Acute aortic syndrome

Acute aortic syndrome Microchapters
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Patient Information
Overview
Classification • Aortic dissection • Aortic intramural hematoma • Penetrating atherosclerotic aortic ulcer
Differentiating Acute Aortic Syndrome from other Diseases
Causes
Guidelines

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2]

Overview

Acute aortic syndrome (AAS) describes a constellation of emergency conditions with a similar clinical feature that involves the aorta. These include aortic dissection, intramural thrombus, and penetrating atherosclerotic aortic ulcer. It is possible for AAS to get complicated by acute coronary syndrome. The term was introduced in 2001.

Classification

Acute aortic syndrome is classified into 5 entities as follows:

• Type I: classic aortic dissection involving an intimal layer between the true and false lumen (with no communication between the two lumen)
• Type II: aortic dissection with medial rupture and the subsequent intramural hematoma formation
• Type III: subtle aortic dissection with bulging of the aortic wall
• Type IV: aortic dissection due to plaque rupture and subsequent ulceration
• Type V: iatrogenic/traumatic dissection

Differentiating Acute Aortic Syndrome from other Diseases

• Acute aortic syndrome should be differentiated from other conditions causing signs and symptoms such as chest pain, dyspnea, back pain and etc.
• For more information on the differential diagnosis of the acute aortic syndrome click here.

Causes

• Causes include aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer or a thoracic aneurysm that has become unstable.
• Basically, AAS can be caused by a breakdown on the wall of the aorta that involves the tunica intima and/or media.
• For more information on aortic dissection causes click here.
• For more information on aortic intramural hematoma causes click here.
• For more information on penetrating atherosclerotic aortic ulcer causes click here.

Guidelines

2014 ESC Guidelines on the Diagnosis and Treatment of Aortic Diseases (DO NOT EDIT)

Recommendations	Class	Level	References
History and clinical assessment
"In all patients with suspected AAS, pre-test probability assessment is recommended, according to the patient’s condition, symptoms, and clinical features."	I	B
Laboratory testing
"In case of suspicion of AAS, the interpretation of biomarkers should always be considered along with the pretest clinical probability."	IIa	B
"In case of low clinical probability of AAS, negative D-dimer levels should be considered as ruling out the diagnosis."	IIa	C
"In case of intermediate clinical probability of AAS with a positive (point-of-care) D-dimer test, further imaging tests should be considered."	IIa	B
"In patients with high probability (risk score 2 or 3) of AD, testing of D-dimers is not recommended."	III	C
Imaging
"TTE is recommended as an initial imaging investigation."	I	C
"In unstabled patients with a suspicion of AAS, the following imaging modalities are recommended according to local availability and expertise:
TOE"	I	C
CT	I	C
"In stable patients with a suspicion of AAS, the following imaging modalities are recommended (or should be considered) according to local availability and expertise:
CT	I	C
MRI	I	C
TOE"	IIa	C
"In case of initially negative imaging with the persistence of suspicion of AAS, repetitive imaging (CT or MRI) is recommended."	I	C
"Chest X-ray maybe considered in cases of low clinical probability of AAS."	IIb	C
"In case of uncomplicated Type B AD treated medically, repeated imaging (CT or MRI)e during the first days is recommended."	I	C

Abbreviations: AAS: acute aortic syndrome; AD: aortic dissection; CT: computed tomography; MRI: magnetic resonance imaging; TOE: transoesophageal echocardiography; TTE: transthoracic echocardiography.

References

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