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
Other diagnostic factors
- hypertension
- dyspnea
- altered mental status
- paraplegia
- hemiparesis/paresthesia
- 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
- 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
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
Tests to consider
- chest x-ray
- D-dimer
- transthoracic echocardiography
- transesophageal echocardiography
- MRI
- intravascular ultrasound
- smooth muscle myosin heavy chain protein
Treatment algorithm
hemodynamically unstable: suspected aortic dissection
confirmed aortic dissection
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.
Differentials
- Acute coronary syndrome
- Pericarditis
- Aortic aneurysm
More DifferentialsGuidelines
- 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 GuidelinesPatient information
Aortic dissection
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