Acute aortic syndrome: Difference between revisions
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* Type V: [[iatrogenic]]/traumatic dissection | * Type V: [[iatrogenic]]/traumatic dissection | ||
==Causes== | ==Causes== | ||
Causes can include [[aortic dissection]], [[intramural hematoma]], [[penetrating atherosclerotic ulcer]] or a [[thoracic aneurysm]] that has become unstable.<ref name="pmid18236724">{{cite journal |author=Smith AD, Schoenhagen P |title=CT imaging for acute aortic syndrome |journal=Cleve Clin J Med |volume=75 |issue=1 |pages=7–9, 12, 15–7 passim |date=January 2008 |pmid=18236724 |doi= 10.3949/ccjm.75.1.7|url=}}</ref> The potential causes of AAS are life-threatening and present with similar symptoms, making it difficult to distinguish the ultimate cause, though high resolution, high contrast [[computerised tomography]] can be used.<ref name="pmid18236724"/><ref name="pmid17612751">{{cite journal |author=Marijon E, Vilanculos A, Tivane A, ''et al.'' |title=Thoracic aortic aneurysm: direct sign of rupture |journal=Cardiovasc J Afr |volume=18 |issue=3 |pages=180–1 |year=2007 |pmid=17612751 |doi= | format = pdf |url=http://blues.sabinet.co.za/WebZ/Authorize?sessionid=0:autho=pubmed:password=pubmed2004&/AdvancedQuery?&format=F&next=images/ejour/cardio/cardio_v18_n3_a10.pdf}}</ref> | Causes can include [[aortic dissection]], [[intramural hematoma]], [[penetrating atherosclerotic ulcer]] or a [[thoracic aneurysm]] that has become unstable.<ref name="pmid18236724">{{cite journal |author=Smith AD, Schoenhagen P |title=CT imaging for acute aortic syndrome |journal=Cleve Clin J Med |volume=75 |issue=1 |pages=7–9, 12, 15–7 passim |date=January 2008 |pmid=18236724 |doi= 10.3949/ccjm.75.1.7|url=}}</ref> The potential causes of AAS are life-threatening and present with similar symptoms, making it difficult to distinguish the ultimate cause, though high resolution, high contrast [[computerised tomography]] can be used.<ref name="pmid18236724" /><ref name="pmid17612751">{{cite journal |author=Marijon E, Vilanculos A, Tivane A, ''et al.'' |title=Thoracic aortic aneurysm: direct sign of rupture |journal=Cardiovasc J Afr |volume=18 |issue=3 |pages=180–1 |year=2007 |pmid=17612751 |doi= | format = pdf |url=http://blues.sabinet.co.za/WebZ/Authorize?sessionid=0:autho=pubmed:password=pubmed2004&/AdvancedQuery?&format=F&next=images/ejour/cardio/cardio_v18_n3_a10.pdf}}</ref> | ||
== Diagnosis == | == Diagnosis == | ||
The condition can be mimicked by a ruptured [[cyst]] of the [[pericardium]],<ref name="pmid18296680">{{cite journal |author=Nishigami K, Hirayama T, Kamio T |title=Pericardial cyst rupture mimicking acute aortic syndrome |journal=Eur. Heart J. |volume= 29|issue= 14|pages= 1752|date=February 2008 |pmid=18296680 |doi=10.1093/eurheartj/ehn038 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=18296680}}</ref> ruptured [[aortic aneurysm]]<ref name="pmid17612751"/> and [[acute coronary syndrome]].<ref name="pmid17350381">{{cite journal |author=Hansen MS, Nogareda GJ, Hutchison SJ |title=Frequency of and inappropriate treatment of misdiagnosis of acute aortic dissection |journal=Am. J. Cardiol. |volume=99 |issue=6 |pages=852–6 |date=March 2007 |pmid=17350381 |doi=10.1016/j.amjcard.2006.10.055 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(06)02407-6}}</ref> | The condition can be mimicked by a ruptured [[cyst]] of the [[pericardium]],<ref name="pmid18296680">{{cite journal |author=Nishigami K, Hirayama T, Kamio T |title=Pericardial cyst rupture mimicking acute aortic syndrome |journal=Eur. Heart J. |volume= 29|issue= 14|pages= 1752|date=February 2008 |pmid=18296680 |doi=10.1093/eurheartj/ehn038 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=18296680}}</ref> ruptured [[aortic aneurysm]]<ref name="pmid17612751" /> and [[acute coronary syndrome]].