Aortic dissection risk factors: Difference between revisions
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== Risk Factors == | == Risk Factors == | ||
* [[Aging]]. The highest incidence of aortic dissection is in individuals who are 50 to 70 years old. | * [[Aging]]. The highest [[incidence]] of [[aortic]] dissection is in individuals who are 50 to 70 years old. | ||
* [[Atherosclerosis]] and its associated risk factors like [[diabetes]] | * [[Atherosclerosis]] and its associated risk factors like [[diabetes]] | ||
* [[Bicuspid aortic valve]] is present in approximately 7%-14% of patients. These individuals are prone to dissection in the [[ascending aorta]]. The risk of dissection in individuals with bicuspid aortic valve is not associated with the degree of [[aortic stenosis|stenosis]] of the valve. | * [[Bicuspid aortic valve]] is present in approximately 7%-14% of patients. These individuals are prone to dissection in the [[ascending aorta]]. The risk of dissection in individuals with [[bicuspid aortic valve]] is not associated with the degree of [[aortic stenosis|stenosis]] of the [[valve]]. | ||
* [[Chest trauma]]. Chest trauma leading to aortic dissection can be divided into two groups based on etiology: blunt chest trauma (commonly seen in car accidents) and [[iatrogenic]]. Iatrogenic causes include trauma during [[cardiac catheterization]] or due to an [[intra-aortic balloon pump]]. | * [[Chest trauma]]. Chest trauma leading to [[aortic]] dissection can be divided into two groups based on etiology: blunt chest trauma (commonly seen in car accidents) and [[iatrogenic]]. [[Iatrogenic]] causes include trauma during [[cardiac catheterization]] or due to an [[intra-aortic balloon pump]]. | ||
* [[Cocaine abuse]] | * [[Cocaine abuse]] | ||
* [[Coarctation of the aorta]] | * [[Coarctation of the aorta]] | ||
* [[Cystic medial necrosis]] | * [[Cystic medial necrosis]] | ||
* Deceleration [[trauma]] most commonly causes aortic rupture, not dissection | * Deceleration [[trauma]] most commonly causes [[aortic rupture]], not dissection | ||
* [[Ehlers-Danlos syndrome]] | * [[Ehlers-Danlos syndrome]] | ||
* [[Giant cell arteritis]] | * [[Giant cell arteritis]] | ||
* [[Heart surgery]] particularly [[aortic valve replacement]]; 18% of individuals who present with an acute aortic dissection have a history of open heart surgery. | * [[Heart surgery]] particularly [[aortic valve replacement]]; 18% of individuals who present with an [[acute]] [[aortic]] dissection have a history of open [[heart surgery]]. Individuals who have undergone [[aortic valve replacement]] for [[aortic insufficiency]] are at particularly high risk. This is because [[aortic insufficiency]] causes increased blood flow in the [[ascending aorta]]. This can cause [[dilatation]] and weakening of the walls of the [[ascending aorta]]. | ||
* [[Hypertension]] is seen in 71-86% of patients. It occurs most frequently in those with type III dissection. | * [[Hypertension]] is seen in 71-86% of patients. It occurs most frequently in those with type III dissection. | ||
* Male gender. The incidence is twice as high in males as in females (male-to-female ratio is 2:1). | * Male gender. The [[incidence]] is twice as high in males as in females (male-to-female ratio is 2:1). | ||
* [[Marfan’s syndrome]] is present in 5%-9% of patients. In this subset, there is an increased incidence in young individuals. Individuals with Marfan syndrome patients are more prone to proximal dissections of the aorta. | * [[Marfan’s syndrome]] is present in 5%-9% of patients. In this subset, there is an increased [[incidence]] in young individuals. Individuals with [[Marfan syndrome]] patients are more prone to [[proximal]] dissections of the [[aorta]]. | ||
* [[Pseudoxanthoma elasticum]] | * [[Pseudoxanthoma elasticum]] | ||
* [[Turner's syndrome]]. | * [[Turner's syndrome]]. [[Turner syndrome]] increases the risk of [[aortic]] dissection as a result of [[aortic root dilatation]]<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>. | ||
