Aortic dissection risk factors: Difference between revisions

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{{CMG}}; {{AE}} {{CZ}}; {{RT}} {{Sahar}}
{{CMG}}; {{AE}} {{CZ}}; {{RT}} {{Sahar}}
==Overview==
==Overview==
Common [[risk factors]] in the development of aortic dissection include [[aging]], [[atherosclerosis]], [[diabetes]], [[hypertension]] and [[trauma]]. Less common risk factors include [[bicuspid aortic valve]], [[cocaine]] abuse, [[coarctation of the aorta]], [[cystic medial necrosis]], a history of collagen vascular disoders, [[giant cell arteritis]], [[heart surgery]], [[pseudoxanthoma elasticum]], [[Turner's syndrome]], [[tertiary syphilis]] and the [[third trimester of pregnancy]].
Common [[risk factors]] in the development of aortic dissection include [[aging]], [[atherosclerosis]], [[diabetes]], [[hypertension]] and [[trauma]]. Less common risk factors include [[bicuspid aortic valve]], [[cocaine]] abuse, [[coarctation of the aorta]], [[cystic medial necrosis]], a history of [[Connective Tissue Disease|collagen vascular disoders]], [[giant cell arteritis]], [[heart surgery]], [[pseudoxanthoma elasticum]], [[Turner's syndrome]], [[tertiary syphilis]] and the [[third trimester of pregnancy]].
== Risk Factors ==
==Risk Factors==
Common [[risk factors]] in the development of aortic dissection include:<ref name="LarsonEdwards1984">{{cite journal|last1=Larson|first1=Eric W.|last2=Edwards|first2=William D.|title=Risk factors for aortic dissection: A necropsy study of 161 cases|journal=The American Journal of Cardiology|volume=53|issue=6|year=1984|pages=849–855|issn=00029149|doi=10.1016/0002-9149(84)90418-1}}</ref><ref name="JanuzziIsselbacher2004">{{cite journal|last1=Januzzi|first1=James L|last2=Isselbacher|first2=Eric M|last3=Fattori|first3=Rossella|last4=Cooper|first4=Jeanna V|last5=Smith|first5=Dean E|last6=Fang|first6=Jianming|last7=Eagle|first7=Kim A|last8=Mehta|first8=Rajendra H|last9=Nienaber|first9=Christoph A|last10=Pape|first10=Linda A|title=Characterizing the young patient with aortic dissection: results from the international registry of aortic dissection (IRAD)|journal=Journal of the American College of Cardiology|volume=43|issue=4|year=2004|pages=665–669|issn=07351097|doi=10.1016/j.jacc.2003.08.054}}</ref>
Common [[risk factors]] in the development of aortic dissection include:<ref name="LarsonEdwards1984">{{cite journal|last1=Larson|first1=Eric W.|last2=Edwards|first2=William D.|title=Risk factors for aortic dissection: A necropsy study of 161 cases|journal=The American Journal of Cardiology|volume=53|issue=6|year=1984|pages=849–855|issn=00029149|doi=10.1016/0002-9149(84)90418-1}}</ref><ref name="JanuzziIsselbacher2004">{{cite journal|last1=Januzzi|first1=James L|last2=Isselbacher|first2=Eric M|last3=Fattori|first3=Rossella|last4=Cooper|first4=Jeanna V|last5=Smith|first5=Dean E|last6=Fang|first6=Jianming|last7=Eagle|first7=Kim A|last8=Mehta|first8=Rajendra H|last9=Nienaber|first9=Christoph A|last10=Pape|first10=Linda A|title=Characterizing the young patient with aortic dissection: results from the international registry of aortic dissection (IRAD)|journal=Journal of the American College of Cardiology|volume=43|issue=4|year=2004|pages=665–669|issn=07351097|doi=10.1016/j.jacc.2003.08.054}}</ref><ref>{{cite journal|title=Correspondence|journal=The Annals of Thoracic Surgery|volume=67|issue=2|year=1999|pages=593|issn=00034975|doi=10.1016/S0003-4975(99)00037-5}}</ref>
* [[Aging]] with the highest [[incidence]] in individuals who are 50 to 70 years old
 
