Thoracic aortic disease risk factors: Difference between revisions
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/* ACC/AHA Guidelines - Guidelines for the Evaluation and Management of acute Thoracic aortic disease (DO NOT EDIT) {{cite journal| author=Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE et al.| title=2010 ACCF/AHA/AATS/ACR/ASA/SC... |
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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]] | ||
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Providers should routinely evaluate any patient presenting with complaints that may represent acute thoracic aortic dissection to establish a pretest risk of disease that can then be used to guide diagnostic decisions. This process should include specific questions about medical history, family history, and pain features as well as a focused examination to identify findings that are associated with aortic dissection, including: <nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Providers should routinely evaluate any patient presenting with complaints that may represent acute thoracic [[aortic dissection]] to establish a pretest risk of disease that can then be used to guide diagnostic decisions. This process should include specific questions about medical history, family history, and pain features as well as a focused examination to identify findings that are associated with aortic dissection, including: <nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''a.''' High-risk conditions and historical features ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]]): | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''a.''' High-risk conditions and historical features ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]]): | ||
:* Marfan syndrome, Loeys-Dietz syndrome, vascular Ehlers-Danlos syndrome, Turner syndrome, or other connective tissue disease. | :* [[Marfan syndrome]], [[Loeys-Dietz syndrome]], [[vascular Ehlers-Danlos syndrome]], [[Turner syndrome]], or other connective tissue disease. | ||
:* Patients with mutations in genes known to predispose to thoracic aortic aneurysms and dissection, such as FBN1, TGFBR1, TGFBR2, ACTA2, and MYH11. | :* Patients with mutations in genes known to predispose to [[thoracic aortic aneurysms]] and [[aortic dissection|dissection]], such as [[FBN1]], [[TGFBR1]], [[TGFBR2]], [[ACTA2]], and [[MYH11]]. | ||
:* Family history of aortic dissection or thoracic aortic aneurysm. | :* Family history of [[aortic dissection]] or thoracic aortic aneurysm. | ||
:* Known aortic valve disease. | :* Known [[aortic valve disease]]. | ||
:* Recent aortic manipulation (surgical or catheter-based). | :* Recent aortic manipulation (surgical or catheter-based). | ||
:* Known thoracic aortic aneurysm.<nowiki>"</nowiki> | :* Known thoracic aortic aneurysm.<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''b.''' High-risk chest, back, or abdominal pain features ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]]): | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''b.''' High-risk chest, back, or [[abdominal pain]] features ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]]): | ||
:* Pain that is abrupt or instantaneous in onset. | :* Pain that is abrupt or instantaneous in onset. | ||
:* Pain that is severe in intensity. | :* Pain that is severe in intensity. | ||
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:* Pulse deficit. | :* Pulse deficit. | ||
:* Systolic blood pressure limb differential greater than 20 mm Hg. | :* Systolic blood pressure limb differential greater than 20 mm Hg. | ||
:* Focal neurologic deficit. | :* [[Focal neurologic deficit]]. | ||
:* Murmur of aortic regurgitation (new).<nowiki>"</nowiki> | :* [[Murmur]] of [[aortic regurgitation]] (new).<nowiki>"</nowiki> | ||
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Patients presenting with sudden onset of severe chest, back, and/or abdominal pain, particularly those less than 40 years of age, should be questioned about a history and examined for physical features of Marfan syndrome, Loeys-Dietz syndrome, vascular Ehlers-Danlos syndrome, Turner syndrome, or other connective tissue disorder associated with thoracic aortic disease. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Patients presenting with sudden onset of severe chest, back, and/or abdominal pain, particularly those less than 40 years of age, should be questioned about a history and examined for physical features of [[Marfan syndrome]], Loeys-Dietz syndrome, vascular Ehlers-Danlos syndrome, Turner syndrome, or other connective tissue disorder associated with thoracic aortic disease. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Patients presenting with sudden onset of severe chest, back, and/or abdominal pain should be questioned about a history of aortic pathology in immediate family members as there is a strong familial component to acute thoracic aortic disease. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]]) <nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Patients presenting with sudden onset of severe chest, back, and/or abdominal pain should be questioned about a history of aortic pathology in immediate family members as there is a strong familial component to acute thoracic aortic disease. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]]) <nowiki>"</nowiki> | ||
