Aortic dissection physical examination

Aortic dissection Microchapters
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Case #1

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Physical Examination

• Cardiac tamponade, hemothorax, Horner syndrome, and hoarseness (due to compression of the left recurrent laryngeal nerve) can also be seen.
• Descending dissection can lead to splanchnic ischemia, renal insufficiency

Heart

• Aortic regurgitation is present in approximately 40 – 66 % of patients and is almost always seen in those with type I or type II dissection. The murmur of aortic insufficiency (AI) due to aortic dissection is best heard at the R 2nd intercostal space (ICS), as compared with the lower left sternal border for AI due to primary aortic valvular disease.

Lungs

Rales may be present due to cardiogenic pulmonary edema

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.

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".

Acknowledgements

The content on this page was first contributed by: David Feller-Kopman, MD and C. Michael Gibson M.S., M.D.