* [[Atherosclerosis]] and its associated risk factors like [[diabetes]]
*[[Aging]] with the highest [[incidence]] in individuals who are 50 to 70 years old
* [[Bicuspid aortic valve]] especially important in [[ascending aorta]] dissection<ref name="LosennoGoodman2012">{{cite journal|last1=Losenno|first1=Katie L.|last2=Goodman|first2=Robert L.|last3=Chu|first3=Michael W. A.|title=Bicuspid Aortic Valve Disease and Ascending Aortic Aneurysms: Gaps in Knowledge|journal=Cardiology Research and Practice|volume=2012|year=2012|pages=1–16|issn=2090-8016|doi=10.1155/2012/145202}}</ref>
*[[Atherosclerosis]] and its associated risk factors like [[diabetes]]
** The risk of dissection in individuals with [[bicuspid aortic valve]] is not associated with the degree of [[aortic stenosis|stenosis]] of the [[valve]].
*[[Bicuspid aortic valve]] especially important in [[ascending aorta]] dissection<ref name="LosennoGoodman2012">{{cite journal|last1=Losenno|first1=Katie L.|last2=Goodman|first2=Robert L.|last3=Chu|first3=Michael W. A.|title=Bicuspid Aortic Valve Disease and Ascending Aortic Aneurysms: Gaps in Knowledge|journal=Cardiology Research and Practice|volume=2012|year=2012|pages=1–16|issn=2090-8016|doi=10.1155/2012/145202}}</ref>
* [[Chest trauma]] including blunt trauma and [[iatrogenic]] (for example during [[cardiac catheterization]] or due to an [[intra-aortic balloon pump]])
**The risk of dissection in individuals with [[bicuspid aortic valve]] is not associated with the degree of [[aortic stenosis|stenosis]] of the [[valve]].
* [[Coarctation of the aorta]]<ref name="pmid25743550">{{cite journal |vauthors=Senaha S, Uezu T, Shimoji M, Akasaki M |title=[Stanford type B aortic dissection associated with coarctation of the aorta] |language=Japanese |journal=Kyobu Geka |volume=68 |issue=3 |pages=184–7 |date=March 2015 |pmid=25743550 |doi= |url=}}</ref>
*[[Chest trauma]] including blunt trauma and [[iatrogenic]] (for example during [[cardiac catheterization]] or due to an [[intra-aortic balloon pump]])
=== Less Common Risk Factors===
*[[Coarctation of the aorta]]<ref name="pmid25743550">{{cite journal |vauthors=Senaha S, Uezu T, Shimoji M, Akasaki M |title=[Stanford type B aortic dissection associated with coarctation of the aorta] |language=Japanese |journal=Kyobu Geka |volume=68 |issue=3 |pages=184–7 |date=March 2015 |pmid=25743550 |doi= |url=}}</ref>
Less common [[risk factors]] in the development of aortic dissection include:
 
* [[Cocaine abuse]]
===Less Common Risk Factors===
* [[Cystic medial necrosis]]
Less common [[risk factors]] in the development of aortic dissection include:<ref name="pmid7826227">{{cite journal |vauthors=Dioguardi GS, Pimenta J, Knoplich J, Ghorayeb N, Ramos LR, Giannini SD |title=[Risk factors for cardiovascular diseases in physicians. Preliminary data from the VIDAM Project of the Paulista Medical Association] |language=Portuguese |journal=Arq. Bras. Cardiol. |volume=62 |issue=6 |pages=383–8 |date=June 1994 |pmid=7826227 |doi= |url=}}</ref><ref name="CaglayanDundar2009">{{cite journal|last1=Caglayan|first1=Ahmet Okay|last2=Dundar|first2=Munis|title=Inherited diseases and syndromes leading to aortic aneurysms and dissections|journal=European Journal of Cardio-Thoracic Surgery|volume=35|issue=6|year=2009|pages=931–940|issn=10107940|doi=10.1016/j.ejcts.2009.01.006}}</ref><ref>{{cite journal|title=Acute aortic dissection: pathogenesis, risk factors and diagnosis|journal=Swiss Medical Weekly|volume=147|issue=3334|year=2017|issn=1424-7860|doi=10.4414/smw.2017.14489}}</ref><ref>[http://www.ncbi.nlm.nih.gov/sites/entrez?Db=PubMed&Cmd=ShowDetailView&TermToSearch=17055808&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum Increased maternal cardiovascular mortality associated with pregnancy in women with Turner syndrome.]</ref>
* Deceleration [[trauma]] most commonly causes [[aortic rupture]], not dissection
 
* [[Diabetes]]
*[[Cocaine abuse]]
* A history of collagen vascular disorders such as:
*[[Cystic medial necrosis]]
*Deceleration [[trauma]] most commonly causes [[aortic rupture]], not dissection
*[[Diabetes]]
*A history of collagen vascular disorders such as:
**[[Ehlers-Danlos syndrome]]
**[[Ehlers-Danlos syndrome]]
**[[Marfan syndrome]]
**[[Marfan syndrome]]
* [[Familial hypercholesterolemia]]
*[[Familial hypercholesterolemia]]
* [[Giant cell arteritis]]
*[[Giant cell arteritis]]
* [[Heart surgery]] particularly [[aortic valve replacement]]
*[[Heart surgery]] particularly [[aortic valve replacement]]
* [[Hypertension]] most frequently in those with type III dissection
*[[Hypertension]] most frequently in those with type III dissection
* Male gender
*Male gender
* Preexisting [[aortic aneurysm]]
*Preexisting [[aortic aneurysm]]
* Preexisting [[aortic stenosis|aortic valve disease]]
*Preexisting [[aortic stenosis|aortic valve disease]]
* Prior [[aortic aneurysm]] repair
*Prior [[aortic aneurysm]] repair
* Prior aortic dissection
*Prior aortic dissection
* Prior aortic dissection repair
*Prior aortic dissection repair
* [[Pseudoxanthoma elasticum]]
*[[Pseudoxanthoma elasticum]]
* [[Tertiary syphilis]]
*[[Tertiary syphilis]]
* [[Tetralogy of Fallot]]
*[[Tetralogy of Fallot]]
* [[Third trimester of pregnancy]]
*[[Third trimester of pregnancy]]
* [[Turner's syndrome]] due to [[aortic root]] [[dilatation]] in this syndrome<ref>[http://www.ncbi.nlm.nih.gov/sites/entrez?Db=PubMed&Cmd=ShowDetailView&TermToSearch=17055808&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum Increased maternal cardiovascular mortality associated with pregnancy in women with Turner syndrome.]</ref>.
*[[Turner's syndrome]] due to [[aortic root]] [[dilatation]] in this syndrome
* [[Vasculitis]] ([[inflammation]] (rarely)
*[[Vasculitis]] ([[inflammation]] (rarely)
 
