Diagnosis Of Acute Aortic Dissection Research Articles

D-dimer measurements in acute aortic dissection

Acute aortic dissection (AAD) is a medical emergency with significant morbidity and mortality. The diagnosis can be challenging due to the wide array of presenting symptoms and a broad differential diagnosis. Computed tomographic angiography is currently the gold standard for diagnosis of AAD. However, it carries the risk of contrast and radiation exposure and has a financial burden for patients. Multiple biomarkers have been evaluated as a screening tool for AAD. D-dimer has previously been suggested as a sole rule-out test for AAD. It is rapid and inexpensive, is widely available in the emergency rooms, and is highly sensitive for any thrombotic event. This review article evaluates the evidence for the use of D-dimer assays in the diagnosis of AAD, in differentiation of AAD from acute coronary syndromes, and in risk stratification of AAD patients.

Usefulness of triphasic CT aortic angiography in acute and surveillance: Our experience in the assessment of acute aortic dissection and endoleak

IntroductionComputed tomography angiography (CTA) has been widely used in the diagnostic evaluation of many aortic diseases, but no standardized techniques actually exist for aortic CTA. The aim of this study was to describe the usefulness of triphasic CTA in aortic assessment in both non-traumatic emergency and surveillance conditions. MethodsWe performed non ECG-gated CTA examinations with a 64-slice CT scanner using a triphasic protocol consisting of an unenhanced acquisition, and two (early and delayed) contrastographic phases with a delay of 25–30 s and 100–120 s respectively after the injection of contrast medium. Were retrospectively selected adult patients with imaging findings of acute aortic dissection (AAD) or endoleak (EL) from November 2012 to November 2014. ResultsAAD was detected in 36 (67%) patients: 23 type A-AADs, and 13 type B-AADs. The presence of EL was observed in 18 (33%) patients: 1 type Ia, 5 types IIa, 2 types IIb, 1 type IIIa and 9 types IIIb. DiscussionTriphasic CTA is useful to provide correct and prompt diagnosis of AAD in emergency, allowing the evaluation of type and atypical forms of AAD, and the identification of possible branch-vessel involvement and complications. During surveillance, triphasic CTA assures accurate and complete assessment of all known and unknown ELs and it is essential for first follow-up examination. ConclusionTriphasic CTA represents a reliable imaging tool for aortic assessment in both non-traumatic emergency and surveillance after endovascular aneurysm repair. Modified protocol could be employed in selected patients and tailored in their known disease.

LO075: Clinical exam for acute aortic dissection: a systematic review and meta-analysis

Introduction: Acute aortic dissection (AAD) is difficult to diagnose and if missed carries a significant mortality rate. Our aim was to assess the accuracy of history, physical exam and plain radiographs compared to advanced imaging in the diagnosis of AAD in adults presenting to the ED with a clinical suspicion of AAD. Methods: We conducted a librarian assisted systematic review. Databases searched: Pubmed, Medline, Embase and the Cochrane database from 1968 to January 2016. No restrictions for language were imposed. Studies were reviewed and data extracted by two independent reviewers. AAD was defined by CTA, MRI or TEE Prospective and retrospective studies of patients presenting with a clinical suspicion of AAD were included. Case series were excluded. Studies were combined if low clinical and statistical heterogeonity (I2<30%). Study quality was assessed using the QUADAS tool. Bivariate random effects meta analyses using Revman 5 and SAS 9.3 was performed. Results: We identified 792 records: 61 selected for full text review, 13 included and a further 7 from reference searches. 20 studies with 4721 participants were included (mean QUADAS score 12/14 SD 1.2, Kappa 0.8). Prevalence of AAD ranged from 9.6-76.1% (mean 39.1% SD 17.1%). Mean diagnosis in those without AAD varied between studies with ACS (30.3% SD 30.1%), Anuerysm(12.4% SD 9.8%), Chest wall pain(18.1% SD 13.3%) and PE(7.9% SD 7.85%) being the most common. The clinical findings most suggestive of AAD were, neurological deficit (specificity 94% LR 4.1 [95% CI, 3.1-5.2], I2 0%, n=9), hypotension(specificity 94% LR 2.6 [95% CI 1.6-4.2], I2 0%, n=8), pulse deficit (specificity 92% LR 3.4 [95% CI 1.8-6.4], I2 0%, n=9) and syncope (specificity 92% LR 1.4 [95% CI 1.1-1.8], I2 10%, n=6). The most useful for identifying patients less likely to have AAD were an absence of a widened mediastinum (sensitivity 80% LR 0.3 [95% CI 0.2-0.5], I2 20%, n=13) and an AHA Aortic dissection risk score <1 (n=2 sensitivity 91%,99% LR 0.02,0.22, [95% CI 0.003-0.128, 95%CI 0.2-0.3]). Conclusion: Suspicion for AAD should be raised with syncope, hypotension and pulse or neurological deficit in the appropriate clinical setting. Conversely the absence of a widened mediastinum and a low ADD score decreases likelihood. Clinical exam alone cannot rule out acute aortic dissection but it can help risk stratify for further testing.

