Screening, Evaluation, and Early Management of Acute Aortic Dissection in the ED (original) (raw)

An Atypical presentation of Acute Aortic Dissection in the Emergency Department

Journal of Case Reports, 2017

Background: Acute aortic dissection, an emergent vascular catastrophe, varies in its clinical presentation and embraces a high mortality rate if not recognized early. The symptoms of acute aortic dissection may vary. Most patients complain of an abrupt onset of severe pain in the chest, back, or abdomen. Other uncommon presentation may be shortness of breath, pain in the arms or legs, weakness, or loss of consciousness. Case Report: We present a 50 year old male who presented with complaints of sudden onset of shortness of breath, sweating and pain in the right leg 30 minutes before arrival. Patient was diagnosed as having acute aortic dissection (Stanford Type A) with cardiac tamponade. Patient underwent a successful Bentall's procedure. Conclusion: Acute aortic dissection is uncommon but still poses a clinical challenge as patients can deteriorate very quickly. Patients may present with varied symptoms and it is imperative for an emergency physician to have high index of suspicion to diagnose these patients as soon as possible so that appropriate care can be administered.

Echocardiographic diagnosis of acute aortic dissection in the emergency room: case report

2012

BACKGROUND AND OBJECTIVES: The transthoracic echocardiography in the emergency room, by ultra-portable equipment has been increasingly useful for the diagnosis of acute dissection of ascending aorta, reason for the present report, the objective of which was to elucidate this emergency, using that important propedeutic method.CASE REPORT: A previously healthy, 49 year-old patient admitted to the Emergency Unit with typical chest pain (without triggers) whose diagnosis of acute aortic dissection was performed with the aid of transthoracic echocardiography. CONCLUSION: Considering that 65% of intimal tears occurin the ascending aorta, transthoracic echocardiography is afast and effective tool in a medical emergency. The method has a sensitivity of 59% - 85% and specificity of 63% - 96% for the diagnosis of aortic dissection. It is noteworthy that, even though infrequent in experienced hands, negative findings at transthoracic echocariography do not rule out the diagnosis of this diseas...

Aortic dissection: prompt diagnosis and emergency treatment are critical

Cleveland Clinic journal of medicine, 2011

Diagnosing aortic dissection requires a high index of suspicion, as it may mimic other more common conditions that cause chest pain. Prompt diagnosis is key, as it requires emergency evaluation and treatment for optimal chances of survival. This paper reviews key clinical features as well as laboratory and imaging tests.

Aortic Dissection - The Role of Echocardiography in Emergency Unit: Case Report

Acta Facultatis Medicae Naissensis, 2016

SummaryAortic dissection is a quite rare but serious condition, often associated with a very high mortality rate; it is manifested by sudden chest pain and acute hemodynamic compromise. In the presented review, a case of an ascending aortic dissection with the lethal outcome is been shown. A healthy man with no past history of illness suddenly felt acute excruciating chest pain which was radiating to the back. A quick diagnosis, ideally within one hour of manifestation, heart auscultation and echocardiography are the key to aortic dissection recovery.

The International Registry of Acute Aortic Dissection (IRAD)

JAMA, 2000

Dr Evangelista), and Hospital 12 de Octubre, Context Acute aortic dissection is a life-threatening medical emergency associated with high rates of morbidity and mortality. Data are limited regarding the effect of recent imaging and therapeutic advances on patient care and outcomes in this setting.

Painless Acute Aortic Dissection - Diagnostic, Prognostic and Clinical Implications