==2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease (DO NOT EDIT)<ref name="pmid20233780">{{cite journal| author=Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE et al.| title=2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. | journal=Circulation | year= 2010 | volume= 121 | issue= 13 | pages= e266-369 | pmid=20233780 | doi=10.1161/CIR.0b013e3181d4739e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20233780  }} </ref>==
==2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease (DO NOT EDIT)<ref name="pmid20233780">{{cite journal| author=Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE et al.| title=2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. | journal=Circulation | year= 2010 | volume= 121 | issue= 13 | pages= e266-369 | pmid=20233780 | doi=10.1161/CIR.0b013e3181d4739e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20233780  }} </ref>==
===Estimation of Pretest Risk of Thoracic Aortic Dissection (DO NOT EDIT)<ref name="pmid20233780">{{cite journal |vauthors=Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM |title=2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine |journal=Circulation |volume=121 |issue=13 |pages=e266–369 |date=April 2010 |pmid=20233780 |doi=10.1161/CIR.0b013e3181d4739e |url=}}</ref>===
===Estimation of Pretest Risk of Thoracic Aortic Dissection (DO NOT EDIT)<ref name="pmid20233780">{{cite journal |vauthors=Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM |title=2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine |journal=Circulation |volume=121 |issue=13 |pages=e266–369 |date=April 2010 |pmid=20233780 |doi=10.1161/CIR.0b013e3181d4739e |url=}}</ref>===
{|class="wikitable"
{| class="wikitable"
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Providers should routinely evaluate any patient presenting with complaints that may represent [[acute]] [[thoracic]] [[aortic dissection]] to establish a pretest risk of disease that can then be used to guide [[diagnosis|diagnostic]] decisions. This process should include specific questions about medical history, family history, and [[pain]] features as well as a focused examination to identify findings that are associated with [[aortic dissection]], including:
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' Providers should routinely evaluate any patient presenting with complaints that may represent [[acute]] [[thoracic]] [[aortic dissection]] to establish a pretest risk of disease that can then be used to guide [[diagnosis|diagnostic]] decisions. This process should include specific questions about medical history, family history, and [[pain]] features as well as a focused examination to identify findings that are associated with [[aortic dissection]], including:
|-
|-
| bgcolor="LightGreen"|'''a.''' High-risk conditions and historical features<ref name="pmid10685714">{{cite journal |vauthors=Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, Evangelista A, Fattori R, Suzuki T, Oh JK, Moore AG, Malouf JF, Pape LA, Gaca C, Sechtem U, Lenferink S, Deutsch HJ, Diedrichs H, Marcos y Robles J, Llovet A, Gilon D, Das SK, Armstrong WF, Deeb GM, Eagle KA |title=The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease |journal=JAMA |volume=283 |issue=7 |pages=897–903 |date=February 2000 |pmid=10685714 |doi=10.1001/jama.283.7.897 |url=}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'':
| bgcolor="LightGreen" |'''a.''' High-risk conditions and historical features<ref name="pmid10685714">{{cite journal |vauthors=Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, Evangelista A, Fattori R, Suzuki T, Oh JK, Moore AG, Malouf JF, Pape LA, Gaca C, Sechtem U, Lenferink S, Deutsch HJ, Diedrichs H, Marcos y Robles J, Llovet A, Gilon D, Das SK, Armstrong WF, Deeb GM, Eagle KA |title=The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease |journal=JAMA |volume=283 |issue=7 |pages=897–903 |date=February 2000 |pmid=10685714 |doi=10.1001/jama.283.7.897 |url=}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'':
:* [[Marfan syndrome]], [[Loeys-Dietz syndrome]], [[vascular Ehlers-Danlos syndrome]], [[Turner syndrome]], or other [[connective tissue disease]].
 
