Aortic dissection

Last reviewed: 16 Apr 2022
Last updated: 27 Jan 2021

Summary

Definition

History and exam

Key diagnostic factors

  • features of Marfan syndrome
  • features of Ehlers-Danlos syndrome
  • acute severe chest pain
  • interscapular and lower pain
  • left/right blood pressure differential
  • pulse deficit
  • diastolic murmur
  • syncope
  • hypotension
More key diagnostic factors

Other diagnostic factors

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

Risk factors

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

Diagnostic investigations

1st investigations to order

  • ECG
  • chest x-ray
  • cardiac enzymes
  • computed tomography angiography
  • renal function tests
  • liver function tests
  • lactate
  • complete blood count
  • type and cross
More 1st investigations to order

Investigations to consider

  • D-dimer
  • transthoracic echocardiography
  • transesophageal echocardiography
  • magnetic resonance angiography
  • intravascular ultrasound
  • smooth muscle myosin heavy chain protein
More investigations to consider

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 declares that she has no competing interests.

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 is a proctor for Cook, Inc.

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

    • ESVS guidelines on the management of descending thoracic aorta diseases
    • 2014 ESC guidelines on the diagnosis and treatment of aortic diseases
    More Guidelines
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