EMPOWERING PHYSICIANS WITH EVIDENCE-BASED CONTENT
 

Home > Browse Topics

Aortic Emergencies: Part I - Thoracic Dissections And Aneurysms

February 2006

Abstract

Acute aortic dissection was first described by Morgagni more than 200 years ago.1,2 The original term coined by Laennec in 1819 that described this pathological state — dissecting aortic aneurysm —has since been replaced by aortic dissection, since it is rare for a dissecting aorta to become aneurysmal.3 As famously illustrated by the unfortunate demise of King George the II, aortic dissection was historically diagnosed postmortem, and many years passed before the first successful operative repair by DeBakery in 1955.  Patients with aortic emergencies generally present with acute symptoms and clinical signs of severe pathology.  However, there is a subset of patients who have vague or atypical complaints woth normal vital signs, thus posing a diagnostic challenge to even the best clinician.  Therefore, physicians must include aortic emergencies in their differential diagnosis in patients presenting with many typical complaints of chest, abdomminal, and back pain, as well as atypical complaints of syncope, focal neurological deficits, and gastrointestinal bleeding.

Patients with aortic emergencies are at high risk for morbidity and mortality and must be aggressively managed to prevent or limit adverse outcomes.5-7 Mortality is directly proportional to the time from onset to symptoms to the appropriate diagnosis and treatment. Initail mortality rates of 1-2% per hour have been described, with apporximately 33% of patients dying in the first 24 hours  and 50% within 48 hours. The 2-week mortality rate approaches 75%, and the 1-year mortality rate is 95%. These Numbers represent mortality in patients whose aortic dissections remain undiagnosed or are not surgically corrcted.  Advances in diagnostic and surgical techniques have significantly improved outcomes ocer the past 20 years.7

This 2 part issue of Emergency Medicine Practice will explore aortic dissection and aortic aneurysm, with a specific focus on the symptoms and siigns to look for on history and examination. radiological diagnosis of aortic dissection and aneurysm, and initial treatment and stabilization. A review of present treatment options, including surgical versus nonsurgical interventions, as well as specific mention of other aortic disease states and inherited disorders, is included

See also the March 2006 Emergency Medicine Practice issue "Aortic Emergencies Part II: Abdominal Aneurysms And Aortic Trauma."
Table Of Contents:
Related Links:

 

About EB Medicine:

Products:

Accredited By:

ACCME ACCME
AMA AMA
ACEP ACEP
AAFP AAFP
AOA AOA
AAP AAP

Endorsed By:

AEMAA AEMAA
HONcode HONcode
STM STM

 

Last Modified: 09/22/2017
© EB Medicine