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__NOTOC__
{{Template:Aortic dissection}}
{{Template:Aortic dissection}}
{{CMG}}; {{AE}} {{VR}} {{Sahar}}


{{CMG}}
==Overview==
 
[[Atherosclerosis]] and [[hypertension]] are associated with spontaneous aortic dissection, while [[blunt trauma]] and [[whiplash (medicine)|sudden deceleration]] in a [[motor vehicle accident]] are major causes of traumatic [[aortic]] dissection.
'''Associate Editor-In-Chief:''' {{CZ}}
==Causes==
 
===Common Causes===
==Causes of aortic dissection==
The most common causes of aortic dissection include:<ref name="pmid25805614">{{cite journal |vauthors=Penn JL, Martindale JL, Milne LW, Marill KA |title=Aortic dissection associated with blunt chest trauma diagnosed by elevated D-dimer |journal=Int J Surg Case Rep |volume=10 |issue= |pages=76–9 |date=2015 |pmid=25805614 |pmc=4429846 |doi=10.1016/j.ijscr.2015.03.027 |url=}}</ref><ref name="pmid15121626">{{cite journal| author=Weissmann-Brenner A, Schoen R, Divon MY| title=Aortic dissection in pregnancy. | journal=Obstet Gynecol | year= 2004 | volume= 103 | issue= 5 Pt 2 | pages= 1110-3 | pmid=15121626 | doi=10.1097/01.AOG.0000124984.82336.43 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15121626  }} </ref><ref name="pmid22829842">{{cite journal| author=Brooke V, Goswami S, Mohanty A, Kasi PM| title=Aortic dissection and renal failure in a patient with severe hypothyroidism. | journal=Case Rep Med | year= 2012 | volume= 2012 | issue=  | pages= 842562 | pmid=22829842 | doi=10.1155/2012/842562 | pmc=PMC3399550 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22829842  }} </ref><ref name="pmid2062514">{{cite journal| author=| title=Classification of diabetic retinopathy from fluorescein angiograms. ETDRS report number 11. Early Treatment Diabetic Retinopathy Study Research Group. | journal=Ophthalmology | year= 1991 | volume= 98 | issue= 5 Suppl | pages= 807-22 | pmid=2062514 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2062514  }} </ref><ref name="pmid23401778">{{cite journal |vauthors=Cury M, Zeidan F, Lobato AC |title=Aortic disease in the young: genetic aneurysm syndromes, connective tissue disorders, and familial aortic aneurysms and dissections |journal=Int J Vasc Med |volume=2013 |issue= |pages=267215 |date=2013 |pmid=23401778 |pmc=3557640 |doi=10.1155/2013/267215 |url=}}</ref>
The exact cause is unknown, but risks include atherosclerosis (hardening of the arteries) and high blood pressure. Traumatic injury is a major cause of aortic dissection, especially blunt trauma to the chest. Hitting the steering wheel of a car during an accident is a common traumatic cause.
*[[Atherosclerosis]]
 
*[[Chest trauma]]
Other risk factors and conditions associated with the development of aortic dissection include:
*[[Chronic hypertension]]
 
