the perfusion of the reciprocal lung
Transesophageal echocardiography (transverse aortic section) showing a circumferential dissection of the ascending aorta in a 30-year-old patient with features of Marfan syndrome
CT scan showing dissecting aneurysm in a 45-year-old patient with Marfan syndrome experiencing chest pain
Dissection status post proximal repair with late distal aneurysm

Citations

Key Articles

Isselbacher EM, Preventza O, Hamilton Black J, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022 Dec 13;80(24):e223-e393.[Abstract]
Erbel R, Aboyans V, Boileau C, et al; ESC Committee for Practice Guidelines. 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. Eur Heart J. 2014 Nov 1;35(41):2873-926.[Abstract][Full Text]
Bossone E, LaBounty TM, Eagle KA. Acute aortic syndromes: diagnosis and management, an update. Eur Heart J. 2018 Mar 1;39(9):739-49d.[Abstract][Full Text]
Fleischmann D, Afifi RO, Casanegra AI, et al. Imaging and surveillance of chronic aortic dissection: a scientific statement from the American Heart Association. Circ Cardiovasc Imaging. 2022 Mar;15(3):e000075.[Abstract][Full Text]

Referenced Articles

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