Aidan: Created page with "== Background == * Life-threatening spectrum of acute aortic diseases, including: Aortic dissection Intramural hematoma ** Penetrating atherosclerotic ulcer..."

2020-10-23T13:27:32Z

Created page with "== Background == * Life-threatening spectrum of acute aortic diseases, including: ** Aortic dissection ** Intramural hematoma ** Penetrating atherosclerotic ulcer..."

New page

== Background ==

* Life-threatening spectrum of acute aortic diseases, including:
** [[Aortic dissection]]
** [[Intramural hematoma]]
** [[Penetrating atherosclerotic ulcer]]

=== Epidemiology ===

* Incidence of about 3 per 100,000 people
* About 25% go undiagnosed for more than 24 hours after ED presentation

== Clinical Presentation ==

=== Complications and Prognosis ===

* Mortality is proportional to delay in diagnosis, about 2% per hour

== Diagnosis ==

* Mainly made by ECG-gated contrast-enhanced CT of the aorta
* Current recommended approach[[CiteRef::ohle2020di]] is to clinically risk stratify (see Pretest Probability, below)
** For low risk, no further investigations are needed; for intermediate risk, use D-dimer to exclude AAS; for high risk, or for intermediate risk with elevated D dimer, proceed to ECG-gated CT aorta

=== Pretest Probability ===
{| class="wikitable"
!Feature
!Criterion
!Score
|-
| rowspan="3" |Risk factors
|No risk factors
|0
|-
|Any nonaneurysmal risk factors, including [[connective tissue diseases]], [[aortic valve disease]], recent aortic manipulation, or family history of AAS
|1
|-
|Aortic aneurysm
|2
|-
| rowspan="3" |High-risk pain features
|No high-risk pain features
|0
|-
|1 or 2 high-risk pain features, including severe or worst ever, thunderclap or abrupt, tearing or ripping, or migrating or radiating
|1
|-
|3 or more of the above high-risk pain features
|2
|-
| rowspan="2" |Physical examination findings
|No high-risk physical exam findings
|0
|-
|Any high-risk physical examination finding, including [[pulse deficit]], neurologic deficit, [[aortic insufficiency]], or [[hypotension]] with SBP <90 or [[pericardial effusion]]
|2
|-
| rowspan="3" |Alternative diagnosis
|Suspicion for an alternative diagnosis
| -1
|-
|Unsure
|0
|-
|AAS is the most likely diagnosis
|1
|}

* Interpretation:
** 0: low-risk (<0.5%); no further investigations
** 1: moderate-risk probability (0.5 to 5%): D-dimer to further stratify
** ≥2: high-risk probability (>5%): ECG-gated CT aorta

[[Category:Cardiology]]
[[Category:Critical care]]

Acute aortic syndrome - Revision history

Aidan: Created page with "== Background == * Life-threatening spectrum of acute aortic diseases, including: ** Aortic dissection ** Intramural hematoma ** Penetrating atherosclerotic ulcer..."

Aidan: Created page with "== Background == * Life-threatening spectrum of acute aortic diseases, including: Aortic dissection Intramural hematoma ** Penetrating atherosclerotic ulcer..."