<ref name="pmid17350381">{{cite journal |author=Hansen MS, Nogareda GJ, Hutchison SJ |title=Frequency of and inappropriate treatment of misdiagnosis of acute aortic dissection |journal=Am. J. Cardiol. |volume=99 |issue=6 |pages=852–6 |date=March 2007 |pmid=17350381 |doi=10.1016/j.amjcard.2006.10.055 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(06)02407-6}}</ref> | ||
Misdiagnosis is estimated at 39% and is associated with delays correct diagnosis and improper treatment with [[anticoagulant]]s producing excessive bleeding and extended hospital stay.<ref name="pmid17350381"/> | Misdiagnosis is estimated at 39% and is associated with delays correct diagnosis and improper treatment with [[anticoagulant]]s producing excessive bleeding and extended hospital stay.<ref name="pmid17350381" /> | ||
==Management== | ==Management== | ||
AAS is life-threatening, with a high [[mortality rate]] if appearing [[Acute (medicine)|acutely]], reduced only when diagnosed early and treated by a [[Surgery|surgeon]] with considerable expertise.<ref name="pmid17521551"/> If patients survive acute presentation, within three to five years 30% will develop [[complication (medicine)|complications]] and require close follow-up.<ref name="pmid17521551"/> Early diagnosis is essential for survival and management is challenging though greater awareness of the syndrome and improving management strategies are improving patient outcomes.<ref name="pmid17535765">{{cite journal |author=Ince H, Nienaber CA |title=[Management of acute aortic syndromes] |language=Spanish; Castilian |journal=Rev Esp Cardiol |volume=60 |issue=5 |pages=526–41 |date=May 2007 |pmid=17535765 |doi= 10.1016/S1885-5857(07)60194-7|url=http://www.revespcardiol.org/cgi-bin/wdbcgi.exe/cardio/mrevista_cardio.pubmed_full?inctrl=05ZI0113&vol=60&num=5&pag=526}}</ref | AAS is life-threatening, with a high [[mortality rate]] if appearing [[Acute (medicine)|acutely]], reduced only when diagnosed early and treated by a [[Surgery|surgeon]] with considerable expertise.<ref name="pmid17521551" /> If patients survive acute presentation, within three to five years 30% will develop [[complication (medicine)|complications]] and require close follow-up.<ref name="pmid17521551" /> Early diagnosis is essential for survival and management is challenging though greater awareness of the syndrome and improving management strategies are improving patient outcomes.<ref name="pmid17535765">{{cite journal |author=Ince H, Nienaber CA |title=[Management of acute aortic syndromes] |language=Spanish; Castilian |journal=Rev Esp Cardiol |volume=60 |issue=5 |pages=526–41 |date=May 2007 |pmid=17535765 |doi= 10.1016/S1885-5857(07)60194-7|url=http://www.revespcardiol.org/cgi-bin/wdbcgi.exe/cardio/mrevista_cardio.pubmed_full?inctrl=05ZI0113&vol=60&num=5&pag=526}}</ref> | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 20:15, 19 December 2019
|
Acute aortic syndrome Microchapters |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief:
Overview
Acute aortic syndrome (AAS) describes a constellation of emergency conditions with a similar clinical feature that involves the aorta.[1] These include aortic dissection, intramural thrombus, and penetrating atherosclerotic aortic ulcer.[2] AAS can be caused by a breakdown on the wall of the aorta that involves the tunica intima and/or media.[3] It is possible for AAS to lead to acute coronary syndrome.[4] The term was introduced in 2001.[5][6]
