Clinical Case Database / Category: Clinical Care
The dissecting aorta
Dr Adrian Spiteri MD FRCS Ed (A&E) FCEM, Dr Ruth Brown FRCS FCEM
Foundation Years Journal, volume 7, issue 2, p.43 (123Doc Education, London, February 2013)
Aortic dissection is a rare vascular emergency with very high mortality if left untreated, thus needing rapid assessment and resuscitation with early involvement of high level care teams. Patients are usually acutely unwell at presentation, but a proportion of patients have vague and atypical symptoms and signs, making diagnosis diffiult and liable to error. Aortic dissection should be part of the differential diagnosis of any patient with chest, abdominal and back pain. It may also present in an atypical manner such as with syncope, abnormal neurological signs, congestive heart failure and respiratory or gastrointestinal bleeding. The structured diagnostic approach and immediate management for a patient presenting with chest pain is discussed.
Access the Clinical Cases Database
A subscription is required to read the full article. Please subscribe using one of the options below.
|Foundation Years Clinical Cases Database||£29.00||6 months|
|Foundation Years Clinical Cases Database||£39.00||12 months|
Dr Adrian Spiteri MD FRCS Ed (A&E) FCEM (Corresponding author)
Consultant Emergency Medicine
St Georgeâ€™s Healthcare NHS Trust
Dr Ruth Brown FRCS FCEM
Consultant Emergency Medicine
Imperial College Healthcare NHS Trust
St Maryâ€™s Hospital
4. Januzzi JL, Marayati F, Mehta RH, Cooper JV, OâGara PT, Sechtem U, et al. Comparison of aortic dissection in patients with and without Marfanâs syndrome (results from the International Registry of Aortic Dissection). Am J Cardiol. 2004 Aug 1;94(3):400-2.
7. Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000 Feb 16;283(7):897-903.
10. Suzuki T, Distante A, Zizza A, Trimarchi S, Villani M, Salerno Uriarte JA, et al. Diagnosis of acute aortic dissection by D-dimer: the International Registry of Acute Aortic Dissection Substudy on Biomarkers (IRAD-Bio) experience. Circulation. 2009 May 26;119(20):2702-7.
11. Johnson TR, Nikolaou K, Wintersperger BJ, Knez A, Boekstegers P, Reiser MF, et al. ECG-gated 64-MDCT angiography in the differential diagnosis of acute chest pain. AJR Am J Roentgenol. 2007 Jan;188(1):76-82.
13. Walsh SR, Tang TY, Sadat U, Naik J, Gaunt ME, Boyle JR, et al. Endovascular stenting versus open surgery for thoracic aortic disease: systematic review and meta-analysis of perioperative results. J Vasc Surg. 2008 May;47(5):1094-8.
Conflict Of Interest
The Journal requires that authors disclose any potential conflict of interest that they may have. This is clearly stated in the Journal’s published “Guidelines for Authors”. The Journal follows the Guidelines against Conflict of Interest published in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (http://www.icmje.org/urm_full.pdf).
The authors of this article have not been paid. The Journal is financed by subscriptions and advertising. The Journal does not receive money from any other sources. The decision to accept or refuse this article for publication was free from financial considerations and was solely the responsibility of the Editorial Panel and Editor-in-Chief.
Patient Consent statement
All pictures and investigations shown in this article are shown with the patients’ consent. We require Authors to maintain patients’ anonymity and to obtain consent to report investigations and pictures involving human subjects when anonymity may be compromised. The Journal follows the Guidelines of the Uniform Requirements for Manuscripts (http://www.icmje.org/urm_full.pdf). The Journal requires in its Guidelines for Authors a statement from Authors that “the subject gave informed consent”.
Animal & Human Rights
When reporting experiments on human subjects, the Journal requires authors to indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the HelsinkiDeclaration of 1975, as revised in 2008.
About the Clinical Cases Database
The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.