Circulation Journal, 2011

cute aortic dissection (AAD) is the most common fatal condition that involves the aorta. AAD has a mortality rate as high as 1%/h during the first 48 h after the onset of symptoms if left untreated. 1-5 Rapid diagnosis is essential in improving prognosis. Classically, aortic dissection presents with severe chest, back, or abdominal pain. Patients characterize the pain as ripping or tearing in nature. Hagan et al assessed the clinical presentation and course of patients with AAD who were enrolled in the International Registry of Acute Aortic Dissection (IRAD), which involved 12 international referral centers. 6 They reported that 95.5% of patients complained of pain. In recent years, however, there have been several documented cases presenting with atypical features. 7-13 Making a diagnosis is difficult when the classic pattern of pain is absent. Most studies that have evaluated patients with AAD have focused their attention on the patients selected to undergo surgery. This may have excluded patients who were too ill for surgery, or died before they received surgical repair. There have been only a few reports that assessed the clinical characteristics of painless AAD. 14 The purpose of this study was to investigate the frequency, clinical characteristics and outcomes of patients with painless AAD in the emergency setting. Editorial p 47 Methods Patient Population One hundred and twenty-four patients with AAD were admitted to our hospital from January 2002 to December 2007. After excluding patients with an out-of-hospital cardiac arrest, 98 patients were studied. A diagnosis of AAD was based on imaging study findings, surgical visualization and postmortem examination. Patients with an aortic disruption secondary to trauma were also excluded. An aortic dissection was defined as acute if a patient presented within 14 days of the onset of

CT evaluation of aortic dissection and other acute aortic syndromes: An update

International Journal of Radiology & Radiation Therapy

Acute aortic syndromes consist of aortic dissection, intramural hematoma, penetrating aortic ulcer, and ruptured aortic aneurysm. Acute aortic syndromes are considered a clinical emergency with patients presenting with severe chest pain. MDCT is considered as the investigation of choice to evaluate and classify acute aortic syndromes. Correct diagnosis and prompt management of acute aortic syndromes are imperative to reduce mortality and morbidity. Hence, imaging departments must have a basic understanding of their pathophysiology, imaging characteristics, and possible complications, this article reviews the updates in CT imaging of these syndromes and their pitfalls.

Acute thoracic aortic dissection: The basics

The Journal of Emergency Medicine, 1997

3 Abstract-With an increasing incidence, aortic dissection is the most common acute illness of the aorta. In the setting of chronic hypertension, with or without other risk factors for aortic dissection, this diagnosis should be considered a diagnustic possibiiity in patients presenting to the emergency department with acute chest or back pain. Left unto, about 75 % of patients with dissections involving the ascendhtg aorta dii within 2 weeks of an acute episode. But with successftd initiai therapy, the J-year survival rate increases to 75%. Hence, timely recognition of thii disease entity coupled with urgent and appropriate management is the key to a successful outcome in a majority of the patients. Thii arti& reviews acute thoracic aortic dissection, inchtding ED diagnosis and management. 0 1997 Elsevier Science Inc. 0

Acute aortic dissection: Clinical characteristics and outcomes

Journal of Emergency Medicine, Trauma and Acute Care

Background: Acute aortic dissection (AAD) is a serious emergency. This prospective study aims to reveal the clinical characteristics and outcomes of medical and surgical treatments of AAD at the Ibn Al-Bitar Cardiac Centre. Methods: Over a 30-month period ending on Feb 27, 2019, 33 patients (27 males) admitted within 14 days after the onset of AAD symptoms were enrolled. The diagnosis was based on clinical findings and was confirmed by echocardiography and/or CT aortography. Intensive medical therapy was immediately initiated. Stanford classification was applied. Uncomplicated type B aortic dissections (AD) were managed conservatively while complicated type B and all type A dissections were referred for surgery. Perioperative data were entered into a Microsoft Excel-designed database, and the results were collected and statistically analyzed. Results: The male-to-female ratio was 9:2. The age range was 22-75 years, with a mean age of 48.8 ± 13.9 years. The main risk factors were hypertension (66.66%), smoking (42.42%), and Marfan's syndrome (15.15%). In 84.84% of the cases, chest pain was the presenting symptom. CT aortography revealed dissection of the thoracic aorta in 91% of the cases and the abdominal aorta in 51.5% of the cases. A total of 24 (72.7%) patients had type A AD, and 7 (21.2%) patients had type B AD, whereas two (6.1%) had Non-A Non-B categories. Among those with type B AD, 71.42% had complications. For 48.5% of the patients, surgery was offered. The overall mortality rate was 48.5%, matching the rates that had been already published. Surgery had a lower mortality rate than medical treatment (37.5% vs. 62.5%). The mortality rate of type A was higher than type B (58.3% vs. 28.6%). Conclusions: Urgent surgery performed by expert surgeons is essential to save victims of AAD primarily type A dissection.