Aortic dissection risk factors
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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]
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.
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):
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"b. High-risk chest, back, or abdominal pain features (Level of Evidence: B):
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"c. High-risk examination features (Level of Evidence: B):
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| "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)" |
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[2].
- 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.
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.
- ↑ Increased maternal cardiovascular mortality associated with pregnancy in women with Turner syndrome.