Summary
Definition
History and exam
Key diagnostic factors
- acute severe chest pain
- acute severe interscapular and lower back pain
- left/right blood pressure differential
- pulse deficit
- diastolic murmur
- features of Marfan syndrome
- features of Ehlers-Danlos syndrome
- 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
- hypertension
- atherosclerotic aneurysmal disease
- Marfan syndrome
- Ehlers-Danlos syndrome
- bicuspid aortic valve
- annulo-aortic 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
- non-diabetic
Diagnostic investigations
1st investigations to order
- ECG
- echocardiography
- chest x-ray
- CT (chest, abdomen, and pelvis)
- high-sensitivity troponin
- .renal function tests
- liver function tests
- lactate
- full blood count
- C-reactive protein
- group and save/cross match
- blood gas
- creatine kinase
- procalcitonin
Investigations to consider
- D-dimer
- magnetic resonance angiography
- intravascular ultrasound
Treatment algorithm
suspected aortic dissection: haemodynamically unstable
confirmed type A aortic dissection
confirmed type B aortic dissection: complicated
confirmed type B aortic dissection: uncomplicated
chronic aortic dissection
Contributors
Expert advisers
Ian Chetter, MBChb, FRCS (eng), MD, FRCS (Gen surg), PGCert Medical Ultrasound, PGDip Clinical Education
Chair of Surgery
University of Hull
Honorary Consultant Vascular Surgeon
Hull University Teaching Hospitals NHS Trust
Hull
UK
Disclosures
IC is Editor in chief for the Journal of Vascular Societies Great Britain and Ireland, and the research chair for the Vascular Society of Great Britain and Ireland. IC is also a member of NIHR Prioritising Committee and has received research grants from the NIHR.
Alexander Alexiou, MBBS, BSc, DCH, FRCEM, Dip IMC, RCSEd
Emergency Medicine Consultant
Barts Health NHS Trust
Physician Response Unit Consultant
London’s Air Ambulance
Royal London Hospital
London
UK
Disclosures
AA declares that he has no competing interests.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:
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
James H. Black III MD, FACS
Chief Vascular Surgery and Endovascular Therapy
Department of Surgery
The Johns Hopkins University School of Medicine
Baltimore
MD
Disclosures
CWH declares that she has no competing interests. JHB is a proctor for Cook, Inc.
Peer reviewers
Greg McMahon, MD, FRCS
Consultant Vascular Surgeon
University Hospitals of Leicester NHS Trust
Honorary Lecturer, College of Life Sciences
University of Leicester
Leicester
UK
Disclosures
GM declares that he has no competing interests.
Editors
Annabel Sidwell
Section Editor and Comorbidities Editor, BMJ Best Practice
Disclosures
AS declares that she has no competing interests.
Rachel Wheeler
Lead Section Editor, BMJ Best Practice
Disclosures
RW declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
Disclosures
AM declares that he has no competing interests.
Differentials
- Acute coronary syndrome
- Pericarditis
- Aortic aneurysm
More DifferentialsGuidelines
- Acute aortic syndromes: diagnosis and management, an update
- 2014 ESC guidelines on the diagnosis and treatment of aortic diseases
More GuidelinesPatient information
Aortic dissection
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