What are the signs and symptoms of aortic dissection?

From the Guidelines

Aortic dissection typically presents with sudden, severe chest or back pain that is often described as tearing or ripping in nature, and is a medical emergency requiring immediate attention as mortality increases significantly with each hour of delay. The pain may migrate as the dissection extends, and can radiate to the neck, jaw, shoulders, abdomen, or legs. Other common signs include:

• Differences in blood pressure between arms
• A new heart murmur suggesting aortic valve involvement
• Pulse deficits in extremities
• Symptoms of organ ischemia such as stroke, paralysis, or abdominal pain
• Patients may also experience shortness of breath, fainting, or symptoms of heart failure Risk factors include hypertension, genetic disorders affecting connective tissue (like Marfan syndrome), previous cardiac surgery, and advanced age 1. Physical examination may reveal hypotension or hypertension, tachycardia, and signs of poor perfusion. Diagnosis is typically confirmed with imaging studies such as CT angiography, MRI, or transesophageal echocardiography, but treatment should not be delayed if clinical suspicion is high 1. It is essential to 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 1.

The clinical manifestations of acute aortic dissection can be challenging to diagnose, but the diagnosis can be suspected based on the patient's history, physical examination, and imaging findings 1. The patient's history 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 1.

Given the high mortality rate associated with aortic dissection, prompt recognition and treatment are crucial to improve outcomes. The condition requires immediate attention, and treatment should not be delayed if clinical suspicion is high 1. Imaging studies should be directed toward confirming the presence of aortic dissection, classifying the location, and identifying any complications such as aortic branch involvement or pericardial tamponade 1.

In summary, aortic dissection is a life-threatening condition that requires prompt recognition and treatment. The diagnosis should be suspected in patients with sudden, severe chest or back pain, and risk factors such as hypertension or genetic disorders. Imaging studies and physical examination can help confirm the diagnosis, and treatment should not be delayed if clinical suspicion is high 1.

From the Research

Signs and Symptoms of Aortic Dissection

• The signs and symptoms of aortic dissection are not explicitly stated in the provided studies, but the studies discuss the treatment and management of the condition.
• Acute aortic dissection is described as a devastating condition requiring prompt intensive pharmacologic management geared toward control of blood pressure and reduction in myocardial contractility 2.
• During acute aortic dissection, hemorrhage may spread into the interatrial septum, extending to the atrioventricular junctional tissues, thus causing conduction abnormalities 2.

Treatment and Management

• The treatment of choice for acute aortic dissection currently is sodium nitroprusside and intravenous propranolol hydrochloride 2.
• Esmolol hydrochloride, an ultrashort-acting beta-blocker, has been successfully used in treating patients with compromised cardiac function and aortic dissection 2, 3.
• Clevidipine has been shown to be a less costly and reasonable alternative to sodium nitroprusside as adjunct therapy to esmolol in acute aortic dissection 4.
• Beta-blockers have become the cornerstone for medical management in patients with chronic type B aortic dissection (TBAD) 5.

Complications and Outcomes

• The use of oral beta-blockers was associated with significant protection against in-hospital mortality and stroke following repair of nontraumatic TBAD 5.
• Intravenous metoprolol was the only IV beta-blocker type associated with improved survival in patients with nontraumatic TBAD 5.
• Cardiac complications, such as heart failure, arrhythmia, and myocardial infarction, were not affected by beta-blocker use in patients with nontraumatic TBAD 5.