Aortic dissection in children and young adults: diagnosis, patients at risk, and outcomes

Objective: To heighten the awareness of pediatricians and pediatric cardiologists to aortic dissection, a potentially dangerous medical condition. Methods: We reviewed the charts of 13 patients, seen in four medical centers, who suffered acute or chronic aortic dissection over the period 1970 through 2000 whilst under the age of 25 years. Results: There were seven male and six female patients, with the mean age at diagnosis being 12.1 years, with a range from one day to 25 years. Congenital cardiac defects were present in five patients, and Marfan syndrome in four. In three of the patients with congenital cardiac defects, aortic dissection developed as a complication of medical procedures. In three patients, dissection followed blunt trauma to the chest. We could not identify any risk factors in one patient. The presenting symptoms included chest pain in four patients, abdominal pain and signs of ischemic bowel in two, non-palpable femoral pulses in one, and obstruction of the superior caval vein in one. Angiography and magnetic resonance imaging were the main diagnostic tools. Overall mortality was 38%. Only six patients had successful surgical outcomes. Conclusion: Due to the rarity of aortic dissection a high index of suspicion is required to reach the diagnosis in a timely manner. It should be considered in young patients complaining of chest pain in association with Marfan syndrome, anomalies of the aortic valve and arch, and chest trauma.

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Nearly Asymptomatic Eight-Month Thoracic Aortic Dissection

Clinical Medicine Insights Cardiology ◽

10.4137/cmc.s38328 ◽

2016 ◽

Vol 10 ◽

pp. CMC.S38328 ◽

Cited By ~ 2

Author(s):

Arjun Kumar ◽

Krishan Kumar ◽

Roman Zeltser ◽

Amgad N. Makaryus

Keyword(s):

Myocardial Infarction ◽

Chest Pain ◽

Aortic Dissection ◽

Medical Condition ◽

Unique Case ◽

Thoracic Aortic Dissection ◽

Aortic Dissections

Thoracic aortic dissection is a rare, but lethal, medical condition that is either misdiagnosed as a myocardial infarction or overlooked completely. Though thoracic aortic dissections are commonly diagnosed in patients exhibiting sharp chest pain, there are some notable cases where patients do not report the expected severity of pain. We report a unique case of a patient with a thoracic aortic dissection who was initially nearly asymptomatic for eight months, in order to heighten awareness, highlight diagnosis protocol, and improve prognosis for this commonly misdiagnosed, but fatal, condition.

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Slowly Progressive and Painless Thoracic Aortic Dissection Presenting with a Persistent Fever in an Elderly Patient: The Usefulness of Combined Measurement of Biochemical Parameters

Case Reports in Medicine ◽

10.1155/2013/498129 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Shunsuke Yamada ◽

Masanori Tokumoto ◽

Toshiaki Ohkuma ◽

Yasuo Kansui ◽

Yoshinobu Wakisaka ◽

...

Keyword(s):

Chest Pain ◽

Aortic Dissection ◽

Medical Condition ◽

Correct Diagnosis ◽

Delayed Diagnosis ◽

Clinical Manifestations ◽

Unknown Origin ◽

Sudden Onset ◽

Proper Diagnosis ◽

Typical Chest Pain

Aortic dissection is a fatal medical condition that requires urgent diagnosis and appropriate intervention. Because acute aortic dissection often manifests as sudden onset excruciating chest pain, physicians can easily reach a proper diagnosis. However, some patients with aortic dissection present with varied clinical manifestations without exhibiting typical chest pain, leading to a delayed diagnosis and possible fatality. We herein present the case of an elderly subject with a fever of unknown origin who was ultimately diagnosed with aortic dissection. In the present case, a negative procalcitonin test, increased D-dimer and serum creatinine phosphokinase-BB levels, and reelevation of the CPR level led us to the correct diagnosis.

