Last reviewed: September 2018
Last updated: March  2018



History and exam

Key diagnostic factors

  • features of Marfan's/Ehlers-Danlos syndromes
  • acute severe chest pain
  • interscapular pain
  • left/right BP differential
  • pulse differential/deficit
  • diastolic murmur
  • syncope
  • hypotension

Other diagnostic factors

  • hypertension
  • dyspnoea
  • altered mental status
  • paraplegia
  • hemiparesis/paraesthesia
  • abdominal pain
  • limb pain/pallor
  • left-sided decreased breath sounds/dullness

Risk factors

  • HTN
  • atherosclerotic aneurysmal disease
  • Marfan's syndrome
  • Ehlers-Danlos syndrome
  • bicuspid aortic valve
  • annulo-aortic ectasia
  • coarctation
  • smoking
  • FHx of aortic aneurysm or dissection
  • older age
  • giant cell arteritis
  • overlap connective-tissue disorders
  • surgical/catheter manipulation
  • cocaine/amfetamine use
  • heavy lifting
  • pregnancy

Diagnostic investigations

1st investigations to order

  • ECG
  • CXR
  • cardiac enzymes
  • CT scan
  • renal function tests
  • FBC
  • type and cross
Full details

Investigations to consider

  • D-dimer
  • trans-thoracic echocardiography (TTE)
  • trans-oesophageal echocardiography
  • MRI
  • intravascular ultrasound
  • smooth muscle myosin heavy chain protein
Full details

Treatment algorithm


Authors VIEW ALL

Professor and Chairman

Department of Cardiothoracic and Vascular Surgery

The University of Texas Medical School at Houston




HJS declares that he has no competing interests.

Professor Hazim J. Safi would like to gratefully acknowledge Dr Jeffrey Wu and Dr Eric E. Roselli, previous contributors to this monograph. JW and EER declare that they have no competing interests.

Peer reviewers VIEW ALL

Associate Professor of Surgery

Acting Chief

Division of Vascular and Endovascular Surgery

Montefiore Medical Center and the Albert Einstein College of Medicine




EL declares that he has no competing interests.

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