Aortic dissection

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Última revisão: 11 Aug 2025
Última atualização: 15 Jul 2025

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • acute severe chest pain
  • acute severe interscapular and lower back pain
  • features of Marfan syndrome
  • features of Ehlers-Danlos syndrome
  • left/right blood pressure differential
  • pulse deficit
  • diastolic murmur
  • syncope
  • hypotension
Detalhes completos

Outros fatores diagnósticos

  • hypertension
  • dyspnea
  • altered mental status
  • paraplegia
  • hemiparesis/paresthesia
  • abdominal pain
  • limb pain/pallor
  • left-sided decreased breath sounds/dullness
Detalhes completos

Fatores de risco

  • hypertension
  • atherosclerotic aneurysmal disease
  • Marfan syndrome
  • Ehlers-Danlos syndrome
  • bicuspid aortic valve
  • annuloaortic ectasia
  • coarctation
  • smoking
  • family history of aortic disease or connective-tissue disorder
  • older age
  • giant cell arteritis
  • overlap connective-tissue disorders
  • surgical/catheter manipulation
  • cocaine/amphetamine use
  • heavy lifting
  • pregnancy
  • nondiabetic
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • ECG
  • cardiac enzymes
  • computed tomography angiography (CTA)
  • renal function tests
  • liver function tests
  • lactate
  • complete blood count
  • type and cross
Detalhes completos

Investigações a serem consideradas

  • chest x-ray
  • D-dimer
  • transthoracic echocardiography (TTE)
  • transesophageal echocardiography
  • MRI
  • intravascular ultrasound
Detalhes completos

Algoritmo de tratamento

Inicial

hemodynamically unstable: suspected aortic dissection

AGUDA

confirmed aortic dissection

CONTÍNUA

chronic (all types)

Colaboradores

Consultores especialistas

Caitlin W. Hicks, MD, MS

Assistant Professor of Surgery

Division of Vascular Surgery and Endovascular Therapy

The Johns Hopkins University School of Medicine

Baltimore

MD

Declarações

CWH receives grant funding from NIH/NIDDK, the Society for Vascular Surgery, and the American College of Surgeons; and has been reimbursed by W.L. Gore and Cook Medical for speaker engagements.

James H. Black III, MD, FACS

Chief

Vascular Surgery and Endovascular Therapy

Department of Surgery

The Johns Hopkins University School of Medicine

Baltimore

MD

Declarações

JHB declares that he has no competing interests.

Agradecimentos

Dr Caitlin W. Hicks and Dr James H. Black III would like to gratefully acknowledge Professor Hazim J. Safi, Dr Jeffrey Wu, and Dr Eric E. Roselli, previous contributors to this topic.

Declarações

HJS, JW, and EER declare that they have no competing interests.

Revisores

Evan Lipsitz, MD

Associate Professor of Surgery

Acting Chief

Division of Vascular and Endovascular Surgery

Montefiore Medical Center and the Albert Einstein College of Medicine

Bronx

NY

Declarações

EL declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Isselbacher EM, Preventza O, Hamilton Black J, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022 Dec 13;80(24):e223-393.Texto completo  Resumo

Mazzolai L, Teixido-Tura G, Lanzi S, et al. 2024 ESC guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J. 2024 Sep 29;45(36):3538-700.Texto completo  Resumo

Bossone E, LaBounty TM, Eagle KA. Acute aortic syndromes: diagnosis and management, an update. Eur Heart J. 2018 Mar 1;39(9):739-49d.Texto completo  Resumo

Fleischmann D, Afifi RO, Casanegra AI, et al. Imaging and surveillance of chronic aortic dissection: a scientific statement from the American Heart Association. Circ Cardiovasc Imaging. 2022 Mar;15(3):e000075.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Aortic dissection images
  • Diagnósticos diferenciais

    • Acute coronary syndrome
    • Pericarditis
    • Aortic aneurysm
    Mais Diagnósticos diferenciais
  • Diretrizes

    • 2022 ACC/AHA guideline for the diagnosis and management of aortic disease
    • 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain
    Mais Diretrizes
  • Folhetos informativos para os pacientes

    Aortic dissection

    Mais Folhetos informativos para os pacientes
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