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' Patients presenting with sudden onset of severe chest, back, and/or abdominal pain should be questioned about recent aortic manipulation (surgical or catheter-based) or a known history of aortic valvular disease, as these factors predispose to acute aortic dissection. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' Patients presenting with sudden onset of severe chest, back, and/or abdominal pain should be questioned about recent aortic manipulation (surgical or catheter-based) or a known history of aortic valvular disease, as these factors predispose to acute aortic dissection. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''5.''' In patients with suspected or confirmed aortic dissection who have experienced a syncopal episode, a focused examination should be performed to identify associated neurologic injury or the presence of pericardial tamponade. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''5.''' In patients with suspected or confirmed aortic dissection who have experienced a [[syncope|syncopal episode]], a focused examination should be performed to identify associated neurologic injury or the presence of pericardial tamponade. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''6.''' All patients presenting with acute neurologic complaints should be questioned about the presence of chest, back, and/or abdominal pain and checked for peripheral pulse deficits as patients with dissection related neurologic pathology are less likely to report thoracic pain than the typical aortic dissection patient. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''6.''' All patients presenting with acute neurologic complaints should be questioned about the presence of chest, back, and/or abdominal pain and checked for peripheral pulse deficits as patients with dissection related neurologic pathology are less likely to report thoracic pain than the typical [[aortic dissection]] patient. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])<nowiki>"</nowiki> | ||
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Revision as of 15:55, 29 October 2012
Overview
2010 ACCF/AHA Guideline Recommendations: Evaluation and Management of Acute Thoracic Aortic Disease (DO NOT EDIT) [1]
Recommendations for Estimation of Pretest Risk of Thoracic Aortic Dissection
| Class I |
| "1. Providers should routinely evaluate any patient presenting with complaints that may represent acute thoracic aortic dissection to establish a pretest risk of disease that can then be used to guide diagnostic decisions. This process should include specific questions about medical history, family history, and pain features as well as a focused examination to identify findings that are associated with aortic dissection, including: " |
"a. High-risk conditions and historical features (Level of Evidence: B):
|
"b. High-risk chest, back, or abdominal pain features (Level of Evidence: B):
|
"c. High-risk examination features (Level of Evidence: B):
|
| "2. Patients presenting with sudden onset of severe chest, back, and/or abdominal pain, particularly those less than 40 years of age, should be questioned about a history and examined for physical features of Marfan syndrome, Loeys-Dietz syndrome, vascular Ehlers-Danlos syndrome, Turner syndrome, or other connective tissue disorder associated with thoracic aortic disease. (Level of Evidence: B)" |
| "3. Patients presenting with sudden onset of severe chest, back, and/or abdominal pain should be questioned about a history of aortic pathology in immediate family members as there is a strong familial component to acute thoracic aortic disease. (Level of Evidence: B) " |
| "4. Patients presenting with sudden onset of severe chest, back, and/or abdominal pain should be questioned about recent aortic manipulation (surgical or catheter-based) or a known history of aortic valvular disease, as these factors predispose to acute aortic dissection. (Level of Evidence: C)" |
| "5. In patients with suspected or confirmed aortic dissection who have experienced a syncopal episode, a focused examination should be performed to identify associated neurologic injury or the presence of pericardial tamponade. (Level of Evidence: C)" |
| "6. All patients presenting with acute neurologic complaints should be questioned about the presence of chest, back, and/or abdominal pain and checked for peripheral pulse deficits as patients with dissection related neurologic pathology are less likely to report thoracic pain than the typical aortic dissection patient. (Level of Evidence: C)" |
References
- ↑ 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.