Aortic dissection physical examination: Difference between revisions
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*[[Hemothorax]] and / or [[pleural effusion]] may cause [[dullness to percussion]]. | *[[Hemothorax]] and / or [[pleural effusion]] may cause [[dullness to percussion]]. | ||
== Extremities == | |||
Diminution or absence of pulses is found in up to 40% of patients, and occurs due to occlusion of a major aortic branch. For this reason it is critical to assess the pulse and blood pressure in both arms. The iliac arteries may be affected as well. | Diminution or absence of pulses is found in up to 40% of patients, and occurs due to occlusion of a major aortic branch. For this reason it is critical to assess the pulse and blood pressure in both arms. The iliac arteries may be affected as well. | ||
Revision as of 01:17, 29 October 2012
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Aortic dissection Microchapters |
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Diagnosis |
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Treatment |
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Special Scenarios |
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Case Studies |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Vitals
Blood Pressure
Pseudohypotension (falsely low blood pressure measurement) may occur due to involvement of the brachiocephalic artery (supplying the right arm) or the left subclavian artery (supplying the left arm).
While many patients with an aortic dissection have a history of hypertension, the blood pressure is quite variable among patients with acute aortic dissection, and tends to be higher in individuals with a distal dissection. In individuals with a proximal aortic dissection, 36% present with hypertension, while 25% present with hypotension. In those that present with distal aortic dissections, 70% present with hypertension while 4% present with hypotension.
Severe hypotension at presentation is a grave prognostic indicator. It is usually associated with pericardial tamponade, severe aortic insufficiency, or rupture of the aorta. Accurate measurement of the blood pressure is important.
Pulse
- Tachycardia may be present due to pain, anxiety, aortic rupture with massive bleeding, pericardial tamponade, aortic insufficiency with acute pulmonary edema and hypoxemia.
- A wide pulse pressure may be present if acute aortic insufficiency develops.
General
The patient may be hoarse due to compression of the left recurrent laryngeal nerve
Head, Eyes, Ears, Nose, Throat
, hemothorax, Horner syndrome,
- Descending dissection can lead to splanchnic ischemia, renal insufficiency
Heart
Aortic Insufficiency
Aortic insufficiency occurs in 1/2 to 2/3 of ascending aortic dissections, and the murmur of aortic insufficiency is audible in about 32% of proximal dissections. The intensity (loudness) of the murmur is dependent on the blood pressure and may be inaudible in the event of hypotension. Aortic insufficiency is more commonly associated with type I or type II dissection. The murmur of aortic insufficiency (AI) due to aortic dissection is best heard at the right 2nd intercostal space (ICS), as compared with the lower left sternal border for AI due to primary aortic valvular disease.
Cardiac Tamponade
Lungs
- Rales may be present due to cardiogenic pulmonary edema which may result from acute aortic regurgitation.
- Hemothorax and / or pleural effusion may cause dullness to percussion.
Extremities
Diminution or absence of pulses is found in up to 40% of patients, and occurs due to occlusion of a major aortic branch. For this reason it is critical to assess the pulse and blood pressure in both arms. The iliac arteries may be affected as well.
Neurologic
- Neurologic deficits such as coma, altered mental status, Cerebrovascular accident (CVA) and vagal episodes are seen in up to 20%.
- There can also be focal neurologic signs due to occlusion of a spinal artery. This condition is known as Anterior spinal artery syndrome or "Beck's syndrome".