Acute aortic dissection in the ED: risk factors and predictors for missed diagnosis

Chua, Mui Teng; Ibrahim, Irwani; Neo, Xinyi; Sorokin, Vitaly; Shen, Liang; Ooi, Shirley Beng Suat

doi:10.1016/j.ajem.2011.11.017

Cited by 64 publications

(52 citation statements)

References 21 publications

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“…Actually, there is growing evidence that multiple assessments of several biomarkers may provide complementary information about the risk of death in aortic dissection patients. 12,13) Fragmented QRS complex (fQRS) is a simple available electrocardiographic entity that provides an additional risk stratification level and conventional risk parameters in predicting in-hospital mortality of AAD. 14) Bonnefoy, et al 15) believe that troponin I (TnI) elevation is frequent in patients with AAD, which further reflects a higher hemodynamic stress but does not necessarily reflect a negative prognosis.…”

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Biomarkers Investigation for In-Hospital Death in Patients With Stanford Type A Acute Aortic Dissection

et al. 2016

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SummaryThis retrospective study aimed to investigate the predictive value of biomarkers for in-hospital mortality of patients with Stanford type A acute aortic dissection (AAD).AAD is a life-threatening disease with an incidence of about 2.6-3.6 cases per 100,000/year. A total of 67 consecutive Stanford type A AAD patients admitted to hospital were divided into a deceased group and survival group. The baseline information of the patients between two groups was systematically compared, followed by examination of the electrocardiograms (ECG). Based on the follow-up during hospitalization, we investigated the simultaneous assessment of indexes like fragmented QRS complex (fQRS), admission systolic blood pressure (SBP), aortic diameter, surgical management, troponin I (TnI), white blood cell (WBC) count, N-terminal pro-brain natriuretic peptide (NT-proBNP), and D-dimer.The levels of TnI and NT-proBNP, WBC counts, and rate of fQRS (+) in patients of the deceased group were significantly higher than those in the survival group. The male sex (hazard ratio, 10.88; P = 0.001), admission SBP (hazard ratio, 0.98; P = 0.012), NT-proBNP (hazard ratio, 1.00; P = 0.001), and WBC count (hazard ratio, 1.10; P = 0.033) were independently related with in-hospital death. As a single marker, WBC count had the highest sensitivity at 84.6% (specificity 65.9%).Admission SBP, NT-proBNP, and WBC count were potential independent risk factors of in-hospital death in Stanford type A AAD patients. WBC count may be a more accurate predictor of type A AAD than either alone. (Int Heart J 2016; 57: 622-626)

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Biomarkers Investigation for In-Hospital Death in Patients With Stanford Type A Acute Aortic Dissection

et al. 2016

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“…Although a widened mediastinum in a chest roentgenogram is an important finding, which suggests the presence of AAAD, 15) not a few patients present with normal mediastinum shadow; thus, aortic dissection cannot be ruled out, only with chest X-ray findings. 16) Among blood examinations, D-dimer can be useful for quickly suspecting or ruling out aortic dissection. Negative D-dimer (<500 ng/mL) in patients with chest pain makes the presence of AAAD or pulmonary embolism unlikely.…”

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Acute Type A Aortic Dissection: for Further Improvement of Outcomes

