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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Medical/Family history

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When taking medical history, the following should raise suspicion of aortic dissection:

  • Family history of aortic aneurysm/dissection or unexplained sudden cardiac death, especially under the age of 50
  • Diagnosis of a genetic syndrome that predisposes to aortic dissection in patient or family member (Marfan, Loeys-Dietz, Ehlers-Danlos, or Turner syndrome) or a mutation in a gene known to predispose to aortic aneurysm/dissection: FBN1, TGFBR1, TGFBR2, COL3A1, ACTA2, SMAD3, MYH11, MYLK, TGFB2, PRKG1)
  • Bicuspid aortic valve or family history of bicuspid aortic valve
  • Past ascending aortic repair or aortic coarctation repair
  • Known aortic aneurysm or aneurysm/dissection/rupture in another artery
  • History of conditions predisposing to aortic dissection (Marfan syndrome, Loeys-Dietz syndrome, Ehlers-Danlos syndrome-vascular type, familial thoracic aortic aneurysms/dissections, Turner syndrome, bicuspid aortic valve, Loeys-Dietz syndrome)
  • History of pectus repair, scoliosis treatment, cleft palate repair, or cranial surgery
  • History of hypertension, mitral valve prolapse, or “heart murmur”
  • History of spontaneous pneumothorax, early onset emphysema, or other lung problems
  • History of rupture of the bowel/intestines, uterus, or other hollow organs or tendon/muscle rupture
  • Chronic joint subluxations/dislocations
  • Congenital hip dislocation, club foot
  • Ectopia lentis (dislocated lens of the eye)
  • Primary ovarian failure
  • Joint hypermobility

Further assessment

Triage staff may also observe:

  • Physical characteristics of genetic disorder
  • Patient in distress or obvious pain
  • Sense of doom or that something is terribly wrong
  • Pain like she or he has never felt before
  • Altered mental status
Keep in mind that a normal EKG or chest radiograph does not rule in or out the possibility of an aortic dissection.If aortic dissection is even remotely suspected, studies should be performed and read as soon as possible – waiting could be the difference between life and death.