Classification
Acute aortic syndromes is classified into 5 entities as follows:[7][8]
- 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
Causes
Causes can include aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer or a thoracic aneurysm that has become unstable.[9] The potential causes of AAS are life-threatening and present with similar symptoms, making it difficult to distinguish the ultimate cause, though high resolution, high contrast computerised tomography can be used.[9][10]
Diagnosis
The condition can be mimicked by a ruptured cyst of the pericardium,[11] ruptured aortic aneurysm[10] and acute coronary syndrome.[12]
Misdiagnosis is estimated at 39% and is associated with delays correct diagnosis and improper treatment with anticoagulants producing excessive bleeding and extended hospital stay.[12]
Management
AAS is life-threatening, with a high mortality rate if appearing acutely, reduced only when diagnosed early and treated by a surgeon with considerable expertise.[3] If patients survive acute presentation, within three to five years 30% will develop complications and require close follow-up.[3] Early diagnosis is essential for survival and management is challenging though greater awareness of the syndrome and improving management strategies are improving patient outcomes.[13]
References
- ↑ Ahmad F, Cheshire N, Hamady M (May 2006). "Acute aortic syndrome: pathology and therapeutic strategies". Postgrad Med J. 82 (967): 305–12. doi:10.1136/pgmj.2005.043083. PMC 2563796. PMID 16679467.
- ↑ Macura, KJ; Corl FM; Fishman EK; Bluemke DA (1 August 2003). "Pathogenesis in acute aortic syndromes: aortic dissection, intramural hematoma, and penetrating atherosclerotic aortic ulcer". American Journal of Roentgenology. 181 (2): 309–316. doi:10.2214/ajr.181.2.1810309. PMID 12876003. Retrieved 2008-05-28.
- ↑ 3.0 3.1 3.2 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.
- ↑ Manghat NE, Morgan-Hughes GJ, Roobottom CA (December 2005). "Multi-detector row computed tomography: imaging in acute aortic syndrome". Clin Radiol. 60 (12): 1256–67. doi:10.1016/j.crad.2005.06.011. PMID 16291307.
- ↑ van der Loo B, Jenni R (August 2003). "Acute aortic syndrome: proposal for a novel classification". Heart. 89 (8): 928. doi:10.1136/heart.89.8.928. PMC 1767786. PMID 12860875.
- ↑ Vilacosta I, Román JA (April 2001). "Acute aortic syndrome". Heart. 85 (4): 365–8. doi:10.1136/heart.85.4.365. PMC 1729697. PMID 11250953.
- ↑ 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.
- ↑ "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.
- ↑ 9.0 9.1 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.
- ↑ 10.0 10.1 Marijon E, Vilanculos A, Tivane A; et al. (2007). "Thoracic aortic aneurysm: direct sign of rupture" (pdf). Cardiovasc J Afr. 18 (3): 180–1. PMID 17612751.
- ↑ Nishigami K, Hirayama T, Kamio T (February 2008). "Pericardial cyst rupture mimicking acute aortic syndrome". Eur. Heart J. 29 (14): 1752. doi:10.1093/eurheartj/ehn038. PMID 18296680.
- ↑ 12.0 12.1 Hansen MS, Nogareda GJ, Hutchison SJ (March 2007). "Frequency of and inappropriate treatment of misdiagnosis of acute aortic dissection". Am. J. Cardiol. 99 (6): 852–6. doi:10.1016/j.amjcard.2006.10.055. PMID 17350381.
- ↑ Ince H, Nienaber CA (May 2007). "[Management of acute aortic syndromes]". Rev Esp Cardiol (in Spanish; Castilian). 60 (5): 526–41. doi:10.1016/S1885-5857(07)60194-7. PMID 17535765.