*[[Iatrogenic|Complication of cardiac procedures]]
:*[[Aging]]
*[[Connective tissue disorders]]
:*[[Bicuspid aortic valve]]
*[[Vasculitis]]
:*[[Chest trauma]]
===Causes by Organ System===
:*[[Coarctation of the aorta]]
*Causes of aortic dissection include:<ref name="LarsonEdwards1984">{{cite journal|last1=Larson|first1=Eric W.|last2=Edwards|first2=William D.|title=Risk factors for aortic dissection: A necropsy study of 161 cases|journal=The American Journal of Cardiology|volume=53|issue=6|year=1984|pages=849–855|issn=00029149|doi=10.1016/0002-9149(84)90418-1}}</ref><ref name="JanuzziIsselbacher2004">{{cite journal|last1=Januzzi|first1=James L|last2=Isselbacher|first2=Eric M|last3=Fattori|first3=Rossella|last4=Cooper|first4=Jeanna V|last5=Smith|first5=Dean E|last6=Fang|first6=Jianming|last7=Eagle|first7=Kim A|last8=Mehta|first8=Rajendra H|last9=Nienaber|first9=Christoph A|last10=Pape|first10=Linda A|title=Characterizing the young patient with aortic dissection: results from the international registry of aortic dissection (IRAD)|journal=Journal of the American College of Cardiology|volume=43|issue=4|year=2004|pages=665–669|issn=07351097|doi=10.1016/j.jacc.2003.08.054}}</ref><ref>{{cite journal|title=Correspondence|journal=The Annals of Thoracic Surgery|volume=67|issue=2|year=1999|pages=593|issn=00034975|doi=10.1016/S0003-4975(99)00037-5}}</ref><ref name="LosennoGoodman2012">{{cite journal|last1=Losenno|first1=Katie L.|last2=Goodman|first2=Robert L.|last3=Chu|first3=Michael W. A.|title=Bicuspid Aortic Valve Disease and Ascending Aortic Aneurysms: Gaps in Knowledge|journal=Cardiology Research and Practice|volume=2012|year=2012|pages=1–16|issn=2090-8016|doi=10.1155/2012/145202}}</ref><ref name="pmid25743550">{{cite journal |vauthors=Senaha S, Uezu T, Shimoji M, Akasaki M |title=[Stanford type B aortic dissection associated with coarctation of the aorta] |language=Japanese |journal=Kyobu Geka |volume=68 |issue=3 |pages=184–7 |date=March 2015 |pmid=25743550 |doi= |url=}}</ref><ref name="pmid7826227">{{cite journal |vauthors=Dioguardi GS, Pimenta J, Knoplich J, Ghorayeb N, Ramos LR, Giannini SD |title=[Risk factors for cardiovascular diseases in physicians. Preliminary data from the VIDAM Project of the Paulista Medical Association] |language=Portuguese |journal=Arq. Bras. Cardiol. |volume=62 |issue=6 |pages=383–8 |date=June 1994 |pmid=7826227 |doi= |url=}}</ref><ref name="CaglayanDundar2009">{{cite journal|last1=Caglayan|first1=Ahmet Okay|last2=Dundar|first2=Munis|title=Inherited diseases and syndromes leading to aortic aneurysms and dissections|journal=European Journal of Cardio-Thoracic Surgery|volume=35|issue=6|year=2009|pages=931–940|issn=10107940|doi=10.1016/j.ejcts.2009.01.006}}</ref><ref>{{cite journal|title=Acute aortic dissection: pathogenesis, risk factors and diagnosis|journal=Swiss Medical Weekly|volume=147|issue=3334|year=2017|issn=1424-7860|doi=10.4414/smw.2017.14489}}</ref><ref>[http://www.ncbi.nlm.nih.gov/sites/entrez?Db=PubMed&Cmd=ShowDetailView&TermToSearch=17055808&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum Increased maternal cardiovascular mortality associated with pregnancy in women with Turner syndrome.]</ref>
:*[[Connective tissue disorders]]
{|style="width:80%; height:100px" border="1"
:*[[Ehlers-Danlos syndrome]]
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
:*[[Heart surgery]] or procedures
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Atherosclerosis]], [[bicuspid aortic valve]], [[hypertension]], [[malignant hypertension]], [[aberrant subclavian artery|ruptured aortic arch with aberrant left subclavian artery]], [[seat belt aorta]], [[vasculitis]]
:*[[Marfan syndrome]]
|-
:*[[Third trimester of pregnancy]]
|-bgcolor="LightSteelBlue"
:*[[Pseudoxanthoma elasticum]]
| '''Chemical/Poisoning'''
:*[[Tertiary syphilis]]
|bgcolor="Beige"| No underlying causes
:*[[Turner's syndrome]]
|-
:*Vascular inflammation due to conditions such as [[arteritis]] and syphilis
|-bgcolor="LightSteelBlue"
 
