High risk features for a diagnosis of an aortic dissection

American Heart Association has described three categories of high risk features which indicate patients at greatest risk:

• high risk predisposing conditions
  • Marfan's syndrome
  • recent aortic manipulation
  • a known thoracic aneurysm
    
    
• high risk pain features
  • an abrupt onset of ripping, tearing, or stabbing pain in the chest, back, or abdomen
    
    
• high risk features of the examination
  • a pulse or blood pressure discrepancy
  • neurological deficit
  • a new murmur of aortic regurgitation
  • shock

Patients who present with one or more high risk features (but without any electrocardiographic changes of myocardial infarction and without any findings that strongly suggest an alternative diagnosis), an urgent aortic imaging should be carried out.

• although the specificity of this method is unknown, sensitivity is reported to be 95.7% (1)

Reference:

• (1) Thrumurthy SG et al. The diagnosis and management of aortic dissection. BMJ. 2011;344:d8290.