:* Patients with [[mutation]]s in [[gene]]s known to predispose to [[thoracic aortic aneurysms]] and [[aortic dissection|dissection]], such as [[FBN1]], [[TGFBR1]], [[TGFBR2]], [[ACTA2]], and [[MYH11]].
:*[[Marfan syndrome]], [[Loeys-Dietz syndrome]], [[vascular Ehlers-Danlos syndrome]], [[Turner syndrome]], or other [[connective tissue disease]].
:* Family history of [[aortic dissection]] or [[thoracic aortic aneurysm]].
:*Patients with [[mutation]]s in [[gene]]s known to predispose to [[thoracic aortic aneurysms]] and [[aortic dissection|dissection]], such as [[FBN1]], [[TGFBR1]], [[TGFBR2]], [[ACTA2]], and [[MYH11]].
:* Known [[aortic valve disease]].
:*Family history of [[aortic dissection]] or [[thoracic aortic aneurysm]].
:* Recent [[aortic]] manipulation ([[surgery|surgical]] or catheter-based).
:*Known [[aortic valve disease]].
:* Known [[thoracic aortic aneurysm]].
:*Recent [[aortic]] manipulation ([[surgery|surgical]] or catheter-based).
:*Known [[thoracic aortic aneurysm]].
|-
|-
| bgcolor="LightGreen"|'''b.''' High-risk chest, back, or [[abdominal pain]] features<ref name="pmid10199307">{{cite journal |vauthors=Coady MA, Davies RR, Roberts M, Goldstein LJ, Rogalski MJ, Rizzo JA, Hammond GL, Kopf GS, Elefteriades JA |title=Familial patterns of thoracic aortic aneurysms |journal=Arch Surg |volume=134 |issue=4 |pages=361–7 |date=April 1999 |pmid=10199307 |doi=10.1001/archsurg.134.4.361 |url=}}</ref><ref name="pmid10685714">{{cite journal |vauthors=Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, Evangelista A, Fattori R, Suzuki T, Oh JK, Moore AG, Malouf JF, Pape LA, Gaca C, Sechtem U, Lenferink S, Deutsch HJ, Diedrichs H, Marcos y Robles J, Llovet A, Gilon D, Das SK, Armstrong WF, Deeb GM, Eagle KA |title=The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease |journal=JAMA |volume=283 |issue=7 |pages=897–903 |date=February 2000 |pmid=10685714 |doi=10.1001/jama.283.7.897 |url=}}</ref><ref name="pmid11041906">{{cite journal |vauthors=von Kodolitsch Y, Schwartz AG, Nienaber CA |title=Clinical prediction of acute aortic dissection |journal=Arch. Intern. Med. |volume=160 |issue=19 |pages=2977–82 |date=October 2000 |pmid=11041906 |doi=10.1001/archinte.160.19.2977 |url=}}</ref><ref name="pmid10807810">{{cite journal |vauthors=Mészáros I, Mórocz J, Szlávi J, Schmidt J, Tornóci L, Nagy L, Szép L |title=Epidemiology and clinicopathology of aortic dissection |journal=Chest |volume=117 |issue=5 |pages=1271–8 |date=May 2000 |pmid=10807810 |doi=10.1378/chest.117.5.1271 |url=}}</ref><ref name="pmid8350637">{{cite journal |vauthors=Spittell PC, Spittell JA, Joyce JW, Tajik AJ, Edwards WD, Schaff HV, Stanson AW |title=Clinical features and differential diagnosis of aortic dissection: experience with 236 cases (1980 through 1990) |journal=Mayo Clin. Proc. |volume=68 |issue=7 |pages=642–51 |date=July 1993 |pmid=8350637 |doi=10.1016/s0025-6196(12)60599-0 |url=}}</ref><ref name="pmid12204498">{{cite journal |vauthors=Mehta RH, O'Gara PT, Bossone E, Nienaber CA, Myrmel T, Cooper JV, Smith DE, Armstrong WF, Isselbacher EM, Pape LA, Eagle KA, Gilon D |title=Acute type A aortic dissection in the elderly: clinical characteristics, management, and outcomes in the current era |journal=J. Am. Coll. Cardiol. |volume=40 |issue=4 |pages=685–92 |date=August 2002 |pmid=12204498 |doi=10.1016/s0735-1097(02)02005-3 |url=}}</ref><ref name="pmid11980527">{{cite journal |vauthors=Klompas M |title=Does this patient have an acute thoracic aortic dissection? |journal=JAMA |volume=287 |issue=17 |pages=2262–72 |date=May 2002 |pmid=11980527 |doi=10.1001/jama.287.17.2262 |url=}}</ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'':
| bgcolor="LightGreen" |'''b.''' High-risk chest, back, or [[abdominal pain]] features<ref name="pmid10199307">{{cite journal |vauthors=Coady MA, Davies RR, Roberts M, Goldstein LJ, Rogalski MJ, Rizzo JA, Hammond GL, Kopf GS, Elefteriades JA |title=Familial patterns of thoracic aortic aneurysms |journal=Arch Surg |volume=134 |issue=4 |pages=361–7 |date=April 1999 |pmid=10199307 |doi=10.1001/archsurg.134.4.361 |url=}}</ref><ref name="pmid10685714">{{cite journal |vauthors=Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, Evangelista A, Fattori R, Suzuki T, Oh JK, Moore AG, Malouf JF, Pape LA, Gaca C, Sechtem U, Lenferink S, Deutsch HJ, Diedrichs H, Marcos y Robles J, Llovet A, Gilon D, Das SK, Armstrong WF, Deeb GM, Eagle KA |title=The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease |journal=JAMA |volume=283 |issue=7 |pages=897–903 |date=February 2000 |pmid=10685714 |doi=10.1001/jama.283.7.897 |url=}}</ref><ref name="pmid11041906">{{cite journal |vauthors=von Kodolitsch Y, Schwartz AG, Nienaber CA |title=Clinical prediction of acute aortic dissection |journal=Arch. Intern. Med. |volume=160 |issue=19 |pages=2977–82 |date=October 2000 |pmid=11041906 |doi=10.1001/archinte.160.19.2977 |url=}}</ref><ref name="pmid10807810">{{cite journal |vauthors=Mészáros I, Mórocz J, Szlávi J, Schmidt J, Tornóci L, Nagy L, Szép L |title=Epidemiology and clinicopathology of aortic dissection |journal=Chest |volume=117 |issue=5 |pages=1271–8 |date=May 2000 |pmid=10807810 |doi=10.1378/chest.117.5.1271 |url=}}</ref><ref name="pmid8350637">{{cite journal |vauthors=Spittell PC, Spittell JA, Joyce JW, Tajik AJ, Edwards WD, Schaff HV, Stanson AW |title=Clinical features and differential diagnosis of aortic dissection: experience with 236 cases (1980 through 1990) |journal=Mayo Clin. Proc. |volume=68 |issue=7 |pages=642–51 |date=July 1993 |pmid=8350637 |doi=10.1016/s0025-6196(12)60599-0 |url=}}</ref><ref name="pmid12204498">{{cite journal |vauthors=Mehta RH, O'Gara PT, Bossone E, Nienaber CA, Myrmel T, Cooper JV, Smith DE, Armstrong WF, Isselbacher EM, Pape LA, Eagle KA, Gilon D |title=Acute type A aortic dissection in the elderly: clinical characteristics, management, and outcomes in the current era |journal=J. Am. Coll. Cardiol. |volume=40 |issue=4 |pages=685–92 |date=August 2002 |pmid=12204498 |doi=10.1016/s0735-1097(02)02005-3 |url=}}</ref><ref name="pmid11980527">{{cite journal |vauthors=Klompas M |title=Does this patient have an acute thoracic aortic dissection? |journal=JAMA |volume=287 |issue=17 |pages=2262–72 |date=May 2002 |pmid=11980527 |doi=10.1001/jama.287.17.2262 |url=}}</ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'':
:* [[Pain]] that is abrupt or instantaneous in onset.
 
