Guilt by association: paradigm for detecting a silent killer (thoracic aortic aneurysm)

Elefteriades, John A.; Sang, Adam X.; Kuzmik, Gregory A.; Hornick, Matthew A.

doi:10.1136/openhrt-2014-000169

Cited by 93 publications

(53 citation statements)

References 32 publications

(25 reference statements)

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“…rapture which is associated with the mortality of ruptured aneurisms rating even up to 90%. (3,4) The disturbing fact is that the rupture of a large AAA can even occur without the manifestation of previous symptoms. Conclusion Despite the progress achieved over the last decades in the field of prehospital diagnostics and therapy, AAA remains a great challenge for EMS physicians.…”

Section: Discussionmentioning

confidence: 99%

“…(2) Mostly asymptomatic, AAA has been termed the"silent killer" because it often remains undiagnosed until the moment of rapture or death of the pa tient. (3,4) According to the recently published articles AAA is considered the ticking time bomb (5) that can develop into catastrophe. (6) Although today there are sophisticated methods for early detection of AAA, even those of large diameter are still discovered as the incidental finding of ultrasound examination performed from other reasons.…”

Section: Introductionmentioning

confidence: 99%

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Ticking time bomb: abdominal aortal aneurism detected at prehospital level

2017

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The cause of sudden death is increasingly more frequent due to abdominal aortal aneurism (AAA). This ticking "time bomb" in the abdomen is particularly inconvenient for diagnosis and treatment at the prehospital level. We present a rare case of prehospitally detected AAA that like the ticking time bomb threatened to rupture. Case scenario. A 66 years old male called Emergency Medical Services (EMS) due to unbearable pain (9/10 at the pain intensity scale) of crescendo type in the right gluteal region and the right hip. Four days before, due to a sudden feeling of pain within the above quoted region he underwent neurological, orthopedic and urological examinations. The diagnosis of coxarthrosis/ coxalgia was made. He was treated with analgesics with suggested rest. Anamnestically, he was previously healthy, without family history of AAA. He is a several-year smoker and hypertonic. Physical findings: conscious, orientated, eupnoic, afebrile, normal skin color, with visible mucosa, excessive sweating and obesity. Auscultatory findings of the lungs and heart were also within normal limits. SaO2 = 99%. Blood pressure (BP) on both hands was 170/100 mmHg. ECG: sinus rhythm with a frequency of 80/min, without acute ST-T changes. The abdomen above the chest was with palpable pulsating tumefaction (size 5-6 cm) in the right inguinum that was respiratory immovable. Lazarević sign negative. Prehospital diagnosis was made: suspected AAA. On admission: treated as the emergency case, after multislice computed tomography (MSCT) and angiographic findings indication for emergency surgical intervention was made. He was of good general condition and satisfactory local status. Ten days after surgery the patient was released from hospital with prescribed antihypertensive and antiaggregant therapy, and was also forbidden smoking. Conclusion. The reported case is the confirmation that AAA represents a ticking "time bomb" in the organism that requires emergency prehospital recognition, emergency care and high emergency transport to a hospital.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ticking time bomb: abdominal aortal aneurism detected at prehospital level

2017

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“…This causes destruction of collagen and elastin in the ECM and loss of smooth muscle cells [11]. ECM breakdown by MMPs is responsible for thinning and destruction of the normal architecture of the aortic wall, rendering it susceptible to dilation and aneurysm formation [12, 13]. (Fig.…”

Section: Background (Pathophysiology Of Aneurysm Formation)mentioning

confidence: 99%

“…TAA is a potentially lethal disease, which is often asymptomatic until a devastating fatal rupture or dissection occurs [12, 39]. About 10.4/100,000 people develop a TAA per year in the USA [39].…”

Section: Specific Impact Of Diabetes On Taamentioning

confidence: 99%

Diabetes Mellitus: Is It Protective against Aneurysm? A Narrative Review

et al. 2018

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Objectives: In the course of extensive clinical aortic surgery, we noticed that the aorta was quite thick and fibrotic in diabetic patients. We thought the diabetic aortic aorta might be inimitable to aortic dissection. On this basis, we set out to review information in the literature regarding aortic growth and dissection in diabetic patients. Methods: We used a 2-step search approach to the available literature on diabetes and aneurysm. Firstly, databases including PubMed, Cochrane, Embase and TRIP were searched. Secondly, relevant studies were identified through secondary sources including references of initially selected articles. We address the relationship between diabetes and the incidence, prevalence, growth, mortality and rupture of an aneurysm. Results: Diabetes is thought to exert a protective role in both thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA). Diabetics were shown to have a slower aneurysm growth rate, lower rupture rate, delayed (> 65 years) age of rupture, decreased rate of mortality from an aneurysm and a decreased length of hospital stay. There was also noted a decreased rate of incidence and prevalence of TAA and AAA in diabetics, smaller aneurysm diameter, reduction in matrix metalloproteinases and an increased aortic wall stress in diabetics. Antidiabetic agents like metformin, thiazolidinediones and dipeptidyl peptidase-4 inhibitors may protect against an aneurysm. Conclusion: Our literature review provides strong (but often circumstantial) evidence that diabetic patients exhibit slower growth of aortic aneurysms and a lower rate of aortic dissection. Furthermore, clinical and experimental studies indicate that common antidiabetic medications on their own inhibit growth of aortic aneurysms. These findings indicate a paradoxically beneficial effect of the otherwise highly detrimental diabetic state.

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“…The question is: how to detect individuals with (or at risk of developing) an asymptomatic disease? In this manuscript we review a paradigm for detection of individuals at risk of thoracic aortic disease that we call "Guilt by Association" (16), which is based on recognition of clinical conditions associated with thoracic aortic disease (Video 1).…”

Section: Introductionmentioning

confidence: 99%

Guilt by association: a paradigm for detection of silent aortic disease

Ziganshin¹,

Elefteriades²

2016

ASVIDE

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Detection of clinically silent thoracic aortic aneurysm (TAA) is challenging due to the lack of symptoms (until aortic rupture or dissection occurs). A large proportion of TAA are identified incidentally while imaging a patient for other reasons. However, recently several clinical "associates" of TAA have been described that can aid in identification of silent TAA. These "associates" include intracranial aneurysm, aortic arch anomalies, abdominal aortic aneurysm (AAA), simple renal cysts (SRC), bicuspid aortic valve, temporal arteritis, a positive family history of aneurysm disease, and a positive thumb-palm sign. In this article we examine these associates of TAA and the data supporting their involvement with asymptomatic TAA.

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Guilt by association: paradigm for detecting a silent killer (thoracic aortic aneurysm)

Cited by 93 publications

References 32 publications

Ticking time bomb: abdominal aortal aneurism detected at prehospital level

Ticking time bomb: abdominal aortal aneurism detected at prehospital level

Diabetes Mellitus: Is It Protective against Aneurysm? A Narrative Review

Guilt by association: a paradigm for detection of silent aortic disease

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