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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Signs & symptoms


Vital signs

A patient experiencing aortic dissection may have normal vital signs, or have:

  • Tachycardia
  • Elevated BP
  • May indicate predisposing factor to aortic dissection
  • Pain from the dissection may cause increase in blood pressure
  • Partially or completely blocked artery to one or both kidneys may cause increase in blood pressure
  • Low blood pressure
  • Abnormally large difference between systolic and diastolic blood pressure
  • Asymmetrical pulse as noted in both wrists, both legs, and/or both sides of neck over carotid arteries
  • Asymmetry of blood pressure (measurement taken in both arms)
  • Heart murmur

Additional findings

Additional findings that suggest aortic dissection include:

  • The 5 P’s:
  • Pain
  • Pallor
  • Pulselessness
  • Paresthesia
  • Paralysis
  • Weakness in one or both legs or arms
  • Fever
  • Radiation of pain to back or stomach
  • Bloody diarrhea or coughing up blood
  • Stroke-like symptoms due to occlusion of carotid artery
  • Neurologic signs, similar to those of a transient ischemic attack or stroke
  • Hoarseness or a sensation of having a lump in the throat, wheezing, dyspnea, or cough

The five Ps:

  • Pain
  • Pallor
  • Pulselessness
  • Paresthesia
  • Paralysis

Aortic dissection is frequently referred to as “the great imitator” because of its tendency to look like more benign medical problems.