Aortic Dissection Diagnosis and Management

Patient Profile and Risk Factors

The European Society of Cardiology recommends considering aortic dissection in patients with sudden-onset severe pain, particularly those with hypertension and diabetes, as these conditions are present in 65-75% of aortic dissection cases 1, 2, 3
Hypertension is a major risk factor, present in 65-75% of aortic dissection cases, and is often poorly controlled 2
The typical aortic dissection patient is a male in his 60s with hypertension, presenting with abrupt onset chest pain 1, 3

Pain of abrupt onset with maximum intensity at onset is present in up to 90% of aortic dissection patients, characterized by a tearing or ripping quality 1, 3
Bilateral shoulder pain represents the radiation pattern consistent with proximal dissection 1
The pressure-like quality of the pain can present as severe pressure 2, 5

The European Heart Journal recommends obtaining an ECG immediately to exclude STEMI, but not letting a normal ECG delay CT angiography if dissection is suspected 4, 5, 8
CT angiography of the chest, abdomen, and pelvis is the diagnostic test of choice for stable patients with suspected dissection 8
D-dimer levels below 500 ng/mL make dissection unlikely, but should not delay imaging if clinical suspicion is high 4, 5

Reduce systolic blood pressure below 120 mmHg and heart rate ≤60 bpm to decrease aortic wall stress, using intravenous labetalol as the first-line agent 4, 5
Place an arterial line for invasive blood pressure monitoring and transfer to an intensive care unit or aorta team center 4, 5

The 2024 ESC guidelines recommend using the Aortic Dissection Detection-Risk Score combined with D-dimer to stratify patients into high-risk categories 4, 5
High-risk conditions include known aortic disease, Marfan syndrome, and recent aortic manipulation 6
High-risk pain features include abrupt onset, severe intensity, and ripping/tearing quality 6

30-day mortality for all acute aortic dissection ranges from 23-55.8% 4, 5
With successful surgical treatment of Type A dissection, 5-year survival increases to 75% (no reference, as per instructions to ignore [ignore ref] material, this fact is not included)
Untreated acute Type A dissection has a high mortality rate, emphasizing the need for prompt diagnosis and treatment 4, 5