The initial observation of the patient may reveal physical features characteristic of a genetic syndrome associated with an increased risk for aortic dissections. These include:
- Marfan syndrome
- Facial features such as long, narrow face, underdeveloped cheekbones, deep set eyes, receding lower jaw, downward slanting eyes
- Ectopia lentis (dislocated lens of the eye)
- High arched palate and crowding of the teeth
- Tall stature, disproprionately long arms, legs, fingers and/or toes
- Pectus excavatum (sunken chest) or pectus carinatum (pigeon breast)
- Scoliosis or kyphosis
- Flat or inwardly rotated feet, hammer toes
- Joint hypermobility
- History of a pneumothorax
- Unexplained striae (skin stretch marks)
- Loeys-Dietz syndrome
- Facial features such as widely spaced eyes,, downward-slanting eyes, underdeveloped cheek bones, small chin and/or receding chin
- Blue sclerae (blue tinge to the whites of the eyes)
- Craniosynostosis (early fusion of the skull bones)
- Cleft palate
- Bifid (split) or broad uvula
- Long fingers and/or toes, contractures of the fingers
- Pectus excavatum (sunken chest) or pectus carinatum (pigeon breast)
- Cervical-spine instability
- Scoliosis
- Clubfoot or skewfoot deformity
- Joint hypermobility
- Congenital heart defects (patent ductus arteriosus atrial or ventricular septal defect, bicuspid aortic valve)
- Ehlers-Danlos syndrome-vascular type
- Facial features such as thin lips and philtrum, small chin, thin nose, large and proptotic eyes
- Thin, translucent skin with prominent veins, particularly on chest and abdomen
- Joint hypermobility
- Acrogeria (aged appearance to the hands and feet)
- Clubfoot
- History of a pneumothorax
- Turner syndrome
- Short stature
- Webbed neck
- Low hairline at the back of the neck
- Lymphedema of the hands and feet
- Bicuspid aortic valve, coarctation of the aorta
Chief Ccomplaint
Symptoms of aortic dissection are extremely variable, but are often described by patients as:
- Sudden onset severe pain along middling in chest, back, or abdominal
- Penetrating pain front to back
- Ripping, burning, or tearing sensation
- Migratory
- Pain like they have never experienced before or sense of impending doom
A patient with an aortic dissection may not appear to be a “typical” chest pain patient – he or she may be younger, tall/thin, and have no known risk factors for heart disease.