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Ritka etiológiájú fiatalkori szívinfarktus

Orvosi Hetilap ◽

10.1556/650.2015.30161 ◽

2015 ◽

Vol 156 (25) ◽

pp. 1020-1025

Author(s):

Gábor Zoltán Nagy ◽

Gábor Gerges ◽

Kálmán Csapó ◽

Erika Csengő ◽

Károly Minik

Keyword(s):

Chest Pain ◽

Coronary Artery ◽

Aortic Dissection ◽

Young Patients ◽

Coronary Artery Occlusion ◽

Artery Occlusion ◽

Left Main ◽

Diagnostic Challenge ◽

Total Occlusion ◽

Coronary Syndrome

Chest pain is not uncommon among young patients below the age of 35 years, however, it is rarely caused by acute coronary syndrome. The rarity of coronary artery occlusion in this population can easily lead to diagnostic mistakes. The authors present the case history of a 19-year-old young female, who was admitted to the emergency department of a local hospital due to the sudden onset of chest pain and malaise. ST-segment elevation was seen on the electrocardiogram raising the possibility of aortic dissection, therefore, emergency thoracic computed tomographic scan was performed. This proved to be negative and the patient was transferred to the coronary care unit. Urgent coronarography was carried out, which revealed the total occlusion of the left main coronary artery. The occluded artery was successfully opened with percutaneous coronary intervention, but despite revascularisation the patient died on the second postoperative day due to asystole. Autopsy revealed thrombotic embolization of the left main artery with consequent extensive haemorrhagic necrosis, involving almost the whole left ventricle. The source of embolization was not found. The authors note that left coronary artery occlusion in young patients can be a diagnostic challenge, because symptoms can be mistaken with aortic dissection or pulmonary embolism. Orv. Hetil., 2015, 156(25), 1020–1025.

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Oxford Cases in Medicine and Surgery

10.1093/oso/9780198716228.001.0001 ◽

2015 ◽

Author(s):

Hugo Farne ◽

Edward Norris-Cervetto ◽

James Warbrick-Smith

Keyword(s):

Chest Pain ◽

Case History ◽

Clinical Medicine ◽

Real Life ◽

General Medicine ◽

Diagnostic Approach ◽

History Taking ◽

Presenting Symptoms ◽

Essential Resource ◽

Physiological Systems

Oxford Cases in Medicine and Surgery, second edition, teaches students a logical step-by-step diagnostic approach to common patient presentations. This approach mirrors that used by successful clinicians on the wards, challenging students with questions at each stage of a case (history-taking, examination, investigation, management). In tackling these questions, students understand how to critically analyse information and learn to integrate their existing knowledge to a real-life scenario from start to finish. Each chapter focuses on a common presenting symptom (e.g. chest pain). By starting with a symptom, mirroring real life settings, students learn to draw on their knowledge of different physiological systems - for example, cardiology, respiratory, gastroenterology - at the same time. All the major presenting symptoms in general medicine and surgery are covered, together with a broad range of pathologies. This book is an essential resource for all medicine students, and provides a modern, well-rounded introduction to life on the wards. Ideal for those starting out in clinical medicine and an ideal refresher for those revising for OSCEs and finals.

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Diagnostic markers for discriminating between acute aortic dissection and acute myocardial infarction during the pre-hospital phase: analysis of 3,195 cases

European Heart Journal ◽

10.1093/ehjci/ehaa946.2326 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Watanabe ◽

H Yoshino ◽

T Takahashi ◽

M Usui ◽

K Akutsu ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Back Pain ◽

Chest Pain ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Diagnostic Markers ◽

