Acute aortic dissection

Acute aortic dissection is an uncommon but lethal cause of acute chest, back, and abdominal pain. Establishing a timely diagnosis is paramount, as mortality from acute aortic dissection rises by the hour. Physical findings are protean and may include acute aortic valve insufficiency, peripheral puls...

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Bibliographic Details
Published in:Journal of hospital medicine 2006-03, Vol.1 (2), p.94-105
Main Author: Siegal, Eric M.
Format: Article
Language:English
Subjects:
Acute Disease
adrenergic beta-antagonists
Aneurysm, Dissecting - diagnosis
Aneurysm, Dissecting - therapy
Aortic Aneurysm - diagnosis
Aortic Aneurysm - therapy
aortic diseases
chest pain
Humans
hypertensive emergency
Marfan syndrome
Risk Factors
shock
thoracic surgery
vascular surgery
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Summary:Acute aortic dissection is an uncommon but lethal cause of acute chest, back, and abdominal pain. Establishing a timely diagnosis is paramount, as mortality from acute aortic dissection rises by the hour. Physical findings are protean and may include acute aortic valve insufficiency, peripheral pulse deficits, a variety of neurologic deficits, or end‐organ ischemia. The keys to establishing a timely diagnosis are maintaining a high index of suspicion and quickly obtaining a diagnostic study. CT angiography, magnetic resonance imaging, transesophageal echocardiography, and, to a lesser extent, aortography are all highly accurate imaging modalities. The choice of study should be driven by the clinical stability of the patient, the information required and the resources available at presentation. Proximal dissections are surgical emergencies, but distal dissections are generally treated medically. Endovascular stents are gaining favor for use in the repair of both acute and chronic distal dissections. Long‐term outcome data for endovascular stenting are still limited, and it remains unclear when stenting should be favored over surgery or medical therapy. Journal of Hospital Medicine 2006;1:94–105. © 2006 Society of Hospital Medicine
ISSN:1553-5592
1553-5606
DOI:10.1002/jhm.69