Aortic dissection history and symptoms: Difference between revisions
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{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}, {{Sahar}} | {{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}, {{Sahar}} | ||
==Overview== | ==Overview== | ||
History of patients with aortic dissection may be positive for factors such as connective tissue disease, known [[aortic valve]] disease, recent [[heart surgery]], Known [[thoracic aortic aneurysm]], and family history of the [[aortic]] disease. Sudden onset chest/back pain is the most common symptom of aortic dissection. Pain may be of sharp, ripping, tearing, and knife-like quality. | History of [[patients]] with aortic dissection may be positive for factors such as [[connective tissue disease]], known [[aortic valve]] disease, recent [[heart surgery]], Known [[thoracic aortic aneurysm]], and family history of the [[aortic]] disease. Sudden onset [[Chest pain|chest]]/[[back pain]] is the most common [[symptom]] of aortic dissection. [[Pain]] may be of sharp, ripping, tearing, and knife-like quality. | ||
==History== | ==History== | ||
History of patients with aortic dissection may include the following factors:<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> | History of [[patients]] with aortic dissection may include the following factors:<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> | ||
* [[Connective tissue disease]] such as * [[Marfan's syndrome]] | * [[Connective tissue disease]] such as * [[Marfan's syndrome]] | ||
* Family history of the [[aortic]] disease | * Family history of the [[aortic]] disease | ||
| Line 13: | Line 13: | ||
* Known [[thoracic aortic aneurysm]] | * Known [[thoracic aortic aneurysm]] | ||
==Common Symptoms== | ==Common Symptoms== | ||
Common symptoms of aortic dissection include:<ref name="HaganNienaber2000">{{cite journal|last1=Hagan|first1=Peter G.|last2=Nienaber|first2=Christoph A.|last3=Isselbacher|first3=Eric M.|last4=Bruckman|first4=David|last5=Karavite|first5=Dean J.|last6=Russman|first6=Pamela L.|last7=Evangelista|first7=Arturo|last8=Fattori|first8=Rossella|last9=Suzuki|first9=Toru|last10=Oh|first10=Jae K.|last11=Moore|first11=Andrew G.|last12=Malouf|first12=Joseph F.|last13=Pape|first13=Linda A.|last14=Gaca|first14=Charlene|last15=Sechtem|first15=Udo|last16=Lenferink|first16=Suzanne|last17=Deutsch|first17=Hans Josef|last18=Diedrichs|first18=Holger|last19=Marcos y Robles|first19=Jose|last20=Llovet|first20=Alfredo|last21=Gilon|first21=Dan|last22=Das|first22=Sugata K.|last23=Armstrong|first23=William F.|last24=Deeb|first24=G. Michael|last25=Eagle|first25=Kim A.|title=The International Registry of Acute Aortic Dissection (IRAD)|journal=JAMA|volume=283|issue=7|year=2000|pages=897|issn=0098-7484|doi=10.1001/jama.283.7.897}}</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="pmid22456637">{{cite journal |vauthors=Trimarchi S, Tolenaar JL, Tsai TT, Froehlich J, Pegorer M, Upchurch GR, Fattori R, Sundt TM, Isselbacher EM, Nienaber CA, Rampoldi V, Eagle KA |title=Influence of clinical presentation on the outcome of acute B aortic dissection: evidences from IRAD |journal=J Cardiovasc Surg (Torino) |volume=53 |issue=2 |pages=161–8 |date=April 2012 |pmid=22456637 |doi= |url=}}</ref><ref name="pmid11980527">{{cite journal |vauthors=Klompas M |title=Does this patient have an acute thoracic aortic dissection? |journal=JAMA |volume=287 |issue=17 |pages=2262–72 |date=May 2002 |pmid=11980527 |doi=10.1001/jama.287.17.2262 |url=}}</ref> | Common [[symptoms]] of aortic dissection include:<ref name="HaganNienaber2000">{{cite journal|last1=Hagan|first1=Peter G.|last2=Nienaber|first2=Christoph A.|last3=Isselbacher|first3=Eric M.|last4=Bruckman|first4=David|last5=Karavite|first5=Dean J.|last6=Russman|first6=Pamela L.|last7=Evangelista|first7=Arturo|last8=Fattori|first8=Rossella|last9=Suzuki|first9=Toru|last10=Oh|first10=Jae K.|last11=Moore|first11=Andrew G.|last12=Malouf|first12=Joseph F.|last13=Pape|first13=Linda A.