Aortic emergencies

Knaut, Andrew L.; Cleveland, Joseph C.

doi:10.1016/s0733-8627(03)00063-4

Cited by 26 publications

(14 citation statements)

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“…Absence of chest radiograph abnormalities, sudden-onset pain, and a history of hypertension all decrease the likelihood of the diagnosis. However, advanced imaging studies such as CT, magnetic resonance imaging (MRI), digital subtraction angiography (DSA), and echocardiography will still be required to confirm to rule out the diagnosis (20,23,24). At this point D-dimer will help physicians as a sensitive test for AAD diagnosis, and potentially a useful test for patients who present with a low likelihood of this disease (absence of tearing or ripping aortic pain, mediastinal widening, pulse and blood pressure differentials) (25,26).…”

Section: Discussionmentioning

confidence: 99%

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Can D-dimer testing help emergency department physicians to detect acute aortic dissections?

Ersel¹,

Aksay²,

Kıyan³

et al. 2010

Anadolu Kardiyol Derg

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Objective: To determine the diagnostic accuracy of D-dimer testing for detection of acute aortic dissection. Methods: This study is a retrospective chart review of patients who had been evaluated with suspicion of acute aortic dissection. All patients' D-dimer levels were determined prior to their further work up in the emergency department. The study was conducted in a tertiary care center between February 2006-August 2008. The D-dimer assay used was the immunoturbidimetric assay, with a normal range up to 0.246 μg/ml. Statistical analysis was accomplished using Chi-square test, Student's t-test and a receiver-operating characteristics (ROC) curve analysis. Results: Ninety-nine patients were included in the study, 30 patients were diagnosed as having acute aortic dissection and 69 patients were evaluated in non-acute aortic dissection group. In comparison of the two groups, positive D-dimer results were found to be significantly higher in acute aortic dissection group than in non-acute aortic dissection group (p<0.001). Sensitivity of the D-dimer test in detection of acute aortic dissection was found as 96.6% and the negative predictive value of the test was 97.3%. Specificity and positive predictive value of the D-dimer test were 52.2% and 46.8%, respectively. The area under the ROC curve yielded an acceptable certainty for excluding acute aortic dissection on base of negative results (AUC: 0.764; CI 95%: 0.674-0.855; p<0.001). Conclusion: D-dimer testing is helpful for emergency physicians in detection of patients with suspected acute aortic dissection in the emergency department. (Anadolu Kardiyol Derg 2010; 10: 434-9) Key words: Acute aortic dissection, D-dimer, fibrin degradation products, emergency department, diagnostic value of tests ÖZET Amaç: D-dimer testinin akut aort disseksiyonunu belirlemede tanısal değerini saptamak. Yöntemler: Bu çalışma retrospektif bir çalışmadır. Acil serviste akut aort disseksiyonu şüphesi mevcut olan ve ileri tetkik öncesi D-dimer testi istenen hastalar çalışmaya dâhil edilmiştir. 3. basamak bir sağlık kuruluşunda gerçekleştirilen çalışmada, Şubat 2006-Ağustos 2008 tarihleri arasındaki kayıtlar incelenmiştir. Kullanılan D-dimer ölçüm yöntemi immunoturbidimetrik yöntemdir ve 0.246 μg/ml'ye kadar olan sonuçlar normal olarak kabul edilmiştir. İstatistiksel analizde Ki-kare testi, Student's t-testi kullanılmış, ayrıca ROC eğrisi analizi yapılmıştır. Bulgular: Çalışmaya 30 akut aort disseksiyonu mevcut, 69 akut aort disseksiyonu mevcut olmayan kontrol grubu olmak üzere 99 hasta dâhil edilmiştir. Bu iki gruba ait D-dimer ölçümlerinin karşılaştırılmasında akut aort disseksiyonu olan hastaların olmayanlara göre istatistiksel anlamlı olarak daha fazla pozitif sonucunun olduğu görülmüştür (p<0.001). Akut aort disseksiyonunu saptamada D-dimer testinin duyarlılığı %96.6 özgünlüğü %52.2 negatif prediktif değeri %97.3 pozitif prediktif değeri ise %46.8 olarak bulunmuştur. ROC analizi sonucunda eğri altında kalan (AUC) değeri 0.764 (CI %95: 0.674-0.855) ve p<0.001) olarak saptanmı...

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Section: Discussionmentioning

confidence: 99%

“…Aortic dissection was considered to be chronic, at least 14 days after onset of aortic dissection (AD) defined by the initial episode of intense pain (20). Dissections were classified on the basis of false lumen propagation to the ascending aorta (DeBakey 1, 2, and 3) (21).…”

Section: Methodsmentioning

confidence: 99%

Can D-dimer testing help emergency department physicians to detect acute aortic dissections?

Ersel¹,

Aksay²,

Kıyan³

et al. 2010

Anadolu Kardiyol Derg

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“…However, transesophageal echocardiography, magnetic resonance imaging, or computed tomography will still be required to confirm or rule out the diagnosis. 7 …”

Section: Take Home Messagementioning

confidence: 99%

Clinical Assessment for Acute Thoracic Aortic Dissection

Bushnell

Brown

2005

Annals of Emergency Medicine

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“…It occurs when blood enters the medial layer of the aortic wall through a tear or penetrating ulcer in the intima and tracks along the media, forming a second blood-filled channel within the wall [1]. The main causes of dissection are hypertension, atherosclerosis, Marfan's syndrome, Ehlers-Danlos syndrome, vasculitis, pregnancy and iatrogenic (aortic catheterization) [2].…”

Section: Introductionmentioning

confidence: 99%

Report on Acute Aortic Dissection Type A

Simoglou¹,

Konstantinou²,

Mikroulis³

et al. 2015

WJCS

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Background: Acute aortic dissection is a common life-threatening disorder affecting the aorta. The immediate mortality rate in aortic dissection is as high as 1% per hour over the first several hours, making early diagnosis and treatment critical for survival. Case presentation: We are presenting a case of Stanford Type A aortic dissection in a 58-year-old male patient with a history of hypertension. He arrived at the emergency department (ED) with diagnosed acute coronary syndrome a few hours after a sudden and severe worsening of his epigastric pain. Interesting case where the dissection starts from the orifice of the right coronary artery, occupies the aortic valve. Conclusion: Predictors of follow-up this cause mortality reflect patient history variables as opposed to in-hospital parameters or in-hospital complications, which may be explained by the successful in-hospital treatment of the acute dissection.

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Aortic emergencies

Cited by 26 publications

References 100 publications

Can D-dimer testing help emergency department physicians to detect acute aortic dissections?

Can D-dimer testing help emergency department physicians to detect acute aortic dissections?

Clinical Assessment for Acute Thoracic Aortic Dissection

Report on Acute Aortic Dissection Type A

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