Abstract:
Patient survival of aortic dissection hinges on timely diagnosis and treatment.
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This deadly cardiac condition requires rapid identification and immediate medical intervention.
Fifty-year-old Ted Burns presents to the emergency department complaining of excruciating chest pain that radiates to his back. He informs the triage nurse that the pain came on suddenly and that it feels like he's being "ripped in half." Burns is extremely anxious, diaphoretic, pale, tachycardic, and hypertensive.
You'll need to act fast because Burns could be experiencing an acute aortic dissection-a tear in the lining (intima) of the aorta followed by bleeding and hematoma formation. 1 Blood, driven by the force of arterial pressure, can cause separation of or delamination between the layers of the aorta, thus creating a new channel or false lumen in the aortic wall.
Unlike aortic aneurysms, aortic dissections usually occur suddenly and without evidence of previous vessel dilatation. The condition is life threatening: The likelihood of death within the first 48 hours is 1% per hour for those left untreated, with a three-month mortality as high as 90%. 2 Aortic dissection requires prompt recognition for a successful outcome. There can be many presentations in aortic dissection that mimic other conditions, thus confusing the clinical picture. And unfortunately, 65% of all aortic dissections are initially misdiagnosed.
Perhaps the single most important factor leading to a successful outcome is a high index of suspicion on the part of the examining clinician. Increased awareness, blood pressure control, and basic imaging are essential for accurate and swift diagnosis.
Aortic dissection occurs in approximately two of every 10,000 people. The incidence may be greater, but it's difficult to pinpoint due to the high mortality rate and misdiagnosis associated with the condition. In fact, evidence of aortic dissection is found in 1% to 3% of all autopsies. 3 Although it strikes both sexes, it's three times more common in men, with a higher rate of occurance among African-Americans and a lower rate among Asians. Approximately 75% of aortic dissections occur in people ages 40 to 70. 4