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Symptoms and Signs of Acute Aortic Dissection 37 handful of the known symptoms or signs. Nevertheless, although aortic dissection is uncommon, it is so life threatening that prompt diagnosis is essential if patients are to survive. It is therefore critical that clinicians be vigilant and have a low threshold for adding aortic dissection to the differential diagnosis. Indeed, if one does not always at least consider the possibility of aortic dissection when even just one of the typical findings is present, one may miss the diagnosis. Moreover, when any combination of cardiac, neurologic, abdominal, or vascular abnormalities cannot be otherwise explained, one must consider aortic dissection as a possible unifying diagnosis, and have a low threshold to obtain an appropriate diagnostic imaging study. Indeed, as the great aortic surgeon Dr. Michael DeBakey once stated, “No physician can diagnose a condition he never thinks about.” EDITOR’S COMMENT The editor wishes to emphasize the following clinical pearls from Dr. Isselbacher’s chapter, which are consonant with the Editor’s clinical experience as well. ● Aortic dissection is “the Great Masquerader.” ● Patient’s often describe their pain as the most severe pain a human being can have. ● It is remarkable that patients describe the pain of dissection with anatomically precise descriptors such as “tearing” and “ripping.” ● The abrupt onset of pain distinguishes dissection from myocardial infarction. ● Anterior chest pain suggests ascending dissection, and posterior interscapular pain suggests descending dissection. ● “No physician can diagnose a condition he never thinks about.” (c/o Dr. Michael DeBakey) ● The inflammation that accompanies dissection can cause fever. ● One must consider aortic dissection in any patient with unexplained cardiac, neurologic, abdominal, or vascular symptoms and signs. ● One must remember to check blood pressure in both arms, to detect the “pulse deficit” of acute aortic dissection. ● Acute aortic insufficiency (in contradistinction to chronic aortic insufficiency) is very poorly tolerated, possibly leading to acute pulmonary edema or even cardiogenic shock in patients with acute ascending dissection. REFERENCES 1. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD)—new insights into an old disease. J Am Med Assoc 2000; 283:897–903. 2. Spittell PC, Spittell JA Jr, Joyce JW, et al. Clinical features and differential diagnosis of aortic dissection: experience with 236 cases (1980 through 1990). Mayo Clin Proc 1993; 68:642–651.
38 Isselbacher 3. Nallamothu BK, Mehta RH, Saint S, et al. Syncope in acute aortic dissection: diagnostic, prognostic, and clinical implications. Am J Med 2002; 113:468–471. 4. Januzzi JL, Eagle KA, Cooper JV, et al. Acute aortic dissection presenting with congestive heart failure: results from the international registry of acute aortic dissection. J Am Coll Cardiol 2005; 46:733–735. 5. Bossone E, Rampoldi V, Nienaber CA, et al. Usefulness of pulse deficits to predict in-hospital complications and mortality in patients with acute type A aortic dissection. Am J Cardiol 2002; 89:851–885.