|last14=Gaca|first14=Charlene|last15=Sechtem|first15=Udo|last16=Lenferink|first16=Suzanne|last17=Deutsch|first17=Hans Josef|last18=Diedrichs|first18=Holger|last19=Marcos y Robles|first19=Jose|last20=Llovet|first20=Alfredo|last21=Gilon|first21=Dan|last22=Das|first22=Sugata K.|last23=Armstrong|first23=William F.|last24=Deeb|first24=G. Michael|last25=Eagle|first25=Kim A.|title=The International Registry of Acute Aortic Dissection (IRAD)|journal=JAMA|volume=283|issue=7|year=2000|pages=897|issn=0098-7484|doi=10.1001/jama.283.7.897}}</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="pmid22456637">{{cite journal |vauthors=Trimarchi S, Tolenaar JL, Tsai TT, Froehlich J, Pegorer M, Upchurch GR, Fattori R, Sundt TM, Isselbacher EM, Nienaber CA, Rampoldi V, Eagle KA |title=Influence of clinical presentation on the outcome of acute B aortic dissection: evidences from IRAD |journal=J Cardiovasc Surg (Torino) |volume=53 |issue=2 |pages=161–8 |date=April 2012 |pmid=22456637 |doi= |url=}}</ref><ref name="pmid11980527">{{cite journal |vauthors=Klompas M |title=Does this patient have an acute thoracic aortic dissection? |journal=JAMA |volume=287 |issue=17 |pages=2262–72 |date=May 2002 |pmid=11980527 |doi=10.1001/jama.287.17.2262 |url=}}</ref> | ||
*Chest pain (especially migrating pain) | *[[Chest pain]] (especially migrating pain) | ||
**Sudden onset of pain is the most common symptom. | **Sudden onset of pain is the most common [[symptom]]. | ||
**The quality of pain is different from other causes of chest pain. it may be sharp, ripping, tearing, and knife-like. | **The quality of [[pain]] is different from other causes of chest pain. it may be sharp, ripping, tearing, and knife-like. | ||
**The most common site of pain in order of frequency is chest (80%), back (40%), and abdomen (25%). | **The most common site of [[pain]] in order of frequency is chest (80%), back (40%), and abdomen (25%). | ||
**Type A aortic dissection more commonly presents with chest pain, whereas type B tends to manifest with back/abdominal pain. | **Type A aortic dissection more commonly presents with [[chest pain]], whereas type B tends to manifest with [[Back pain|back]]/[[abdominal pain]]. | ||
*Neck, throat, and jaw pain | *Neck, throat, and jaw pain | ||
*Back pain | *[[Back pain]] | ||
* | *[[Pleuritic pain]] (maybe suggestive of [[acute pericarditis]] due to [[hemorrhage]] into the [[pericardial sac]]. | ||
It | |||
It worth mentioning that the presence of [[pain]] is not necessary for the [[diagnosis]] of aortic dissection. [[Patients]] may present with [[syncope]], [[stroke]] or symptoms suggestive of [[congestive heart failure|congestive heart failure (CHF)]]. | |||
==Less Common Symptoms== | ==Less Common Symptoms== | ||
Less common symptoms | Less common [[symptoms]] of aortic dissection include:<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> | ||
* [[Abdominal pain]] following [[mesenteric ischemia]] | * [[Abdominal pain]] following [[mesenteric ischemia]] | ||
* [[Cardiac arrest]] (rarely) | * [[Cardiac arrest]] (rarely) | ||
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|bgcolor="LightBlue" | | |bgcolor="LightBlue" | | ||
* Connective tissue disorders including Marfan syndrome | *[[Connective tissue disorders]] including [[Marfan syndrome]] | ||
* Family history of aortic disease | * Family history of [[aortic]] disease | ||
* Personal history aortic valve disease | * Personal history [[aortic valve disease]] | ||
* Personal history of thoracic aortic aneurysm | * Personal history of [[thoracic aortic aneurysm]] | ||
* Previous aortic surgery (including cardiac surgery) | * Previous [[aortic]] surgery (including [[cardiac surgery]]) | ||
|} | |} | ||
{|class="wikitable" | {|class="wikitable" | ||
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|- | |- | ||
|bgcolor="LightBlue" | | |bgcolor="LightBlue" | | ||
* Chest, back, or abdominal pain with at least one of the following features: | *[[Chest pain|Chest]], [[Back pain|back]], or [[abdominal pain]] with at least one of the following features: | ||
