Aortic dissection

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Last reviewed: 20 Aug 2025
Last updated: 15 Jul 2025

Summary

Definição

History and exam

Key diagnostic factors

  • 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
Full details

Other diagnostic factors

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

Risk factors

  • 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
Full details

Diagnostic investigations

1st investigations to order

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

Investigations to consider

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

Treatment algorithm

INITIAL

hemodynamically unstable: suspected aortic dissection

ACUTE

confirmed aortic dissection

ONGOING

chronic (all types)

Contributors

Expert advisers

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

Раскрытие информации

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

Раскрытие информации

JHB declares that he has no competing interests.

Выражение благодарностей

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.

Раскрытие информации

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

Рецензенты

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

Раскрытие информации

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.

Список литературы

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Основные статьи

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.Полный текст  Аннотация

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.Полный текст  Аннотация

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

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.Полный текст  Аннотация

Статьи, указанные как источники

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