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Methonium]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[Cushing's syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Loeys-Dietz syndrome|Aneurysms osteoarthritis syndrome]], [[annuloaortic ectasia]], [[bicuspid aortic valve]], [[Ehlers-Danlos syndrome]], [[Erdheim's cystic medial necrosis]], [[familial aortic dissection]], [[fibromuscular dysplasia]], [[Loeys-Dietz syndrome]], [[Marfan syndrome]], [[Loeys-Dietz syndrome|mutation of TGF-β receptor genes]], [[Familial aortic dissection|mutations in genes encoding α-actin and β-myosin]], [[Loeys-Dietz syndrome|mutations in SMAD3]], [[Ehlers-Danlos syndrome|mutations in the gene encoding filamin A]], [[Noonan syndrome]], [[osteogenesis imperfecta]], [[pseudoxanthoma elasticum]], [[Turner syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| [[Aortic valve replacement|Aortic valve replacement surgery]], [[cardiac catheterization]], [[coronary artery bypass graft surgery]], [[Stent#Stent Graft|implantation of stent graft]], [[Intra-aortic balloon pump#Monitoring for Complications|intra-aortic balloon pump]], [[mitral valve replacement#Postoperative Complications/Risks|mitral valve replacement surgery]], [[aortic coarctation surgery#Surgical Complications|surgical correction of aortic coarctation]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[HIV AIDS natural history, complications, and prognosis|AIDS]], [[annuloaortic ectasia]], [[aortitis]], [[syphilitic aortitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| [[Ehlers-Danlos syndrome]], [[osteogenesis imperfecta]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| [[Homocystinuria]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| [[Cocaine abuse]]
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| [[Polycystic kidney disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| [[Aortitis]], [[arteritis]], [[Behçet's disease]], [[giant cell arteritis]], [[rheumatoid arthritis]], [[scleroderma]], [[systemic lupus erythematosus]], [[Takayasu arteritis]], [[vasculitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| [[Chest trauma]], [[Whiplash (medicine)|deceleration injuries]], [[motor vehicle accident]], [[seat belt aorta]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| [[Connective tissue disorders]], [[exercise|heavy exercise]], [[idiopathic]]
|-
|}
*For more information on potential [[risk factors]] for the development of aortic dissection [[Aortic dissection risk factors|click here]].
== References ==
== References ==
{{Reflist|2}}
{{Reflist|2}}


== Acknowledgements ==
The content on this page was first contributed by: David Feller-Kopman, MD and [[C. Michael Gibson]] M.S., M.D.
{{WH}}
{{WH}}
{{WS}}
{{WS}}
 
[[CME Category::Cardiology]]
[[Category:Disease]]
[[Category:Crowdiagnosis]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date cardiology]]

Latest revision as of 20:58, 12 December 2019

Aortic dissection Microchapters

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Management during Pregnancy

Case Studies

Case #1


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vendhan Ramanujam M.B.B.S [2] Sahar Memar Montazerin, M.D.[3]

Overview

Atherosclerosis and hypertension are associated with spontaneous aortic dissection, while blunt trauma and sudden deceleration in a motor vehicle accident are major causes of traumatic aortic dissection.

Causes

Common Causes

The most common causes of aortic dissection include:[1][2][3][4][5]

Causes by Organ System

Cardiovascular Atherosclerosis, bicuspid aortic valve, hypertension, malignant hypertension, ruptured aortic arch with aberrant left subclavian artery, seat belt aorta, vasculitis
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Methonium
Ear Nose Throat No underlying causes
Endocrine Cushing's syndrome
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic Aneurysms osteoarthritis syndrome, annuloaortic ectasia, bicuspid aortic valve, Ehlers-Danlos syndrome, Erdheim's cystic medial necrosis, familial aortic dissection, fibromuscular dysplasia, Loeys-Dietz syndrome, Marfan syndrome, mutation of TGF-β receptor genes, mutations in genes encoding α-actin and β-myosin, mutations in SMAD3, mutations in the gene encoding filamin A, Noonan syndrome, osteogenesis imperfecta, pseudoxanthoma elasticum, Turner syndrome
Hematologic No underlying causes
Iatrogenic Aortic valve replacement surgery, cardiac catheterization, coronary artery bypass graft surgery, implantation of stent graft, intra-aortic balloon pump, mitral valve replacement surgery, surgical correction of aortic coarctation
Infectious Disease AIDS, annuloaortic ectasia, aortitis, syphilitic aortitis
Musculoskeletal/Orthopedic Ehlers-Danlos syndrome, osteogenesis imperfecta
Neurologic No underlying causes
Nutritional/Metabolic Homocystinuria
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Ophthalmologic No underlying causes
Overdose/Toxicity Cocaine abuse
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte Polycystic kidney disease
Rheumatology/Immunology/Allergy Aortitis, arteritis, Behçet's disease, giant cell arteritis, rheumatoid arthritis, scleroderma, systemic lupus erythematosus, Takayasu arteritis, vasculitis
Sexual No underlying causes
Trauma Chest trauma, deceleration injuries, motor vehicle accident, seat belt aorta
Urologic No underlying causes
Miscellaneous Connective tissue disorders, heavy exercise, idiopathic