** Abrupt onset | ** Abrupt onset | ||
** Severe intensity | ** Severe intensity | ||
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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.''' For patients presenting with a history of [[acute]] [[cardiac]] and non[[cardiac]] [[symptom]]s associated with a significant likelihood of [[thoracic aorta|thoracic aortic]] disease, the clinician should perform a focused physical examination, including a careful and complete search for [[artery|arterial]] [[perfusion]] differentials in both upper and lower extremities, evidence of [[visceral]] [[ischemia]], focal [[neurological]] deficits, a [[murmur]] of [[aortic regurgitation]], [[bruit]]s, and findings compatible with possible [[cardiac tamponade]].<ref>Townsend CM, Beauchamp RD, Evers BM, et al. Sabiston Textbook of Surgery. 18th ed. Philadelphia: Elsevier Health Sciences, 2008.</ref><ref>Libby P, Bonow RO, Mann DL, et al. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia: 2007.</ref><ref>Isselbacher E. Cecil Medicine. 23rd ed. Philadelphia: Elsevier Health Sciences, 2008.</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' For patients presenting with a history of [[acute]] [[cardiac]] and non[[cardiac]] [[symptom]]s associated with a significant likelihood of [[thoracic aorta|thoracic aortic]] disease, the clinician should perform a focused physical examination, including a careful and complete search for [[artery|arterial]] [[perfusion]] differentials in both upper and lower extremities, evidence of [[visceral]] [[ischemia]], focal [[neurological]] deficits, a [[murmur]] of [[aortic regurgitation]], [[bruit]]s, and findings compatible with possible [[cardiac tamponade]].<ref>Townsend CM, Beauchamp RD, Evers BM, et al. Sabiston Textbook of Surgery. 18th ed. Philadelphia: Elsevier Health Sciences, 2008.</ref><ref>Libby P, Bonow RO, Mann DL, et al. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia: 2007.</ref><ref>Isselbacher E. Cecil Medicine. 23rd ed. Philadelphia: Elsevier Health Sciences, 2008.</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | ||
|} | |} | ||
== References == | == References == | ||
Revision as of 23:41, 9 December 2019
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Aortic dissection Microchapters |
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Diagnosis |
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Treatment |
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Special Scenarios |
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Case Studies |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2], Sahar Memar Montazerin, M.D.[3]
Overview
History of patients with aortic dissection may be positive for factors such as connective tissue disease, known aortic valve disease, recent heart surgery, Known thoracic aortic aneurysm, and family history of the aortic disease. Sudden onset chest/back pain is the most common symptom of aortic dissection. Pain may be of sharp, ripping, tearing, and knife-like quality.
History
History of patients with aortic dissection may include the following factors:[1]
- Connective tissue disease such as * Marfan's syndrome
- Family history of the aortic disease
- Known aortic valve disease such as bicuspid aortic valve disease
- Recent heart surgery or aortic manipulation
- Known thoracic aortic aneurysm
Common Symptoms
Common symptoms of aortic dissection include:[2][3][4][5]
- Chest pain (especially migrating pain)
- Sudden onset of pain is the most common symptom.
- The quality of pain is different from other causes of chest pain. it may be sharp, ripping, tearing, and knife-like.
- The most common site of pain in order of frequency is chest (80%), back (40%), and abdomen (25%).
- Type A aortic dissection more commonly presents with chest pain, whereas type B tends to manifest with back/abdominal pain.
- Neck, throat, and jaw pain
- Back pain
- Pleuritic pain (maybe suggestive of acute pericarditis due to hemorrhage into the pericardial sac.
It worth mentioning that the presence of pain is not necessary for the diagnosis of aortic dissection. Patients may present with syncope, stroke or symptoms suggestive of congestive heart failure (CHF).
