Clinical Case Database / Category: Patient Management

Acute aortic dissection

Publication details

Dr Anna Reid, Dr Joanne Corkan, Dr Simrit Ghatorae, FY1, Dr Sanjay Arya
Foundation Years Journal, volume 8, issue 2, p.6 (123Doc Education, London, February 2014)


Acute aortic dissection is the most common, life-threatening pathology affecting this vessel. It is caused by an intimal tear occurring in the wall of the aorta leading to a dissection plane within the media, separating the intima from the overlying adventitia. There is high risk of aortic rupture. Patients most at risk are those with connective tissue disorders and general cardiovascular risk factors, especially hypertension. Typically it presents with tearing chest pain, but can present atypically with collapse, myocardial ischaemia or neurological deficits.

Patients can be misdiagnosed initially. We present two cases of aortic dissection highlighting differences in presentation and management between the different types of aortic dissection, and review current literature regarding optimal investigation and follow up.

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Dr Anna Reid

Cardiology Specialist Registrar, North Western Deanery

Dr Joanne Corkan

Consultant Radiologist, Wrightington, Wigan & Leigh NHS Foundation Trust

Dr Simrit Ghatorae, FY1

Wrightington, Wigan & Leigh NHS Foundation Trust

Dr Sanjay Arya

Consultant Cardiologist
Wrightington, Wigan & Leigh NHS Foundation Trust


1.  Larson E. W., Edwards W. D. Risk factors for aortic dissection: a necropsy study of 161 cases. Am J Cardiol 1984; 53: 849–855.

2.  Meszaros I., Morocz J., Szlavi J., Schmidt J., Tornoci L., Nagy L., Szep L. Epidemiologyand clinicopathology of aortic dissection. Chest 2000; 117: 1271–1278.

3.  Nienaber, C., Powell J. Management of acute aortic syndromes European Heart Journal. 2012; 33: 26–35.

4.  Thrumurthy S. G., Karthikesalingam A., Patterson B. O. Holt P. J. E. Thompson M. M. The diagnosis and management of aortic dissection. BMJ. 2011; 344: d8290.

5.  Januzzi J. L., Isselbacher E. M. Fattori R. et al Characterizing the young patient with aortic dissection: results from the International Registry of Aortic Dissection (IRAD). J Am Coll Cardiol. 2004; 43: 665-669.

6.  Evangelista A. Insights from the International Registry of Acute Aortic Dissection- what have we learned?? European Cardiology. 2008; 4 (1): 79-82.

7.  Hiratzka L. F., Bakris G. L., Beckman J. A., Bersin R. M., Carr V. F., Casey D. E., et al 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM—guidelines for the diagnosis and management of patients with thoracic aortic disease: executive summary. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of

8.  Centre for Maternal and Child Enquiries (CMACE). Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer: 2006–2008. The Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011; 118 (Suppl 1): 1–203.

9.  Immer F. F., Bansi A. G., Immer-Bansi A. S., et al. Aortic dissection in pregnancy: analysis of risk factors and outcome. Ann Thorac Surg 2003; 76: 309–314.

10.  Stout C. L., Scott E. C., Stokes G. K., Panneton J. M. Successful repair of a ruptured Stanford type B aortic dissection during pregnancy. J Vasc Surg. 2010; 51 (4): 990-992.

11.  Tilak M., Smith J., Rogers D., Fox P., Muntazar M., Peyton M. Successful near-term pregnancy outcome after repair of a dissecting thoracic aortic aneurysm at 14 weeks gestation. Can J Anaesth 2005; 52: 1071-1075.

12.  Maraj S., Figueredo V. M., Lynn Morris D. Cocaine and the heart. Clin Cardiol. 2010; 33: 264-269

13.  Finkel J. B., Marhefka G. Rethinking Cocaine-Associated Chest Pain and Acute Coronary Syndromes Mayo Clin Proc. 2011 December; 86 (12): 1198–1207.

14.  McCord J., Jneid H., Hollander J., et al. Management of cocaine-associated chest pain and myocardial infarction: a scientific statement from the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology. Circulation. 2008; 117: 1897–1907.

15.  K. A., IsselbacherE. M., Roman W., DeSanctis M .D., and the International Registry for Aortic Dissection (IRAD) Investigators Cocaine-Related Aortic Dissection in Perspective Circulation. 2002; 105: 1529-1530

16. Last accessed 12/12/12.

17.  Crawford E. S. The diagnosis and management of aortic dissection. JAMA 1990;264:2537–41

18.  Mintz G. S., Kotler M. N., Segal B. L., Parry W. R. Two dimensional echocardiographic recognition of the descending thoracic aorta. Am J Cardiol 1979; 44: 232–238.

19.  Khandheria B. K., Tajik A. J., Taylor C. L. et al. Aortic dissection: review of value and limitations of two-dimensional echocardiography in a six-year experience. J Am Soc Echocardiogr 1989; 2: 17–24.

20.  Iliceto S., Ettore G., Francisco G., Antonelli G., Biasco G., Rizzon P. Diagnosis of aneurysm of the thoracic aorta. Comparison between two non invasive techniques: twodimensional echocardiography and computed tomography. Eur Heart J 1984; 5: 545–555.

21.  Erbel R., Alfonso F., Boileau C., Dirsch O., Eber B., Haverich A., et. al.Diagnosis and management of aortic dissection- Recommendations of the Task Force on Aortic Dissection, European Society of Cardiology European Heart Journal (2001) 22, 1642–1681

22.  Hagan P. G., Nienaber C. A., Isselbacher E. M., Bruckman D., Karavite D. J., The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA 2000; 283: 897–903.

23.  Nordon I. M., Hinchliffe R. J., Morgan R., Loftus I. M., Jahangiri M., Thompson M. M. Progress in Endovascular Management of Type A Dissection Eur J Vasc Endovasc Surg. 2012; 44: 406-410.

24.  Estrera A. L., Miller C. C., Huynh T. T., Azizzadeh A., Porat E. E., Vinnerkvist A., Ignacio C., Sheinbaum R., Safi H. J. Preoperative and operative predictors of delayed neurologic deficit following repair of thoracoabdominal aortic aneurysm. J Thorac Cardiovasc Surg 2003; 126: 1288–1294.

25.  Safi H. J., Estrera A. L., Miller C. C., Huynh T. T., Porat E. E., Azizzadeh A., Meada R., Goodrick J. S. Evolution of risk for neurologic deficit after descending and thoracoabdominal aortic repair. Ann Thorac Surg 2005; 80: 2173–2179


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