* [[Tertiary syphilis]] | * [[Tertiary syphilis]] | ||
* [[Third trimester of pregnancy]]. Half of dissections in females before age 40 occur during [[pregnancy]] (typically in the 3rd trimester or early [[postpartum]] period). | * [[Third trimester of pregnancy]]. Half of dissections in females before age 40 occur during [[pregnancy]] (typically in the 3rd trimester or early [[postpartum]] period). | ||
* [[Vasculitis]] ([[inflammation]] of an artery) is rarely associated with aortic dissection. | * [[Vasculitis]] ([[inflammation]] of an [[artery]]) is rarely associated with [[aortic]] dissection. | ||
==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, Bersin RM, Carr VF, Casey DE 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 | year= 2010 | volume= 121 | issue= 13 | pages= e266-369 | pmid=20233780 | doi=10.1161/CIR.0b013e3181d4739e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20233780 }} </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, Bersin RM, Carr VF, Casey DE 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 | year= 2010 | volume= 121 | issue= 13 | pages= e266-369 | pmid=20233780 | doi=10.1161/CIR.0b013e3181d4739e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20233780 }} </ref>== | ||
Revision as of 19:53, 24 January 2013
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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(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Raviteja Guddeti, M.B.B.S. [3]
Overview
Aging, atherosclerosis, diabetes, hypertension and trauma are common risk factors for aortic dissection. Uncommon risk factors include bicuspid aortic valve, cocaine, coarctation of the aorta, cystic medial necrosis, Ehlers-Danlos syndrome, giant cell arteritis, heart surgery, Marfan’s syndrome, Pseudoxanthoma elasticum, Turner's syndrome, tertiary syphilis and the third trimester of pregnancy.
Risk Factors
- Aging. The highest incidence of aortic dissection is in individuals who are 50 to 70 years old.
- Atherosclerosis and its associated risk factors like diabetes
- Bicuspid aortic valve is present in approximately 7%-14% of patients. These individuals are prone to dissection in the ascending aorta. The risk of dissection in individuals with bicuspid aortic valve is not associated with the degree of stenosis of the valve.
- Chest trauma. Chest trauma leading to aortic dissection can be divided into two groups based on etiology: blunt chest trauma (commonly seen in car accidents) and iatrogenic. Iatrogenic causes include trauma during cardiac catheterization or due to an intra-aortic balloon pump.
- Cocaine abuse
- Coarctation of the aorta
- Cystic medial necrosis
- Deceleration trauma most commonly causes aortic rupture, not dissection
- Ehlers-Danlos syndrome
- Giant cell arteritis
- Heart surgery particularly aortic valve replacement; 18% of individuals who present with an acute aortic dissection have a history of open heart surgery. Individuals who have undergone aortic valve replacement for aortic insufficiency are at particularly high risk. This is because aortic insufficiency causes increased blood flow in the ascending aorta. This can cause dilatation and weakening of the walls of the ascending aorta.
- Hypertension is seen in 71-86% of patients. It occurs most frequently in those with type III dissection.
- Male gender. The incidence is twice as high in males as in females (male-to-female ratio is 2:1).
- Marfan’s syndrome is present in 5%-9% of patients. In this subset, there is an increased incidence in young individuals. Individuals with Marfan syndrome patients are more prone to proximal dissections of the aorta.
- Pseudoxanthoma elasticum
- Turner's syndrome. Turner syndrome increases the risk of aortic dissection as a result of aortic root dilatation[1].
- Tertiary syphilis
- Third trimester of pregnancy. Half of dissections in females before age 40 occur during pregnancy (typically in the 3rd trimester or early postpartum period).
- Vasculitis (inflammation of an artery) is rarely associated with aortic dissection.
