Title:Screening, Evaluation, and Early Management of Acute Aortic Dissection in the ED
Volume: 8
Issue: 2
Author(s): Reuben J. Strayer, Peter L. Shearer and Luke K. Hermann
Affiliation:
Keywords:
Aortic aneurysm/diagnosis, aortic aneurysm/mortality, aortic aneurysm/therapy, d-dimer, echocardiography, guidelines, mortality, risk factors, EPIDEMIOLOGY, Aortic dissection
Abstract: Acute aortic dissection (AAD) is a rare and lethal disease with presenting signs and symptoms that can often be
seen with other high risk conditions; diagnosis is therefore often delayed or missed. Pain is present in up to 90% of cases
and is typically severe at onset. Many patients present with acute on chronic hypertension, but hypotension is an ominous
sign, often reflecting hemorrhage or cardiac tamponade. The chest x-ray can be normal in 10-20% of patients with AAD,
and though transthoracic echocardiography is useful if suggestive findings are seen, and should be used to identify pericardial
effusion, TTE cannot be used to exclude AAD. Transesophageal echocardiography, however, reliably confirms or
excludes the diagnosis, where such equipment and expertise is available. CT scan with IV contrast is the most common
imaging modality used to diagnose and classify AAD, and MRI can be used in patients in whom the use of CT or IV contrast
is undesirable. Recent specialty guidelines have helped define high-risk features and a diagnostic pathway that can be
used the emergency department setting. Initial management of diagnosed or highly suspected acute aortic dissection focuses
on pain control, heart rate and then blood pressure management, and immediate surgical consultation.