:* [[Pain]] that is severe in intensity.
:*[[Pain]] that is abrupt or instantaneous in onset.
:* [[Pain]] that has a ripping, tearing, stabbing, or sharp quality.
:*[[Pain]] that is severe in intensity.
:*[[Pain]] that has a ripping, tearing, stabbing, or sharp quality.
|-
|-
| bgcolor="LightGreen"|'''c.''' High-risk examination features<ref name="pmid10199307">{{cite journal |author=Coady MA, Davies RR, Roberts M, ''et al.'' |title=Familial patterns of thoracic aortic aneurysms |journal=Arch Surg |volume=134 |issue=4 |pages=361–7 |year=1999 |month=April |pmid=10199307 |doi= |url=}}</ref><ref name="pmid14975480">{{cite journal |vauthors=Januzzi JL, Isselbacher EM, Fattori R, Cooper JV, Smith DE, Fang J, Eagle KA, Mehta RH, Nienaber CA, Pape LA |title=Characterizing the young patient with aortic dissection: results from the International Registry of Aortic Dissection (IRAD) |journal=J. Am. Coll. Cardiol. |volume=43 |issue=4 |pages=665–9 |date=February 2004 |pmid=14975480 |doi=10.1016/j.jacc.2003.08.054 |url=}}</ref><ref name="pmid11041906">{{cite journal |author=von Kodolitsch Y, Schwartz AG, Nienaber CA |title=Clinical prediction of acute aortic dissection |journal=Arch. Intern. Med. |volume=160 |issue=19 |pages=2977–82 |year=2000 |month=October |pmid=11041906 |doi= |url=}}</ref><ref name="pmid11980527">{{cite journal |author=Klompas M |title=Does this patient have an acute thoracic aortic dissection? |journal=JAMA |volume=287 |issue=17 |pages=2262–72 |year=2002 |month=May |pmid=11980527 |doi= |url=}}</ref><ref name="pmid9842019">{{cite journal |vauthors=Armstrong WF, Bach DS, Carey LM, Froehlich J, Lowell M, Kazerooni EA |title=Clinical and echocardiographic findings in patients with suspected acute aortic dissection |journal=Am. Heart J. |volume=136 |issue=6 |pages=1051–60 |date=December 1998 |pmid=9842019 |doi=10.1016/s0002-8703(98)70162-0 |url=}}</ref><ref name="pmid17194878">{{cite journal |vauthors=Gaul C, Dietrich W, Friedrich I, Sirch J, Erbguth FJ |title=Neurological symptoms in type A aortic dissections |journal=Stroke |volume=38 |issue=2 |pages=292–7 |date=February 2007 |pmid=17194878 |doi=10.1161/01.STR.0000254594.33408.b1 |url=}}</ref><ref name="pmid16864725">{{cite journal |vauthors=Roberts WC, Ko JM, Moore TR, Jones WH |title=Causes of pure aortic regurgitation in patients having isolated aortic valve replacement at a single US tertiary hospital (1993 to 2005) |journal=Circulation |volume=114 |issue=5 |pages=422–9 |date=August 2006 |pmid=16864725 |doi=10.1161/CIRCULATIONAHA.106.622761 |url=}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'':
| bgcolor="LightGreen" |'''c.''' High-risk examination features<ref name="pmid10199307">{{cite journal |author=Coady MA, Davies RR, Roberts M, ''et al.'' |title=Familial patterns of thoracic aortic aneurysms |journal=Arch Surg |volume=134 |issue=4 |pages=361–7 |year=1999 |month=April |pmid=10199307 |doi= |url=}}</ref><ref name="pmid14975480">{{cite journal |vauthors=Januzzi JL, Isselbacher EM, Fattori R, Cooper JV, Smith DE, Fang J, Eagle KA, Mehta RH, Nienaber CA, Pape LA |title=Characterizing the young patient with aortic dissection: results from the International Registry of Aortic Dissection (IRAD) |journal=J. Am. Coll. Cardiol. |volume=43 |issue=4 |pages=665–9 |date=February 2004 |pmid=14975480 |doi=10.1016/j.jacc.2003.08.054 |url=}}</ref><ref name="pmid11041906">{{cite journal |author=von Kodolitsch Y, Schwartz AG, Nienaber CA |title=Clinical prediction of acute aortic dissection |journal=Arch. Intern. Med. |volume=160 |issue=19 |pages=2977–82 |year=2000 |month=October |pmid=11041906 |doi= |url=}}</ref><ref name="pmid11980527">{{cite journal |author=Klompas M |title=Does this patient have an acute thoracic aortic dissection? |journal=JAMA |volume=287 |issue=17 |pages=2262–72 |year=2002 |month=May |pmid=11980527 |doi= |url=}}</ref><ref name="pmid9842019">{{cite journal |vauthors=Armstrong WF, Bach DS, Carey LM, Froehlich J, Lowell M, Kazerooni EA |title=Clinical and echocardiographic findings in patients with suspected acute aortic dissection |journal=Am. Heart J. |volume=136 |issue=6 |pages=1051–60 |date=December 1998 |pmid=9842019 |doi=10.1016/s0002-8703(98)70162-0 |url=}}</ref><ref name="pmid17194878">{{cite journal |vauthors=Gaul C, Dietrich W, Friedrich I, Sirch J, Erbguth FJ |title=Neurological symptoms in type A aortic dissections |journal=Stroke |volume=38 |issue=2 |pages=292–7 |date=February 2007 |pmid=17194878 |doi=10.1161/01.STR.0000254594.33408.b1 |url=}}</ref><ref name="pmid16864725">{{cite journal |vauthors=Roberts WC, Ko JM, Moore TR, Jones WH |title=Causes of pure aortic regurgitation in patients having isolated aortic valve replacement at a single US tertiary hospital (1993 to 2005) |journal=Circulation |volume=114 |issue=5 |pages=422–9 |date=August 2006 |pmid=16864725 |doi=10.1161/CIRCULATIONAHA.106.622761 |url=}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'':
:* [[Pulse]] deficit.
 
