Potentially life-threatening emergency
Aortic dissection
Alerts and Notices
Synopsis

If suspicion is high, based on history of present illness (HPI), examination, and/or patient history:
- Assess vital signs.
- Establish reliable intravenous (IV) access.
- Blood pressure and heart rate control.
- Analgesia.
- CT angiogram of chest / abdomen / pelvis.
- Expedited consultation with vascular specialist.
Aortic dissection is an intramural tear of the aorta. Aortic dissection is a life-threatening emergency. Tears often occur in the intimal layer of the aorta, with blood collecting in the medial layer. Back pain is the common presenting symptom, but it may also present with chest pain, dyspnea, or a new neurologic deficit. Syncope and hypotension occur less frequently. Aortic dissections most often occur in older men.
Aortic dissection can arise from several etiologies:
- Blunt trauma to chest / abdomen
- Chronic hypertension or hypertensive emergency
- Aortic atherosclerosis
- Sympathomimetic abuse / intoxication (eg, cocaine)
- Connective tissue disease (eg, Marfan syndrome)
- Acute increase in intrathoracic / intraabdominal pressure (eg, weight lifting, labor)
- Recent aortic instrumentation / procedure
- Aortic aneurysm dissection (less common)
- Type A – dissection involving ascending aorta
- Type B – dissection that does not involve ascending aorta (ie, aortic arch and descending aorta)
- DeBakey I – ascending and descending
- DeBakey II – ascending only
- DeBakey III – descending only
Related topic: cystic medial necrosis
Codes
ICD10CM:I71.00 – Dissection of unspecified site of aorta
SNOMEDCT:
308546005 – Dissection of aorta
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Acute myocardial infarction
- Pulmonary embolism (PE)
- Musculoskeletal back pain
- Pericarditis
- Mediastinal tumor
- Pneumothorax
- Esophageal rupture
- Penetrating atherosclerotic ulcer
- Aortic intramural hematoma (IMH)
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:08/16/2022
Last Updated:11/29/2022
Last Updated:11/29/2022