Aortic dissection history and symptoms
Aortic dissection Microchapters
Aortic dissection history and symptoms On the Web
History of patients with aortic dissection may be positive for factors such as connective tissue disease, known aortic valve disease, recent heart surgery, Known thoracic aortic aneurysm, and family history of the aortic disease. Sudden onset chest/back pain is the most common symptom of aortic dissection. Pain may be of sharp, ripping, tearing, and knife-like quality.
History and Symptoms
- Connective tissue disease such as Marfan's syndrome
- Family history of the aortic disease
- Known aortic valve disease such as bicuspid aortic valve disease
- Recent heart surgery or aortic manipulation
- Known thoracic aortic aneurysm
- Chest pain (especially migrating pain)
- Sudden onset of pain is the most common symptom.
- The quality of pain is different from other causes of chest pain. it may be sharp, ripping, tearing, and knife-like.
- The most common site of pain in order of frequency is chest (80%), back (40%), and abdomen (25%).
- Type A aortic dissection more commonly presents with chest pain, whereas type B tends to manifest with back/abdominal pain.
- Neck, throat, and jaw pain
- Back pain
- Pleuritic pain (maybe suggestive of acute pericarditis due to hemorrhage into the pericardial sac.
- It worth mentioning that the presence of pain is not necessary for the diagnosis of aortic dissection. Patients may present with syncope, stroke or symptoms suggestive of congestive heart failure (CHF).
Less Common Symptoms
- Abdominal pain following mesenteric ischemia
- Cardiac arrest (rarely)
- Claudication due to iliac artery involvement
- Symptoms of congestive heart failure may be observed due to aortic root dilatation leading to aortic insufficiency
- Dysphagia due to compression of the esophagus
- Hemoptysis due to compression of and erosion into the bronchus
- Horner syndrome due to compression of the superior cervical ganglia
- Oliguria/ Anuria due to involvement of the renal arteries causing pre-renal azotemia.
- Paraplegia, paralysis from involvement of one of the cerebral or spinal arteries
- Stridor and wheezing due to compression of the airway
- Swelling of the neck and face due to compression of the superior vena cava or Superior vena cava syndrome
- Upper gastrointestinal (UGI) bleed
- hoarseness (compression of the recurrent laryngeal nerve)
History and Symptoms Associated with High Pretest Probability of Aortic Dissection
2014 ESC Guidelines on the Diagnosis and Treatment of Aortic Diseases
Clinical Assessment of Patients Suspicious of Aortic Dissection
|"In all patients with suspected AAS, pre-test probability assessment is recommended, according to the patient’s condition, symptoms, and clinical features.(Level of Evidence: B)"|
2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients with Thoracic Aortic Disease (DO NOT EDIT)
History and Physical Examination for Thoracic Aortic Disease (DO NOT EDIT)
|"1. For patients presenting with a history of acute cardiac and noncardiac symptoms associated with a significant likelihood of thoracic aortic disease, the clinician should perform a focused physical examination, including a careful and complete search for arterial perfusion differentials in both upper and lower extremities, evidence of visceral ischemia, focal neurological deficits, a murmur of aortic regurgitation, bruits, and findings compatible with possible cardiac tamponade. (Level of Evidence: C)"|
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