Aortic dissection electrocardiogram: Difference between revisions

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__NOTOC__
__NOTOC__
{{Template:Aortic dissection}}
{{Template:Aortic dissection}}
{{CMG}}; {{AE}} {{CZ}}; {{RT}}
{{CMG}}; {{AE}} {{Sahar}} {{CZ}} {{RT}}


==Overview==
==Overview==
[[ST elevation myocardial infarction]] ([[MI]]) due to occlusion by the dissection of the coronary artery at its ostium may be present. The [[right coronary artery]] tends to be involved more frequently than the [[left coronary artery]]. [[Electrical alternans]] may be present in the setting of a [[pericardial effusion]] should the dissection have extended into the pericardium.
[[EKG]] findings in [[aortic]] dissection are usually non-specific. Possible findings include non-specific ST-segment changes, atrioventricular block (second degree), [[left ventricular hypertrophy]], and [[sinus bradycardia]]. It worth mentioning that ECG may lead to a delay in the diagnosis. Since clinicians usually follow the diagnosis of coronary artery disease due to its more common prevalence.
 
==Electrocardiogram==
==Electrocardiogram==
EKG findings in aortic dissection are usually non-specific.  Possible findings include:
[[EKG]] findings in [[aortic]] dissection are usually non-specific.  Possible findings include:<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><ref name="HirataWake2010">{{cite journal|last1=Hirata|first1=Kazuhito|last2=Wake|first2=Minoru|last3=Kyushima|first3=Masahiro|last4=Takahashi|first4=Takanori|last5=Nakazato|first5=Jun|last6=Mototake|first6=Hidemitsu|last7=Tengan|first7=Toshiho|last8=Yasumoto|first8=Hiroshi|last9=Henzan|first9=Eisei|last10=Maeshiro|first10=Masao|last11=Asato|first11=Hiroaki|title=Electrocardiographic changes in patients with type A acute aortic dissection|journal=Journal of Cardiology|volume=56|issue=2|year=2010|pages=147–153|issn=09145087|doi=10.1016/j.jjcc.2010.03.007}}</ref>
* [[Sinus tachycardia]]
* Non-specific ST-segment changes
* Acute [[ST segment elevation]] may be seen in 1% - 2% of the patients, signifying the occurrence of [[STEMI]] due to involvement of coronary arteries by the dissection.
* Atrioventricular block (second degree)
* In the setting of dissection involving the [[pericardium]] causing [[pericardial effusion]], an [[electrical alterans]] may be present.
* [[Left ventricular hypertrophy]]
 