:* [[Systolic blood pressure]] limb differential greater than 20 mm Hg.
:*[[Pulse]] deficit.
:* Focal [[neurologic]] deficit.
:*[[Systolic blood pressure]] limb differential greater than 20 mm Hg.
:* [[Murmur]] of [[aortic regurgitation]] (new).<nowiki>"</nowiki>
:*Focal [[neurologic]] deficit.
:*[[Murmur]] of [[aortic regurgitation]] (new).<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Patients presenting with sudden onset of severe [[chest pain|chest]], [[back pain|back]], and/or [[abdominal pain]], particularly those less than 40 years of age, should be questioned about a history and examined for physical features of [[Marfan syndrome]], [[Loeys-Dietz syndrome]], [[vascular]] [[Ehlers-Danlos syndrome]], [[Turner syndrome]], or other [[connective tissue disorders]] associated with [[thoracic aortic disease]].<ref name="pmid10685714">{{cite journal |author=Hagan PG, Nienaber CA, Isselbacher EM, ''et al.'' |title=The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease |journal=JAMA |volume=283 |issue=7 |pages=897–903 |year=2000 |month=February |pmid=10685714 |doi= |url=}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''2.''' Patients presenting with sudden onset of severe [[chest pain|chest]], [[back pain|back]], and/or [[abdominal pain]], particularly those less than 40 years of age, should be questioned about a history and examined for physical features of [[Marfan syndrome]], [[Loeys-Dietz syndrome]], [[vascular]] [[Ehlers-Danlos syndrome]], [[Turner syndrome]], or other [[connective tissue disorders]] associated with [[thoracic aortic disease]].<ref name="pmid10685714">{{cite journal |author=Hagan PG, Nienaber CA, Isselbacher EM, ''et al.'' |title=The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease |journal=JAMA |volume=283 |issue=7 |pages=897–903 |year=2000 |month=February |pmid=10685714 |doi= |url=}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Patients presenting with sudden onset of severe [[chest pain|chest]], [[back pain|back]], and/or [[abdominal pain]] should be questioned about a history of [[aortic]] pathology in immediate family members as there is a strong [[familial]] component to [[acute]] [[thoracic aortic disease]].<ref name="pmid10685714">{{cite journal |author=Hagan PG, Nienaber CA, Isselbacher EM, ''et al.'' |title=The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease |journal=JAMA |volume=283 |issue=7 |pages=897–903 |year=2000 |month=February |pmid=10685714 |doi= |url=}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''3.''' Patients presenting with sudden onset of severe [[chest pain|chest]], [[back pain|back]], and/or [[abdominal pain]] should be questioned about a history of [[aortic]] pathology in immediate family members as there is a strong [[familial]] component to [[acute]] [[thoracic aortic disease]].<ref name="pmid10685714">{{cite journal |author=Hagan PG, Nienaber CA, Isselbacher EM, ''et al.'' |title=The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease |journal=JAMA |volume=283 |issue=7 |pages=897–903 |year=2000 |month=February |pmid=10685714 |doi= |url=}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' Patients presenting with sudden onset of severe [[chest pain|chest]], [[back pain|back]], and/or [[abdominal pain]] should be questioned about recent [[aortic]] manipulation ([[surgery|surgical]] or catheter-based) or a known history of [[aortic]] [[valvular disease]], as these factors predispose to [[acute]] [[aortic dissection]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''4.''' Patients presenting with sudden onset of severe [[chest pain|chest]], [[back pain|back]], and/or [[abdominal pain]] should be questioned about recent [[aortic]] manipulation ([[surgery|surgical]] or catheter-based) or a known history of [[aortic]] [[valvular disease]], as these factors predispose to [[acute]] [[aortic dissection]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''5.''' In patients with suspected or confirmed [[aortic]] dissection who have experienced a [[syncope|syncopal episode]], a focused examination should be performed to identify associated [[neurologic]] injury or the presence of [[pericardial tamponade]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''5.''' In patients with suspected or confirmed [[aortic]] dissection who have experienced a [[syncope|syncopal episode]], a focused examination should be performed to identify associated [[neurologic]] injury or the presence of [[pericardial tamponade]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''6.''' All patients presenting with [[acute]] [[neurologic]] complaints should be questioned about the presence of [[chest pain|chest]], [[back pain|back]], and/or [[abdominal pain]] and checked for peripheral [[pulse]] deficits as patients with dissection related [[neurologic]] [[pathology]] are less likely to report [[thoracic]] [[pain]] than the typical [[aortic dissection]] patient.<ref name="pmid17194878">{{cite journal |vauthors=Gaul C, Dietrich W, Friedrich I, Sirch J, Erbguth FJ |title=Neurological symptoms in type A aortic dissections |journal=Stroke |volume=38 |issue=2 |pages=292–7 |date=February 2007 |pmid=17194878 |doi=10.1161/01.STR.0000254594.33408.b1 |url=}}</ref>
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''6.''' All patients presenting with [[acute]] [[neurologic]] complaints should be questioned about the presence of [[chest pain|chest]], [[back pain|back]], and/or [[abdominal pain]] and checked for peripheral [[pulse]] deficits as patients with dissection related [[neurologic]] [[pathology]] are less likely to report [[thoracic]] [[pain]] than the typical [[aortic dissection]] patient.<ref name="pmid17194878">{{cite journal |vauthors=Gaul C, Dietrich W, Friedrich I, Sirch J, Erbguth FJ |title=Neurological symptoms in type A aortic dissections |journal=Stroke |volume=38 |issue=2 |pages=292–7 |date=February 2007 |pmid=17194878 |doi=10.1161/01.STR.0000254594.33408.b1 |url=}}</ref>
|}
|}
== References ==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WH}}

