AHA/ACC Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease (2010)

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Commentary by Reed E. Pyeritz, MD, PhD

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Approximately 10,000 people experience aortic dissections annually, so it is likely that emergency first responders will encounter this condition. 50% of patients with undiagnosed aortic dissection die with 48 hours, a death rate of approximately 1% per hour. Dissections of the aortic root and ascending aorta require immediate surgical intervention.

As a result, it is extremely important that emergency first responders are prepared to evaluate symptoms that could be related to a dissection and expedite emergency treatment.

About aortic dissection

An aortic dissection is a tear in the inner layer of the aortic wall. This tear allows blood to enter and separate the inner and outer layers of the vessel. In addition, dissection can weaken the outer wall, resulting in instability or rupture; occlusion (blockage) of aortic branch vessels causing myocardial infarction, stroke, kidney failure, bowel ischemia, paraplegia or limb ischemia; and disruption of the aortic valve, resulting in valvular insufficiency and congestive heart failure.

Who is at risk?

Risk factors for thoracic aortic disease, aneurysm, and dissection include certain genetic connective tissue disorders, a family history of thoracic aortic aneurysm/dissection, bicuspid aortic valve, uncontrolled hypertension, heavy weight lifting, trauma to the aorta, and certain inflammatory diseases (Takayasu arteritis, giant cell arteritis, Beh├žet disease, ankylosing spondylitis).

There are genetic syndromes that affect multiple organ systems, including the skeleton, lungs, eyes, heart, and increase the risk for aortic dissections. Genetic syndromes that increase the risk for aortic dissection include:

IMPORTANT:

Take note if the patient tells you he/she has had an aneurysm, Marfan syndrome, Loeys-Dietz syndrome, Ehlers-Danlos syndrome, Turner syndrome, bicuspid aortic valve, a mutation in a gene which predisposes to familial thoracic aortic aneurysms/dissections, or a family history of thoracic aortic aneurysms/dissections This should alert the EMS provider to consider rapid transport with treatment provided en route.

New Feature: Interactive Pathways

Three of the key pathways in the Guidelines for acute aortic dissection (AoD) management and surgical intervention are now available here in an interactive format, enabling you to see at-a-glance the decision points and recommendations while providing links to more in-depth information.

The Interactive Pathways may be found here.