Aortic Dissection

Ankel, Felix

doi:10.1016/b978-0-323-05472-0.00083-9

Cited by 5 publications

(1 citation statement)

References 46 publications

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“…Thrombolytic therapy for acute myocardial infarction would be contraindicated in patients with acute thoracic aortic disease. Further confusion may be caused by EKG analysis because it has been reported that 0.1-0.2% of patients with proximal TAD will have ST-elevation myocardial infarctions occur in the setting [ 27 ]. Luo reported on six patients with clear electrocardiographic and serological evidence of acute myocardial infarction and concomitant thoracic aortic dissection, underscoring the need to be continuously vigilant for acute thoracic aortic disease, even after the diagnosis of myocardial infarction is confirmed [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Early recognition of acute thoracic aortic dissection and aneurysm

et al. 2013

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BackgroundThoracic aortic dissection (TAD) and aneurysm (TAA) are rare but catastrophic. Prompt recognition of TAD/TAA and differentiation from acute coronary syndrome (ACS) is difficult yet crucial. Earlier identification of TAA/TAD based upon routine emergency department screening is necessary.MethodsA retrospective analysis of patients that presented with acute thoracic complaints to the ED from January 2007 through June 2012 was performed. Cases of TAA/TAD were compared to an equal number of controls which consisted of patients with the diagnosis of ACS. Demographics, physical findings, EKG, and the results of laboratory and radiological imaging were compared. P-value of > 0.05 was considered statistically significant.ResultsIn total, 136 patients were identified with TAA/TAD, 0.36% of patients that presented with chest complaints. Compared to ACS patients, TAA/TAD group was older (68.9 vs. 63.2 years), less likely to be diabetic (13% vs 32%), less likely to complain of chest pain (47% vs 85%) and head and neck pain (4% vs 17%). The pain for the TAA/TAD group was less likely characterized as tight/heavy in nature (5% vs 37%). TAA/TAD patients were also less likely to experience shortness of breath (42% vs. 51%), palpitations (2% vs 9%) and dizziness (2% vs 13%) and had a greater incidence of focal lower extremity neurological deficits (6% vs 1%), bradycardia (15% vs. 5%) and tachypnea (53% vs. 22%). On multivariate analysis, increasing heart rate, chest pain, diabetes, head & neck pain, dizziness, and history of myocardial infarction were independent predictors of ACS.ConclusionsIncreasing heart rate, chest pain, diabetes, head & neck pain, dizziness, and history of myocardial infarction can be used to differentiate acute coronary syndromes from thoracic aortic dissections/aneurysms.

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Section: Discussionmentioning

confidence: 99%

Early recognition of acute thoracic aortic dissection and aneurysm

et al. 2013

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Acute Aortic Dissection in the Emergency Department: Diagnostic Challenges and Evidence-Based Management

Upadhye

Schiff

2012

Emergency Medicine Clinics of North America

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Evaluation of Acute Aortic Dissections in the Emergency Department: A Retrospective Study

Çanakçı¹,

Şevik²,

Ay³

et al. 2021

Osmangazi̇ Journal of Medicine

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Aortic dissection (AD) is a life-threatening emergency that has a mortality rate of around 27% even when optimal conditions are met. Atypical process of the disease which can mimic other critical conditions makes it harder to diagnose. The study aimed to determine Emergency department presentations and factors that influence the diagnostic process, emergency department, and in-hospital mortalities of acute AD patients. This study is a single-centered retrospective observational study. Patients with ICD-10 codes for AD in their digital files were analyzed. Patients were categorized into Stanford Type A or B dissections according to their computerized tomography scans. Also, the patients were compared in terms of survival. Eighty-eight patients had an acute AD and the mean age was 61,90±12,67 years. According to Stanford Classification, 68 patients had Type A dissection. Altered mental status and syncope were detected more in Type A (p=0.003 and p=0.001). Bilateral arm blood pressure readings differential was more in Type A (p=0.007). Blood products were used and endotracheal intubation was performed more in Type A (p=0.002 and p=0.005). Patients who had bilateral arm blood pressure differential had 3.5-fold, who had developed cardiac arrest in ED had 5.07-fold, who got blood product transfusions had 5.41-fold more risk of death. [OR:3.50; (CI 95% 1.36-8.94) p=0.009, OR: 5.07; (CI 95% 1.18-21.39) p=0.027 and OR: 5.41; (CI 95% 1.97-14.78) p=0.001 respectively]. The mortality rates in ED and in-hospital were 12.5% and 61.4% respectively. Aortic dissections will stay as important clinical conditions which management in ED is crucial. Atypical presentation of AD and the nature of the disease cause delays in diagnoses. AD should be considered in the foreground in patients presenting with syncope and altered mental status. When there is a clinical suspicion the scan of the aorta with computerized tomography must be ordered rapidly.

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Aortic Dissection

Cited by 5 publications

References 46 publications

Early recognition of acute thoracic aortic dissection and aneurysm

Early recognition of acute thoracic aortic dissection and aneurysm

Acute Aortic Dissection in the Emergency Department: Diagnostic Challenges and Evidence-Based Management

Evaluation of Acute Aortic Dissections in the Emergency Department: A Retrospective Study

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