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)[2]
Estimation of Pretest Risk of Thoracic Aortic Dissection (DO NOT EDIT)[2]
| 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[3][4][5][6] (Level of Evidence: B):
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| b. High-risk chest, back, or abdominal pain features[3][4][5][6][7][8][9][10] (Level of Evidence: B): |
c. High-risk examination features[3][5][6][10][11][12][13] (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 disorders associated with thoracic aortic disease.[4] (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.[4] (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.[12] (Level of Evidence: C)" |
References
- ↑ Increased maternal cardiovascular mortality associated with pregnancy in women with Turner syndrome.
- ↑ 2.0 2.1 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.
- ↑ 3.0 3.1 3.2 Coady MA, Davies RR, Roberts M; et al. (1999). "Familial patterns of thoracic aortic aneurysms". Arch Surg. 134 (4): 361–7. PMID 10199307. Unknown parameter
|month=ignored (help) - ↑ 4.0 4.1 4.2 4.3 Hagan PG, Nienaber CA, Isselbacher EM; et al. (2000). "The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease". JAMA. 283 (7): 897–903. PMID 10685714. Unknown parameter
|month=ignored (help) - ↑ 5.0 5.1 5.2 Januzzi JL, Isselbacher EM, Fattori R; et al. (2004). "Characterizing the young patient with aortic dissection: results from the International Registry of Aortic Dissection (IRAD)". J. Am. Coll. Cardiol. 43 (4): 665–9. doi:10.1016/j.jacc.2003.08.054. PMID 14975480. Unknown parameter
|month=ignored (help) - ↑ 6.0 6.1 6.2 von Kodolitsch Y, Schwartz AG, Nienaber CA (2000). "Clinical prediction of acute aortic dissection". Arch. Intern. Med. 160 (19): 2977–82. PMID 11041906. Unknown parameter
|month=ignored (help) - ↑ Mészáros I, Mórocz J, Szlávi J; et al. (2000). "Epidemiology and clinicopathology of aortic dissection". Chest. 117 (5): 1271–8. PMID 10807810. Unknown parameter
|month=ignored (help) - ↑ Spittell PC, Spittell JA, Joyce JW; et al. (1993). "Clinical features and differential diagnosis of aortic dissection: experience with 236 cases (1980 through 1990)". Mayo Clin. Proc. 68 (7): 642–51. PMID 8350637. Unknown parameter
|month=ignored (help) - ↑ Mehta RH, O'Gara PT, Bossone E; et al. (2002). "Acute type A aortic dissection in the elderly: clinical characteristics, management, and outcomes in the current era". J. Am. Coll. Cardiol. 40 (4): 685–92. PMID 12204498. Unknown parameter
|month=ignored (help) - ↑ 10.0 10.1 Klompas M (2002). "Does this patient have an acute thoracic aortic dissection?". JAMA. 287 (17): 2262–72. PMID 11980527. Unknown parameter
|month=ignored (help) - ↑ Armstrong WF, Bach DS, Carey LM, Froehlich J, Lowell M, Kazerooni EA (1998). "Clinical and echocardiographic findings in patients with suspected acute aortic dissection". Am. Heart J. 136 (6): 1051–60. PMID 9842019. Unknown parameter
|month=ignored (help) - ↑ 12.0 12.1 Gaul C, Dietrich W, Friedrich I, Sirch J, Erbguth FJ (2007). "Neurological symptoms in type A aortic dissections". Stroke. 38 (2): 292–7. doi:10.1161/01.STR.0000254594.33408.b1. PMID 17194878. Unknown parameter
|month=ignored (help) - ↑ Roberts WC, Ko JM, Moore TR, Jones WH (2006). "Causes of pure aortic regurgitation in patients having isolated aortic valve replacement at a single US tertiary hospital (1993 to 2005)". Circulation. 114 (5): 422–9. doi:10.1161/CIRCULATIONAHA.106.622761. PMID 16864725. Unknown parameter
|month=ignored (help)