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Aortic dissection

Last reviewed: 2 Oct 2024
Last updated: 23 May 2023

Summary

Definition

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 tests

1st tests to order

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

Tests to consider

  • chest x-ray
  • D-dimer
  • transthoracic echocardiography
  • transesophageal echocardiography
  • MRI
  • intravascular ultrasound
  • smooth muscle myosin heavy chain protein
Full details

Treatment algorithm

INITIAL

hemodynamically unstable: suspected aortic dissection

ACUTE

confirmed aortic dissection

ONGOING

after hospital discharge

Contributors

Authors

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

Disclosures

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

Disclosures

JHB declares that he has no competing interests.

Acknowledgements

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.

Disclosures

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

Peer reviewers

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

Disclosures

EL declares that he has no competing interests.

  • Aortic dissection images
  • Differentials

    • Acute coronary syndrome
    • Pericarditis
    • Aortic aneurysm
    More Differentials
  • Guidelines

    • 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
    • Clinical practice guidelines on the management of Type B aortic dissection
    More Guidelines
  • Patient information

    Aortic dissection

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