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Acute Aortic Disease
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15. Heart Failure: Basic Science an
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52. Clinical, Interventional, and I
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Informa Healthcare USA, Inc. 270 Ma
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Introduction Informa Healthcare has
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Foreword There is no disease more c
Page 16 and 17: Preface Over 100 years ago, the gre
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Page 91 and 92: 62 Danias DISCUSSION AND COMMENTARY
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90 Elefteriades and Rizzo required
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92 Elefteriades and Rizzo Table 1 S
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94 Elefteriades and Rizzo 70s, this
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96 Elefteriades and Rizzo Table 3 C
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98 Elefteriades and Rizzo DISCUSSIO
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100 Milewicz et al. KNOWN GENETIC S
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102 Milewicz et al. Table 2 Quick G
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104 Milewicz et al. ascending aorti
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106 Milewicz et al. Turner syndrome
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108 Milewicz et al. dissection in t
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110 Milewicz et al. Figure 5 Haplot
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112 Milewicz et al. A genome wide s
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114 Milewicz et al. Structural anal
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116 Milewicz et al. assembly of a h
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118 Milewicz et al. in the nuclei o
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120 Milewicz et al. 22. Furlong J,
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122 Milewicz et al. DISCUSSION AND
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124 Milewicz et al. Figure A Distri
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126 Elefteriades and Koullias Figur
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128 Elefteriades and Koullias prope
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8 Matrix Metalloproteinases in Aort
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Matrix Metalloproteinases in Aortic
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INTRODUCTION 9 Inflammation and Rem
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Inflammation and Remodeling in the
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10 Weight Lifting and Aortic Dissec
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Weight Lifting and Aortic Dissectio
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11 Timing of Acute Aortic Events: H
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Timing of Acute Aortic Events 171 F
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SECTION IV: TREATMENT OF ACUTE AORT
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Natural History of Thoracic Aortic
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206 Shahriari and Farkas properties
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208 Shahriari and Farkas Figure 2 E
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210 Shahriari and Farkas Less than
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216 Shahriari and Farkas (68). Many
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224 Shahriari and Farkas 26. Svenss
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226 Shahriari and Farkas 63. Fehren
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14 Acute Aortic Dissection: Anti-im
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Acute Aortic Dissection 231 lamella
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Acute Aortic Dissection 233 P t is
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Acute Aortic Dissection 235 From th
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Acute Aortic Dissection 237 Figure
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Acute Aortic Dissection 239 concern
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Acute Aortic Dissection 241 Table 2
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Acute Aortic Dissection 243 dissect
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Acute Aortic Dissection 245 22. Bax
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Acute Aortic Dissection 247 62. Lin
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Acute Aortic Dissection 249 DISSCUS
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252 Elefteriades and Griepp ACUTE A
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254 Elefteriades and Griepp Figure
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256 Elefteriades and Griepp sometim
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262 Elefteriades and Griepp to a se
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264 Elefteriades and Griepp Natural
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266 Elefteriades and Griepp CONCLUS
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268 Elefteriades and Griepp DISCUSS
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270 Brinster et al. thoracic aneury
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272 Brinster et al. Figure 1 Retrop
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274 Brinster et al. artery. Z3 land
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276 Brinster et al. or ischemia of
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278 Brinster et al. registry arm (2
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280 Brinster et al. Table 3 Early P
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Table 4 Meta-Analysis of Tevar for
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296 Brinster et al. Thoracoabdomina
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298 Brinster et al. 25. Hagan PG, N
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300 Brinster et al. 60. Elefteriade
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302 Brinster et al. 98. Liu ZG, Sun
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306 Brinster et al. 100% 90% 80% 70
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310 Hackmann et al. treatment. New
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312 Hackmann et al. tissue than in
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314 Hackmann et al. Table 1 Pharmac
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316 Hackmann et al. Some anti-hyper
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318 Hackmann et al. inhibits NF-κB
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322 Hackmann et al. ACKNOWLEDGMENTS
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326 Hackmann et al. 70. LeMaire SA,
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328 Hackmann et al. 105. Marra DE,
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330 Hackmann et al. DISCUSSION AND
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332 Elefteriades Diseases of the th
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334 Elefteriades Table 1 Individual
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336 Elefteriades Table 1 Individual
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338 Elefteriades Failure to Diagnos
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340 Elefteriades of physicians on t
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342 Elefteriades Figure 3 Computed
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344 Elefteriades reviewed over the
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346 Elefteriades DISCUSSION AND COM
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348 Elefteriades Figure 1 (See colo
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350 Elefteriades that are the subje
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SECTION VII: SYNTHESIS 20 The Key L
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The Key Lessons of This Book—In a
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362 Index Aging, aortic aneurysms a
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364 Index Cytokines, aortic aneurys
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366 Index Pathoanatomy classificati
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368 Index [Thoracic aortic aneurysm
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Figure 1.C Note from schematic depi
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Figure 8.1 Dramatic clinical exampl
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Figure 11.2 Proposed schema for the
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Figure 19.1 Future prospects in car
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