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2630 pages added, reviewed or updated during the last month (last updated: 17/4/2021)


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Presentation of aortic dissection is diverse and may overlap with much more common conditions; hence clinicians must maintain a high degree of suspicion (1).

Clinically, presentation of aortic dissection can be divided into two phases:

  • interruption of the intima with severe pain and loss of pulse volume
  • next step is when the pressure exceeds a critical limit and rupture occurs (2)

The patient typically presents with complains of chest pain:

  • sudden and severe pain in the chest, back or abdomen
    • analysis of  the International Registry of Acute Dissection (IRAD) noted that
      • type A dissection - frequently presents with severe chest pain, anterior (71%) and  posterior (32%)
      • type B -  most likely to present with back pain (64%) followed by chest and abdominal pain (63% and 43%, respectively) (3)
    • the pain is described as sharp tearing or stabbing in nature, which may improve slightly over time
      • although classically described as having a tearing or ripping quality, majority of patients are more likely to describe the pain as sharp or stabbing (3)
  • pain may be absent in some patients
    • patients on steroids and patients with Marfan syndrome may be more prone to present without pain (3)
  • the pain may be migratory or may radiate to the
    • neck - in type A dissection
    • interscapular area - in type B dissection
  • myocardial pain may coexist if coronary arteries are involved

Other presenting features may include:

  • sweating, pallor and tachycardia
  • blood pressure abnormalities
    • more than 20 mmHg blood pressure difference between the two arms
    • hypertension - mostly type B dissections
    • hypotension - mainly in patients with type A (may be normotensive as well)
  • a prominent arterial pulsation at the root of the neck
  • pulse deficits
  • diastolic murmur of aortic regurgitation
  • syncope, cerebrovascular accidents and other neurological manifestations
  • end organ ischemia e.g. - symptomatic limb ischaemia, or visceral ischaemia (1,2,4)

Reference:

Last reviewed 01/2018

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