The clinical recognition of dissecting aortic aneurysm

Slater, Eve E.; DeSanctis, Roman W.

doi:10.1016/0002-9343(76)90496-4

Cited by 262 publications

(111 citation statements)

References 18 publications

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“…23 Although we measured BP in the ER, this value was unsuitable for inclusion in the ERAAD score because most patients with ACS or AAD had high BP, and some with type-A AAD were in shock. We initially included a history of hypertension in the score, but the findings from the multivariate regression model indicated that this was not appropriate.…”

Section: Components Of the Eraad Scorementioning

confidence: 99%

Diagnostic Score to Differentiate Acute Aortic Dissection in the Emergency Room

Shirakabe

Hata

Yokoyama

et al. 2008

Circ J

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cute aortic dissection (AAD) and acute coronary syndrome (ACS) are life-threatening cardiovascular emergencies that can be difficult to differentiate in the emergency room (ER), particularly if ACS is complicated with AAD, in which case the clinical signs of AAD may be overlooked. The diagnosis in the ER will affect the choice of treatment and, therefore, prognosis.Electrocardiography, cardiac ultrasonography, and myocardial markers can diagnose ACS, but the clinical symptoms and signs of AAD can be confusing. Enhanced computed tomography (CT) is valuable for diagnosis when AAD is suspected in the ER, although the rate of correct diagnosis has been reported as 40-74%. 1,2 Because AAD progresses to fatal complications within the first 48 h, mortality rates increase at the rate of 1-2% per hour. Other reports have indicated a 9-39% perioperative mortality rate for type-A AAD. [3][4][5] Thus, the correct differential diagnosis of AAD and ACS in the ER is critical 6,7 and the goal of the present study was to establish a diagnostic standard (ERAAD score) by clarifying information that is specific to AAD. Methods Study DesignStudy 1 In order to define the features of AAD and ACS we evaluated 131 patients with AAD or ACS who were admitted between April 2001 and March 2002. The clinical information included age, gender, presence of back pain, systolic and diastolic blood pressures (BP), serum creatine kinase level, ST-T segment changes on electrocardiograms (ECG), mediastinum thoracic ratio (MTR; Fig 1) and cardiothoracic ratio (CTR) on chest X-rays, and aortic regurgitation (AR) and aortic diameter on cardiac ultrasonograms, as well as history of smoking, hypertension, hyperlipidemia or diabetes mellitus. We scored the total number of indexes specific to AAD for each patient to obtain the ERAAD score. J 2008; 72: 986 -990 (Received October 20, 2007; revised manuscript received January 8, 2008; accepted January 17, 2008 Circ

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Section: Components Of the Eraad Scorementioning

confidence: 99%

Diagnostic Score to Differentiate Acute Aortic Dissection in the Emergency Room

Shirakabe

Hata

Yokoyama

et al. 2008

Circ J

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“…2,3) (Table I), usually about 2 cm cephalad to the sinotubularjunction. 117- 13 The entrance tear is in the arch of the aorta in about lo%, in the descending aorta in about 25% (Figs. 4-6) and, rarely (in about 3%), in the abdominal aorta.…”

Section: Atherosclerosismentioning

confidence: 99%

Nonneoplastic diseases of aorta and pulmonary trunk—Part I

Waller

Clary²,

Rohr³

1997

Clinical Cardiology

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“…Yet in studies of patients with proven aortic dissection, abnormal pulses have been found in only a few patients, ranging from 6% to 34%. [3][4][5] In other words, the pulses were normal in 66% to 94% of patients with aortic dissection. If we use the absence of pulse asymmetry to rule out aortic dissection, we would miss the diagnosis 66% to 94% of the time!…”

mentioning

confidence: 94%

“…Keep in mind that evidence on the frequency of clinical manifestations in one disease seldom includes the frequency of these same findings in other diseases. Given this, neither the specificity of the findings [3][4][5] and none presents a critical appraisal or a quantitative compilation of this evidence. †Textbooks are listed alphabetically.…”

mentioning

confidence: 99%

Textbook descriptions of disease -- where's the beef?

Richardson

2002

Evidence-Based Medicine

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The clinical recognition of dissecting aortic aneurysm

Cited by 262 publications

References 18 publications

Diagnostic Score to Differentiate Acute Aortic Dissection in the Emergency Room

Diagnostic Score to Differentiate Acute Aortic Dissection in the Emergency Room

Nonneoplastic diseases of aorta and pulmonary trunk—Part I

Textbook descriptions of disease -- where's the beef?

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