Early recognition of acute thoracic aortic dissection and aneurysm

Abstract

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.

Acute Thoracic Aortic Dissection (Stanford B): Challenges in Early Detection and Management

“…The echocardiogram revealed an important lead for which CTA confirmed the aortic dissection. This is substantiated by the Michael Leitman et al study [5] on early recognition of acute thoracic aortic dissection and aneurysm concluded that increasing heart rate, chest pain, diabetes, head and neck pain, dizziness and history of myocardial infarction (MI) can be used to differentiate acute coronary syndrome (ACS) from thoracic aortic dissection/aneurysm. Nevertheless, both diseases could manifest concomitantly whereby the dissecting flap may extend as far as the commencement of the main coronary artery at the root of the ascending aorta which is more commonly in type A aortic dissection [6].…”

“…The damage of the intimal explains the weakened tunica layers of the aorta as a result of artherosclerotic vessel in hypercholestrolaimic individual [4]. Furthermore, the hemodynamic of hypertension could potentially cause for hydrodynamic or shearing forces which lead to aorta cause tear of intima [5].…”

“…Data showed that average age for aortic dissection to occur is in the 60s and that two thirds of dissections occur in men [5]. The damage of the intimal explains the weakened tunica layers of the aorta as a result of artherosclerotic vessel in hypercholestrolaimic individual [4].…”

Acute aortic dissection overlapping with herniated discs in thoracic and lumbosacral spine

“…Difference in the blood pressure between the arms wasn't greater than 20mmHg. Laboratory: D dimer was high 5.4 (normal range <0.5ug/ml FEU), leukocytes 12 x10 9 (normal range 3.7-10x10 9 ), low hematocrit 0.3 (normal range 0.415-0.53x10 12 ), low haemoglobin 106 g/L (normal range 138-175 g/L), high platelet counts 600x10 9 (normal range 135-450x10 9 ), urea nitrogen 19.0mmol/L (normal range 3-8 mmol/L) and creatinine 120 umol/L (normal range 49-106 umol/L). Echocardiography showed acute aortic dissection presenting with pericardial effusion (with pericardial hematoma), dilated ascending aorta with intimal flap in ascendant and abdominal aorta (Fig 2).…”

Atypical manifestations of pulmonary embolism

“…Thoracic aortic dissection (TAD) can fortuitously coexist with PE. Misdiagnosis may be attributable to the fact that both disorders may be characterized by chest pain and dyspnea [78], pleuritic pain and haemoptysis [79], and elevation in serum D-dimer levels [80]. Furthermore, a Taiwanese nationwide cohort study showed that , after adjusting for age, sex, and duration of hospitalisation, patients with aortic aneurysms(AA) were associated with a 1.88-fold higher risk of DVT (95% Con idence Interval 1.52 to 2.33) and a 1.90-fold higher risk of PE (95% CI 1.58 to 2.25) compared with the non-AA cohort.…”