* [[Sinus bradycardia]]
It worth mentioning that ECG may lead to a delay in the diagnosis. Since clinicians usually follow the diagnosis of coronary artery disease  due to its more common prevalence.
==2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease (DO NOT EDIT)<ref name="pmid20233780">{{cite journal |author=Hiratzka LF, Bakris GL, Beckman JA, ''et al.'' |title=2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine |journal=[[Circulation]] |volume=121 |issue=13 |pages=e266–369 |year=2010 |month=April |pmid=20233780 |doi=10.1161/CIR.0b013e3181d4739e |url=}}</ref>==
==2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease (DO NOT EDIT)<ref name="pmid20233780">{{cite journal |author=Hiratzka LF, Bakris GL, Beckman JA, ''et al.'' |title=2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine |journal=[[Circulation]] |volume=121 |issue=13 |pages=e266–369 |year=2010 |month=April |pmid=20233780 |doi=10.1161/CIR.0b013e3181d4739e |url=}}</ref>==
===Screening Tests (DO NOT EDIT)<ref name="pmid20233780">{{cite journal |author=Hiratzka LF, Bakris GL, Beckman JA, ''et al.'' |title=2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine |journal=[[Circulation]] |volume=121 |issue=13 |pages=e266–369 |year=2010 |month=April |pmid=20233780 |doi=10.1161/CIR.0b013e3181d4739e |url=}}</ref>===
===Screening Tests (DO NOT EDIT)<ref name="pmid20233780">{{cite journal |author=Hiratzka LF, Bakris GL, Beckman JA, ''et al.'' |title=2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine |journal=[[Circulation]] |volume=121 |issue=13 |pages=e266–369 |year=2010 |month=April |pmid=20233780 |doi=10.1161/CIR.0b013e3181d4739e |url=}}</ref>===
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
|bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' An [[electrocardiogram]] should be obtained on all patients who present with symptoms that may represent acute thoracic [[aortic dissection]].<nowiki>"</nowiki>
|bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' An [[electrocardiogram]] should be obtained on all patients who present with [[symptom]]s that may represent [[acute]] [[thoracic aorta|thoracic]] [[aortic dissection]].<nowiki>"</nowiki>
|-
|-
|bgcolor="LightGreen" |<nowiki>"</nowiki>'''a.''' Given the relative infrequency of dissection-related coronary artery occlusion, the presence of [[ST-segment elevation]] suggestive of [[myocardial infarction]] should be treated as a primary cardiac event without delay for definitive aortic imaging unless the patient is at high risk for [[aortic dissection]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>   
|bgcolor="LightGreen" |<nowiki>"</nowiki>'''a.''' Given the relative infrequency of dissection-related [[coronary artery]] occlusion, the presence of [[ST-segment elevation]] suggestive of [[myocardial infarction]] should be treated as a primary [[cardiac]] event without delay for definitive [[aortic]] imaging unless the patient is at high risk for [[aortic dissection]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>   
|}
|}


== References ==
== References ==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}
[[CME Category::Cardiology]]


[[Category:Cardiology]]
[[Category:Cardiology]]
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[[Category:Up-To-Date]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date cardiology]]
[[Category:Up-To-Date cardiology]]
{{WH}}
{{WS}}

Latest revision as of 16:44, 14 December 2019

Aortic dissection Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Cafer Zorkun, M.D., Ph.D. [3] Raviteja Guddeti, M.B.B.S. [4]

Overview

EKG findings in aortic dissection are usually non-specific. Possible findings include non-specific ST-segment changes, atrioventricular block (second degree), left ventricular hypertrophy, and sinus bradycardia. It worth mentioning that ECG may lead to a delay in the diagnosis. Since clinicians usually follow the diagnosis of coronary artery disease due to its more common prevalence.

Electrocardiogram

EKG findings in aortic dissection are usually non-specific. Possible findings include:[1][2]

It worth mentioning that ECG may lead to a delay in the diagnosis. Since clinicians usually follow the diagnosis of coronary artery disease due to its more common prevalence.

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease (DO NOT EDIT)[3]

Screening Tests (DO NOT EDIT)[3]

Class I
"1. An electrocardiogram should be obtained on all patients who present with symptoms that may represent acute thoracic aortic dissection."
"a. Given the relative infrequency of dissection-related coronary artery occlusion, the presence of ST-segment elevation suggestive of myocardial infarction should be treated as a primary cardiac event without delay for definitive aortic imaging unless the patient is at high risk for aortic dissection. (Level of Evidence: B)"

References

  1. ↑ 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.
  2. ↑ Hirata, Kazuhito; Wake, Minoru; Kyushima, Masahiro; Takahashi, Takanori; Nakazato, Jun; Mototake, Hidemitsu; Tengan, Toshiho; Yasumoto, Hiroshi; Henzan, Eisei; Maeshiro, Masao; Asato, Hiroaki (2010). "Electrocardiographic changes in patients with type A acute aortic dissection". Journal of Cardiology. 56 (2): 147–153. doi:10.1016/j.jjcc.2010.03.007. ISSN 0914-5087.
  3. ↑ 3.0 3.1 Hiratzka LF, Bakris GL, Beckman JA; et al. (2010). "2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine". Circulation. 121 (13): e266–369. doi:10.1161/CIR.0b013e3181d4739e. PMID 20233780. Unknown parameter |month= ignored (help)

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