Aortic dissection risk factors

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Raviteja Guddeti, M.B.B.S. [3]

Overview

Aging, atherosclerosis, diabetes, hypertension and trauma are common risk factors for aortic dissection. Uncommon risk factors include bicuspid aortic valve, cocaine, coarctation of the aorta, cystic medial necrosis, Ehlers-Danlos syndrome, giant cell arteritis, heart surgery, Marfan’s syndrome, pseudoxanthoma elasticum, Turner's syndrome, tertiary syphilis and the third trimester of pregnancy.

Risk Factors

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)[2]

Estimation of Pretest Risk of Thoracic Aortic Dissection (DO NOT EDIT)[2]

Class I
"1. Providers should routinely evaluate any patient presenting with complaints that may represent acute thoracic aortic dissection to establish a pretest risk of disease that can then be used to guide diagnostic decisions. This process should include specific questions about medical history, family history, and pain features as well as a focused examination to identify findings that are associated with aortic dissection, including:
a. High-risk conditions and historical features[3][4][5][6] (Level of Evidence: B):
b. High-risk chest, back, or abdominal pain features[3][4][5][6][7][8][9][10] (Level of Evidence: B):
  • Pain that is abrupt or instantaneous in onset.
  • Pain that is severe in intensity.
  • Pain that has a ripping, tearing, stabbing, or sharp quality.
c. High-risk examination features[3][5][6][10][11][12][13] (Level of Evidence: B):
"2. Patients presenting with sudden onset of severe chest, back, and/or abdominal pain, particularly those less than 40 years of age, should be questioned about a history and examined for physical features of Marfan syndrome, Loeys-Dietz syndrome, vascular Ehlers-Danlos syndrome, Turner syndrome, or other connective tissue disorders associated with thoracic aortic disease.[4] (Level of Evidence: B)"
"3. Patients presenting with sudden onset of severe chest, back, and/or abdominal pain should be questioned about a history of aortic pathology in immediate family members as there is a strong familial component to acute thoracic aortic disease.[4] (Level of Evidence: B)"
"4. Patients presenting with sudden onset of severe chest, back, and/or abdominal pain should be questioned about recent aortic manipulation (surgical or catheter-based) or a known history of aortic valvular disease, as these factors predispose to acute aortic dissection. (Level of Evidence: C)"
"5. In patients with suspected or confirmed aortic dissection who have experienced a syncopal episode, a focused examination should be performed to identify associated neurologic injury or the presence of pericardial tamponade. (Level of Evidence: C)"
"6. All patients presenting with acute neurologic complaints should be questioned about the presence of chest, back, and/or abdominal pain and checked for peripheral pulse deficits as patients with dissection related neurologic pathology are less likely to report thoracic pain than the typical aortic dissection patient.[12] (Level of Evidence: C)"

References

  1. Increased maternal cardiovascular mortality associated with pregnancy in women with Turner syndrome.
  2. 2.0 2.1 Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE; et al. (2010). "2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine". Circulation. 121 (13): e266–369. doi:10.1161/CIR.0b013e3181d4739e. PMID 20233780.
  3. 3.0 3.1 3.2 Coady MA, Davies RR, Roberts M; et al. (1999). "Familial patterns of thoracic aortic aneurysms". Arch Surg. 134 (4): 361–7. PMID 10199307. Unknown parameter |month= ignored (help)
  4. 4.0 4.1 4.2 4.3 Hagan PG, Nienaber CA, Isselbacher EM; et al. (2000). "The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease". JAMA. 283 (7): 897–903. PMID 10685714. Unknown parameter |month= ignored (help)
  5. 5.0 5.1 5.2 Januzzi JL, Isselbacher EM, Fattori R; et al. (2004). "Characterizing the young patient with aortic dissection: results from the International Registry of Aortic Dissection (IRAD)". J. Am. Coll. Cardiol. 43 (4): 665–9. doi:10.1016/j.jacc.2003.08.054. PMID 14975480. Unknown parameter |month= ignored (help)
  6. 6.0 6.1 6.2 von Kodolitsch Y, Schwartz AG, Nienaber CA (2000). "Clinical prediction of acute aortic dissection". Arch. Intern. Med. 160 (19): 2977–82. PMID 11041906. Unknown parameter |month= ignored (help)
  7. Mészáros I, Mórocz J, Szlávi J; et al. (2000). "Epidemiology and clinicopathology of aortic dissection". Chest. 117 (5): 1271–8. PMID 10807810. Unknown parameter |month= ignored (help)
  8. Spittell PC, Spittell JA, Joyce JW; et al. (1993). "Clinical features and differential diagnosis of aortic dissection: experience with 236 cases (1980 through 1990)". Mayo Clin. Proc. 68 (7): 642–51. PMID 8350637. Unknown parameter |month= ignored (help)
  9. Mehta RH, O'Gara PT, Bossone E; et al. (2002). "Acute type A aortic dissection in the elderly: clinical characteristics, management, and outcomes in the current era". J. Am. Coll. Cardiol. 40 (4): 685–92. PMID 12204498. Unknown parameter |month= ignored (help)
  10. 10.0 10.1 Klompas M (2002). "Does this patient have an acute thoracic aortic dissection?". JAMA. 287 (17): 2262–72. PMID 11980527. Unknown parameter |month= ignored (help)
  11. Armstrong WF, Bach DS, Carey LM, Froehlich J, Lowell M, Kazerooni EA (1998). "Clinical and echocardiographic findings in patients with suspected acute aortic dissection". Am. Heart J. 136 (6): 1051–60. PMID 9842019. Unknown parameter |month= ignored (help)
  12. 12.0 12.1 Gaul C, Dietrich W, Friedrich I, Sirch J, Erbguth FJ (2007). "Neurological symptoms in type A aortic dissections". Stroke. 38 (2): 292–7. doi:10.1161/01.STR.0000254594.33408.b1. PMID 17194878. Unknown parameter |month= ignored (help)
  13. Roberts WC, Ko JM, Moore TR, Jones WH (2006). "Causes of pure aortic regurgitation in patients having isolated aortic valve replacement at a single US tertiary hospital (1993 to 2005)". Circulation. 114 (5): 422–9. doi:10.1161/CIRCULATIONAHA.106.622761. PMID 16864725. Unknown parameter |month= ignored (help)


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