Network Database ◽

History Of ◽

First Contact

Abstract Both acute aortic dissection (AAD) and acute myocardial infarction (AMI) present with chest pain and are life-threatening diseases that require early diagnosis and treatment for better clinical outcome. However, two critical diseases in the very acute phase are sometimes difficult to differentiate, especially prior to arrival at the hospital for urgent diagnosis and selection of specific treatment. The aim of our study was to clarify the diagnostic markers acquired from the information gathered from medical history taking and physical examination for discriminating AAD from AMI by using data from the Tokyo Cardiovascular Care Unit (CCU) Network database. We examined the clinical features and laboratory data of patients with AAD and AMI who were admitted to the hospital in Tokyo between January 2013 and December 2015 by using the Tokyo CCU Network database. The Tokyo CCU Network consists of >60 hospitals that fulfil certain clinical criteria and receive patients from ambulance units coordinated by the Tokyo Fire Department. Of 15,061 patients diagnosed as having AAD and AMI, 3,195 with chest pain within 2 hours after symptom onset (537 AAD and 2,658 AMI) were examined. The patients with out-of-hospital cardiac arrest were excluded. We compared the clinical data of the patients with chest pain who were diagnosed as having AAD and AMI. The following indicators were more frequent or had higher values among those with AAD: female sex (38% vs. 20%, P<0.001), systolic blood pressures (SBPs) at the time of first contact by the emergency crew (142 mmHg vs. 127 mmHg), back pain in addition to chest pain (54% vs. 5%, P<0.001), history of hypertension (73% vs. 58%, P<0.001), SBP ≥150 mmHg (39% vs. 22%, P<0.001), back pain combined with SBP ≥150 mmHg (23% vs. 0.8%, P<0.001), and back pain with SBP <90 mmHg (4.5% vs. 0.1%, P<0.001). The following data were less frequently observed among those with AAD: diabetes mellitus (7% vs. 28%, P<0.001), dyslipidaemia (17% vs. 42%, P<0.001), and history of smoking (48% vs. 61%, P<0.001). The multivariate regression analysis suggested that back pain with SBP ≥150 mmHg (odds ratio [OR] 47; 95% confidence interval [CI] 28–77; P<0.001), back pain with SBP <90 mmHg (OR 68, 95% CI 16–297, P<0.001), and history of smoking (OR 0.49, 95% CI 0.38–0.63, P<0.001) were the independent markers of AAD. The sensitivity and specificity of back pain with SBPs of ≥150 mmHg and back pain with SBPs <90 mmHg for detecting AAD were 23% and 99%, and 4% and 99%, respectively. In patients with chest pain suspicious of AAD and AMI, “back pain accompanied by chest pain with SBP ≥150 mmHg” or “back pain accompanied by chest pain with SBP <90 mmH” is a reliable diagnostic marker of AAD with high specificity, although the sensitivity was low. The two SBP values with back pain are markers that may be useful for the ambulance crew at their first contact with patients with chest pain. Funding Acknowledgement Type of funding source: None

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Acute Aortic Dissection in Pregnancy in a Woman with Undiagnosed Marfan Syndrome

Case Reports in Obstetrics and Gynecology ◽

10.1155/2012/490169 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Mandana Master ◽

Gavin Day

Keyword(s):

Aortic Dissection ◽

Marfan Syndrome ◽

Acute Aortic Dissection ◽

Congenital Abnormalities ◽

Surgical Repair ◽

Phenotypic Expression ◽

Sudden Onset ◽

Lower Segment Caesarean Section ◽

Type B Dissection ◽

Type A Dissection

We report a case of acute aortic dissection in a lady of 28 weeks of gestation with undiagnosed Marfan syndrome. The patient had been seen in our antenatal clinics. Her history documented in her pregnancy record was negative for genetic/congenital abnormalities. There was no family history documented. Subsequently, at 28 weeks of gestation, the patient presented with sudden onset chest, jaw, and back pain. Further history revealed that her father had died at the age of 27 of an aortic dissection. Echocardiography showed aortic root dissection with occlusion of aortic branches. She subsequently underwent an emergency lower segment caesarean section followed by surgical repair of type A dissection. A simultaneous type B dissection was managed conservatively. On later examination, our patient fulfilled the diagnostic criteria for phenotypic expression of Marfan syndrome. Genetic testing also confirmed that she has a mutation of the fibrillin (FBN 1) gene associated with the disease.

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