Less Common Symptoms
Less common symptoms of aortic dissection include:[1]
- Abdominal pain following mesenteric ischemia
- Cardiac arrest (rarely)
- Claudication due to iliac artery involvement
- Symptoms of congestive heart failure may be observed due to aortic root dilatation leading to aortic insufficiency
- Dysphagia due to compression of the esophagus
- Hemoptysis due to compression of and erosion into the bronchus
- Horner syndrome due to compression of the superior cervical ganglia
- Oliguria/ Anuria due to involvement of the renal arteries causing pre-renal azotemia.
- Paraplegia, paralysis from involvement of one of the cerebral or spinal arteries
- Stridor and wheezing due to compression of the airway
- Swelling of the neck and face due to compression of the superior vena cava or Superior vena cava syndrome
- Syncope
- Upper gastrointestinal (UGI) bleed
- hoarseness (compression of the recurrent laryngeal nerve)
2014 ESC Guidelines on the Diagnosis and Treatment of Aortic Diseases[1]
History and Symptoms associated with High Pretest Probability of Aortic Dissection[1]
| History |
|
| Symptoms |
|
Clinical Assessment of Patients Suspicious of Aortic Dissection[1]
| Class I |
| "In patients suspicious of acute aortic syndrome pretest probability of aortic dissection should be assessed based on patients' history, symptoms and physical examination findings.[6](Level of Evidence: B)" |
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)[7]
History and Physical Examination for Thoracic Aortic Disease (DO NOT EDIT)[7]
| Class I |
| "1. For patients presenting with a history of acute cardiac and noncardiac symptoms associated with a significant likelihood of thoracic aortic disease, the clinician should perform a focused physical examination, including a careful and complete search for arterial perfusion differentials in both upper and lower extremities, evidence of visceral ischemia, focal neurological deficits, a murmur of aortic regurgitation, bruits, and findings compatible with possible cardiac tamponade.[8][9][10] (Level of Evidence: C)" |
References
- ↑ 1.0 1.1 1.2 1.3 1.4 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.
- ↑ Hagan, Peter G.; Nienaber, Christoph A.; Isselbacher, Eric M.; Bruckman, David; Karavite, Dean J.; Russman, Pamela L.; Evangelista, Arturo; Fattori, Rossella; Suzuki, Toru; Oh, Jae K.; Moore, Andrew G.; Malouf, Joseph F.; Pape, Linda A.; Gaca, Charlene; Sechtem, Udo; Lenferink, Suzanne; Deutsch, Hans Josef; Diedrichs, Holger; Marcos y Robles, Jose; Llovet, Alfredo; Gilon, Dan; Das, Sugata K.; Armstrong, William F.; Deeb, G. Michael; Eagle, Kim A. (2000). "The International Registry of Acute Aortic Dissection (IRAD)". JAMA. 283 (7): 897. doi:10.1001/jama.283.7.897. ISSN 0098-7484.
- ↑ "Correspondence". The Annals of Thoracic Surgery. 67 (2): 593. 1999. doi:10.1016/S0003-4975(99)00037-5. ISSN 0003-4975.
- ↑ Trimarchi S, Tolenaar JL, Tsai TT, Froehlich J, Pegorer M, Upchurch GR, Fattori R, Sundt TM, Isselbacher EM, Nienaber CA, Rampoldi V, Eagle KA (April 2012). "Influence of clinical presentation on the outcome of acute B aortic dissection: evidences from IRAD". J Cardiovasc Surg (Torino). 53 (2): 161–8. PMID 22456637.
- ↑ Klompas M (May 2002). "Does this patient have an acute thoracic aortic dissection?". JAMA. 287 (17): 2262–72. doi:10.1001/jama.287.17.2262. PMID 11980527.
- ↑ 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.
- ↑ 7.0 7.1 Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE; 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.
- ↑ Townsend CM, Beauchamp RD, Evers BM, et al. Sabiston Textbook of Surgery. 18th ed. Philadelphia: Elsevier Health Sciences, 2008.
- ↑ Libby P, Bonow RO, Mann DL, et al. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia: 2007.
- ↑ Isselbacher E. Cecil Medicine. 23rd ed. Philadelphia: Elsevier Health Sciences, 2008.