Orihashi¹

2012

Annals of Vascular Diseases

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Despite improved outcomes of acute type A aortic dissection (AAAD), many patients die at the moment of onset, and hospital mortality is still high. This article reviews the latest literature to seek the best possible way to optimize outcomes. Delayed diagnosis is caused by variation in or absence of typical symptoms, especially in patients with neurological symptoms. Misdiagnosis as acute myocardial infarction is another problem. Improved awareness by physicians is needed. On arrival, quick admission to the OR is desirable, followed by assessment with transesophageal echocardiography, and malperfusion already exists or newly develops in the OR; thus, timely diagnosis without delay with multimodality assessment is important. Although endovascular therapy is promising, careful introduction is mandatory so as not to cause complications. While various routes are used for the systemic perfusion, not a single route is perfect, and careful monitoring is essential. Surgical treatment on octogenarians is increasingly performed and produces better outcomes than conservative therapy. Complications are not rare, and consent from the family is essential. Prevention of AAAD is another important issue because more patients die at its onset than in the following treatment. In addition to hereditary diseases, including bicuspid aortic valve disease, the management of blood pressure is important.Keywords: aortic dissection, malperfusion, complication, echocardiography A cute type A aortic dissection (AAAD) not only causes sudden death at the time of onset but leads to various life-threatening complications. In spite of improved diagnostic imaging and surgical strategies, in-hospital mortality is still high, and patients who have survived often suffer from sequelae that make subsequent quality of life poor. This article is aimed to review the latest literature and ideas to seek the best possible way to minimize undesirable results.Various complications of AAAD caused by separation of the aortic wall to outer and inner layers are summarized as three categories: 1) aortic rupture due to disruption of the outer layer; 2) malperfusion caused by the inner layer, that is, the intimal flap; and 3) aortic regurgitation by a deformed aortic valve, leading to acute heart failure. Approximately 20% of patients instantaneously die due to aortic rupture, 1) and 1 to 2% of the remaining patients die every hour unless appropriately treated. 2) Although surgical outcomes are gradually improving, in-hospital mortality of surgical patients (repair on the aortic root to the arch) in 2009 was as high as around 10%, according to the Japanese database. 3) For the further improvement of outcomes, problems should be solved in each of preonset, pre-hospital, and in-hospital stages. In this review, the latter two stages are discussed first, since most of the literature focuses on these stages. After that, the issue of pre-onset stage, i.e., prevention is discussed. DelayeD DiagnosisIn consideration of the natural history of AAAD, the "chain of onset-to-sur...

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“…Travma vetravma dışı nedenlerle de meydana gelebilmektedir (1). Aort diseksiyonu Marfan sendromu, Ehler-Danlos sendromu, transforming growth faktör reseptör mutasyonu olan hastalar ve Turner sendromlu hastalarda normal populasyona göre daha sık görülür (6). Bu olguda kesin bir tanı olmamakla birlikte hastanın klinik görünümü marfanoiddi.…”

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“…Epigastrik ağrı, göğüs ağrısı, bulantı ve ishal şikayetleriyle gelen hastalarda klinik şüphe hayat kurtarıcı olabilir (6). 469,5 ng/dL idi.…”

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The importance of clinical suspicion in the diagnosis of a successfully managed case with De Bakey Type 1 acute aortic dissection: A case report

Salman

Çeliksoy

Yetışır

et al. 2014

UCD

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Type 1 aortic dissection is a catastrophic clinical entity originating from the ascending aorta. Clinical suspicion in patients with epigastric pain, chest pain and gastrointestinal symptoms might be life saving. Aortic dissection and acute mesenteric ischemia might be confusing in diagnosis of patients with epigastric pain, chest pain, gastrointestinal symptoms and high white blood cell count and D-dimer. In this case report of a patient who was admitted to the emergency room with a presentation resembling acute mesenteric ischemia, this diagnosis was excluded within the first 24 hours as a result of clinical suspicion. In this case report, the successful management in diagnosis and treatment of a 30-year-old male patient with type 1 aortic dissection is discussed in light of the literature.

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Acute aortic dissection in the ED: risk factors and predictors for missed diagnosis

Cited by 64 publications

References 21 publications

Biomarkers Investigation for In-Hospital Death in Patients With Stanford Type A Acute Aortic Dissection

Biomarkers Investigation for In-Hospital Death in Patients With Stanford Type A Acute Aortic Dissection

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

The importance of clinical suspicion in the diagnosis of a successfully managed case with De Bakey Type 1 acute aortic dissection: A case report

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