Latest revision as of 20:58, 28 May 2021

Aortic dissection Microchapters

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Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Aortic dissection from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

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Case Studies

Case #1


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Raviteja Guddeti, M.B.B.S. [3] Sahar Memar Montazerin, M.D.[4]

Overview

Common risk factors in the development of aortic dissection include aging, atherosclerosis, diabetes, hypertension and trauma. Less common risk factors include bicuspid aortic valve, cocaine abuse, coarctation of the aorta, cystic medial necrosis, a history of collagen vascular disoders, giant cell arteritis, heart surgery, pseudoxanthoma elasticum, Turner's syndrome, tertiary syphilis and the third trimester of pregnancy.

Risk Factors

Common risk factors in the development of aortic dissection include:[1][2][3]

Less Common Risk Factors

Less common risk factors in the development of aortic dissection include:[6][7][8][9]

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease (DO NOT EDIT)[10]

Estimation of Pretest Risk of Thoracic Aortic Dissection (DO NOT EDIT)[10]

Class I
"1. Providers should routinely evaluate any patient presenting with complaints that may represent acute thoracic aortic dissection to establish a pretest risk of disease that can then be used to guide diagnostic decisions. This process should include specific questions about medical history, family history, and pain features as well as a focused examination to identify findings that are associated with aortic dissection, including:
a. High-risk conditions and historical features[11] (Level of Evidence: B):
b. High-risk chest, back, or abdominal pain features[12][11][13][14][15][16][17](Level of Evidence: B):
  • Pain that is abrupt or instantaneous in onset.
  • Pain that is severe in intensity.
  • Pain that has a ripping, tearing, stabbing, or sharp quality.
c. High-risk examination features[12][18][13][17][19][20][21] (Level of Evidence: B):
"2. Patients presenting with sudden onset of severe chest, back, and/or abdominal pain, particularly those less than 40 years of age, should be questioned about a history and examined for physical features of Marfan syndrome, Loeys-Dietz syndrome, vascular Ehlers-Danlos syndrome, Turner syndrome, or other connective tissue disorders associated with thoracic aortic disease.[11] (Level of Evidence: B)"
"3. Patients presenting with sudden onset of severe chest, back, and/or abdominal pain should be questioned about a history of aortic pathology in immediate family members as there is a strong familial component to acute thoracic aortic disease.[11] (Level of Evidence: B)"
"4. Patients presenting with sudden onset of severe chest, back, and/or abdominal pain should be questioned about recent aortic manipulation (surgical or catheter-based) or a known history of aortic valvular disease, as these factors predispose to acute aortic dissection. (Level of Evidence: C)"
"5. In patients with suspected or confirmed aortic dissection who have experienced a syncopal episode, a focused examination should be performed to identify associated neurologic injury or the presence of pericardial tamponade. (Level of Evidence: C)"
"6. All patients presenting with acute neurologic complaints should be questioned about the presence of chest, back, and/or abdominal pain and checked for peripheral pulse deficits as patients with dissection related neurologic pathology are less likely to report thoracic pain than the typical aortic dissection patient.[20]