References

  1. ↑ Penn JL, Martindale JL, Milne LW, Marill KA (2015). "Aortic dissection associated with blunt chest trauma diagnosed by elevated D-dimer". Int J Surg Case Rep. 10: 76–9. doi:10.1016/j.ijscr.2015.03.027. PMC 4429846. PMID 25805614.
  2. ↑ Weissmann-Brenner A, Schoen R, Divon MY (2004). "Aortic dissection in pregnancy". Obstet Gynecol. 103 (5 Pt 2): 1110–3. doi:10.1097/01.AOG.0000124984.82336.43. PMID 15121626.
  3. ↑ Brooke V, Goswami S, Mohanty A, Kasi PM (2012). "Aortic dissection and renal failure in a patient with severe hypothyroidism". Case Rep Med. 2012: 842562. doi:10.1155/2012/842562. PMC 3399550. PMID 22829842.
  4. ↑ "Classification of diabetic retinopathy from fluorescein angiograms. ETDRS report number 11. Early Treatment Diabetic Retinopathy Study Research Group". Ophthalmology. 98 (5 Suppl): 807–22. 1991. PMID 2062514.
  5. ↑ Cury M, Zeidan F, Lobato AC (2013). "Aortic disease in the young: genetic aneurysm syndromes, connective tissue disorders, and familial aortic aneurysms and dissections". Int J Vasc Med. 2013: 267215. doi:10.1155/2013/267215. PMC 3557640. PMID 23401778.
  6. ↑ Larson, Eric W.; Edwards, William D. (1984). "Risk factors for aortic dissection: A necropsy study of 161 cases". The American Journal of Cardiology. 53 (6): 849–855. doi:10.1016/0002-9149(84)90418-1. ISSN 0002-9149.
  7. ↑ Januzzi, James L; Isselbacher, Eric M; Fattori, Rossella; Cooper, Jeanna V; Smith, Dean E; Fang, Jianming; Eagle, Kim A; Mehta, Rajendra H; Nienaber, Christoph A; Pape, Linda A (2004). "Characterizing the young patient with aortic dissection: results from the international registry of aortic dissection (IRAD)". Journal of the American College of Cardiology. 43 (4): 665–669. doi:10.1016/j.jacc.2003.08.054. ISSN 0735-1097.
  8. ↑ "Correspondence". The Annals of Thoracic Surgery. 67 (2): 593. 1999. doi:10.1016/S0003-4975(99)00037-5. ISSN 0003-4975.
  9. ↑ Losenno, Katie L.; Goodman, Robert L.; Chu, Michael W. A. (2012). "Bicuspid Aortic Valve Disease and Ascending Aortic Aneurysms: Gaps in Knowledge". Cardiology Research and Practice. 2012: 1–16. doi:10.1155/2012/145202. ISSN 2090-8016.
  10. ↑ Senaha S, Uezu T, Shimoji M, Akasaki M (March 2015). "[Stanford type B aortic dissection associated with coarctation of the aorta]". Kyobu Geka (in Japanese). 68 (3): 184–7. PMID 25743550.
  11. ↑ Dioguardi GS, Pimenta J, Knoplich J, Ghorayeb N, Ramos LR, Giannini SD (June 1994). "[Risk factors for cardiovascular diseases in physicians. Preliminary data from the VIDAM Project of the Paulista Medical Association]". Arq. Bras. Cardiol. (in Portuguese). 62 (6): 383–8. PMID 7826227.
  12. ↑ Caglayan, Ahmet Okay; Dundar, Munis (2009). "Inherited diseases and syndromes leading to aortic aneurysms and dissections". European Journal of Cardio-Thoracic Surgery. 35 (6): 931–940. doi:10.1016/j.ejcts.2009.01.006. ISSN 1010-7940.
  13. ↑ "Acute aortic dissection: pathogenesis, risk factors and diagnosis". Swiss Medical Weekly. 147 (3334). 2017. doi:10.4414/smw.2017.14489. ISSN 1424-7860.
  14. ↑ Increased maternal cardiovascular mortality associated with pregnancy in women with Turner syndrome.

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