References

  1. ↑ Larson, Eric W.; Edwards, William D. (1984). "Risk factors for aortic dissection: A necropsy study of 161 cases". The American Journal of Cardiology. 53 (6): 849–855. doi:10.1016/0002-9149(84)90418-1. ISSN 0002-9149.
  2. ↑ Januzzi, James L; Isselbacher, Eric M; Fattori, Rossella; Cooper, Jeanna V; Smith, Dean E; Fang, Jianming; Eagle, Kim A; Mehta, Rajendra H; Nienaber, Christoph A; Pape, Linda A (2004). "Characterizing the young patient with aortic dissection: results from the international registry of aortic dissection (IRAD)". Journal of the American College of Cardiology. 43 (4): 665–669. doi:10.1016/j.jacc.2003.08.054. ISSN 0735-1097.
  3. ↑ "Correspondence". The Annals of Thoracic Surgery. 67 (2): 593. 1999. doi:10.1016/S0003-4975(99)00037-5. ISSN 0003-4975.
  4. ↑ Losenno, Katie L.; Goodman, Robert L.; Chu, Michael W. A. (2012). "Bicuspid Aortic Valve Disease and Ascending Aortic Aneurysms: Gaps in Knowledge". Cardiology Research and Practice. 2012: 1–16. doi:10.1155/2012/145202. ISSN 2090-8016.
  5. ↑ Senaha S, Uezu T, Shimoji M, Akasaki M (March 2015). "[Stanford type B aortic dissection associated with coarctation of the aorta]". Kyobu Geka (in Japanese). 68 (3): 184–7. PMID 25743550.
  6. ↑ Dioguardi GS, Pimenta J, Knoplich J, Ghorayeb N, Ramos LR, Giannini SD (June 1994). "[Risk factors for cardiovascular diseases in physicians. Preliminary data from the VIDAM Project of the Paulista Medical Association]". Arq. Bras. Cardiol. (in Portuguese). 62 (6): 383–8. PMID 7826227.
  7. ↑ Caglayan, Ahmet Okay; Dundar, Munis (2009). "Inherited diseases and syndromes leading to aortic aneurysms and dissections". European Journal of Cardio-Thoracic Surgery. 35 (6): 931–940. doi:10.1016/j.ejcts.2009.01.006. ISSN 1010-7940.
  8. ↑ "Acute aortic dissection: pathogenesis, risk factors and diagnosis". Swiss Medical Weekly. 147 (3334). 2017. doi:10.4414/smw.2017.14489. ISSN 1424-7860.
  9. ↑ Increased maternal cardiovascular mortality associated with pregnancy in women with Turner syndrome.
  10. ↑ 10.0 10.1 Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE; et al. (2010). "2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine". Circulation. 121 (13): e266–369. doi:10.1161/CIR.0b013e3181d4739e. PMID 20233780.
  11. ↑ 11.0 11.1 11.2 11.3 Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, Evangelista A, Fattori R, Suzuki T, Oh JK, Moore AG, Malouf JF, Pape LA, Gaca C, Sechtem U, Lenferink S, Deutsch HJ, Diedrichs H, Marcos y Robles J, Llovet A, Gilon D, Das SK, Armstrong WF, Deeb GM, Eagle KA (February 2000). "The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease". JAMA. 283 (7): 897–903. doi:10.1001/jama.283.7.897. PMID 10685714.
  12. ↑ 12.0 12.1 Coady MA, Davies RR, Roberts M, Goldstein LJ, Rogalski MJ, Rizzo JA, Hammond GL, Kopf GS, Elefteriades JA (April 1999). "Familial patterns of thoracic aortic aneurysms". Arch Surg. 134 (4): 361–7. doi:10.1001/archsurg.134.4.361. PMID 10199307.
  13. ↑ 13.0 13.1 von Kodolitsch Y, Schwartz AG, Nienaber CA (October 2000). "Clinical prediction of acute aortic dissection". Arch. Intern. Med. 160 (19): 2977–82. doi:10.1001/archinte.160.19.2977. PMID 11041906.
  14. ↑ Mészáros I, Mórocz J, Szlávi J, Schmidt J, Tornóci L, Nagy L, Szép L (May 2000). "Epidemiology and clinicopathology of aortic dissection". Chest. 117 (5): 1271–8. doi:10.1378/chest.117.5.1271. PMID 10807810.
  15. ↑ Spittell PC, Spittell JA, Joyce JW, Tajik AJ, Edwards WD, Schaff HV, Stanson AW (July 1993). "Clinical features and differential diagnosis of aortic dissection: experience with 236 cases (1980 through 1990)". Mayo Clin. Proc. 68 (7): 642–51. doi:10.1016/s0025-6196(12)60599-0. PMID 8350637.
  16. ↑ Mehta RH, O'Gara PT, Bossone E, Nienaber CA, Myrmel T, Cooper JV, Smith DE, Armstrong WF, Isselbacher EM, Pape LA, Eagle KA, Gilon D (August 2002). "Acute type A aortic dissection in the elderly: clinical characteristics, management, and outcomes in the current era". J. Am. Coll. Cardiol. 40 (4): 685–92. doi:10.1016/s0735-1097(02)02005-3. PMID 12204498.
  17. ↑ 17.0 17.1 Klompas M (May 2002). "Does this patient have an acute thoracic aortic dissection?". JAMA. 287 (17): 2262–72. doi:10.1001/jama.287.17.2262. PMID 11980527.
  18. ↑ Januzzi JL, Isselbacher EM, Fattori R, Cooper JV, Smith DE, Fang J, Eagle KA, Mehta RH, Nienaber CA, Pape LA (February 2004). "Characterizing the young patient with aortic dissection: results from the International Registry of Aortic Dissection (IRAD)". J. Am. Coll. Cardiol. 43 (4): 665–9. doi:10.1016/j.jacc.2003.08.054. PMID 14975480.
  19. ↑ Armstrong WF, Bach DS, Carey LM, Froehlich J, Lowell M, Kazerooni EA (December 1998). "Clinical and echocardiographic findings in patients with suspected acute aortic dissection". Am. Heart J. 136 (6): 1051–60. doi:10.1016/s0002-8703(98)70162-0. PMID 9842019.
  20. ↑ 20.0 20.1 Gaul C, Dietrich W, Friedrich I, Sirch J, Erbguth FJ (February 2007). "Neurological symptoms in type A aortic dissections". Stroke. 38 (2): 292–7. doi:10.1161/01.STR.0000254594.33408.b1. PMID 17194878.
  21. ↑ Roberts WC, Ko JM, Moore TR, Jones WH (August 2006). "Causes of pure aortic regurgitation in patients having isolated aortic valve replacement at a single US tertiary hospital (1993 to 2005)". Circulation. 114 (5): 422–9. doi:10.1161/CIRCULATIONAHA.106.622761. PMID 16864725.

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