LO061: Variation in emergency department use of computed tomography for investigation of acute aortic dissection

Introduction: Acute aortic dissection (AAD) is a life threatening condition making early diagnosis critical. Although 90% present with acute pain, the myriad of associated symptoms can make investigation and diagnosis a challenge. Our objectives were to assess emergency physician use of CT, yield of CT and ordering variation among physicians in patients presenting with pain for diagnosis of AAD. Methods: This historical cohort study of consecutive adult patients presenting to two tertiary academic care EDs over one calendar year included patients with a primary complaint of non-traumatic chest, back, abdominal or flank pain. Patients were excluded if clear diagnosis was made by basic investigations or exam. Primary outcome was rate of CT Thorax or Thorax/Abdomen ordered to rule out AAD as per clinical indication on diagnostic requisition. Secondary outcome was variation in CT ordering. Variation was measured with; Cochrane q test for homogeneity, proportion of positive CT’s (z-test) and mean CT’s (t test) ordered between high (>5CT/yr) and low (<5CT/yr) test users. Sample size of 6 per group was calculated based on an expected delta in mean CT ordered of 5 and a within group SD of 3. Results: 31,201 patients presented with chest, abdominal, back, flank pain during the study period. 8,472 were excluded based on a diagnosis made by clinical exam or basic investigations. 22,776 were included (Mean 47years SD 18.5yrs 56.2% Female). Most common diagnoses; Chest pain NYD(23.3%), Abdominal pain NYD(20.8%), Lower back pain NYD(10.5%), Renal Colic (5.3%), ACS (2.9%). CT was ordered to rule out AAD in 175 (0.7%) (Mean 62 years SD 16.5, 50.6% Female). Only 4(2.3%) were found to have an AAD. There was significant variation (range 0.6-12% Q test P<0.027) between proportion of CT's ordered by physicians. Between high (Mean 7.9 n=10 AAD=2) and low test users (Mean 2.3 n=41 AAD=2), there was significant difference in mean number of CT’s ordered (p<0.001) but no difference in number of AAD found (p<0.2). No AAD were missed. Conclusion: Current rate of imaging for aortic dissection is appropriately low but inefficient, with 98% of advanced imaging negative. There is significant variation in physician CT ordering (almost 20-fold) without an increase in diagnosis. These findings suggest great potential for more standardized and efficient use of CT for the diagnosis of AAD.

Acute Aortic Dissection Biomarkers Identified Using Isobaric Tags for Relative and Absolute Quantitation.

The purpose of this study was to evaluate the utility of potential serum biomarkers for acute aortic dissection (AAD) that were identified by isobaric Tags for Relative and Absolute Quantitation (iTRAQ) approaches. Serum samples from 20 AAD patients and 20 healthy volunteers were analyzed using iTRAQ technology. Protein validation was performed using samples from 120 patients with chest pain. A total of 355 proteins were identified with the iTRAQ approach; 164 proteins reached the strict quantitative standard, and 125 proteins were increased or decreased more than 1.2-fold (64 and 61 proteins were up- and downregulated, resp.). Lumican, C-reactive protein (CRP), thrombospondin-1 (TSP-1), and D-dimer were selected as candidate biomarkers for the validation tests. Receiver operating characteristic (ROC) curves show that Lumican and D-dimer have diagnostic value (area under the curves [AUCs] 0.895 and 0.891, P < 0.05). For Lumican, the diagnostic sensitivity and specificity were 73.33% and 98.33%, while the corresponding values for D-dimer were 93.33% and 68.33%. For Lumican and D-dimer AAD combined diagnosis, the sensitivity and specificity were 88.33% and 95%, respectively. In conclusion, Lumican has good specificity and D-dimer has good sensitivity for the diagnosis of AAD, while the combined detection of D-dimer and Lumican has better diagnostic value.

Clinical Predictors for Delayed or Inappropriate Initial Diagnosis of Type A Acute Aortic Dissection in the Emergency Room.

BackgroundInitial diagnosis of acute aortic dissection (AAD) in the emergency room (ER) is sometimes difficult or delayed. The aim of this study is to define clinical predictors related to inappropriate or delayed diagnosis of Stanford type A AAD.MethodsWe conducted a retrospective analysis of 127 consecutive patients with type A AAD who presented to the ER within 12 h of symptom onset (age: 69.0 ± 15.4 years, male/female = 49/78). An inappropriate initial diagnosis (IID) was considered if AAD was not included in the differential diagnosis or if chest computed tomography or echocardiography was not performed as initial imaging tests. Clinical variables were compared between IID and appropriate diagnosis group. The time to final diagnosis (TFD) was also evaluated. Delayed diagnosis (DD) was defined as TFD > third quartile. Clinical factors predicting DD were evaluated in comparison with early diagnosis (defined as TFD within the third quartile). In addition, TFD was compared with respect to each clinical variable using a rank sum test.ResultsAn IID was determined for 37% of patients. Walk-in (WI) visit to the ER [odds ratio (OR) 2.6, 95% confidence interval (CI) = 1.01–6.72, P = 0.048] and coronary malperfusion (CM, OR = 6.48, 95% CI = 1.14–36.82, P = 0.035) were predictors for IID. Overall, the median TFD was 1.5 h (first/third quartiles = 0.5/4.0 h). DD (>4.5 h) was observed in 27 cases (21.3%). TFD was significantly longer in WI patients (median and first/third quartiles = 1.0 and 0.5/2.85 h for the ambulance group vs. 3.0 and 1.0/8.0 h for the WI group, respectively; P = 0.003). Multivariate analysis revealed that WI visit was the only predictor for DD (OR = 3.72, 95% CI = 1.39–9.9, P = 0.009). TFD was significantly shorter for appropriate diagnoses than for IIDs (1.0 vs. 6.0 h, respectively; P < 0.0001).ConclusionsWI visit to the ER and CM were predictors for IID, and WI was the only predictor for DD in acute type A AAD in the community hospital.

Differential expression of microRNAs in aortic tissue and plasma in patients with acute aortic dissection.

BackgroundBiomarker-assisted diagnosis of acute aortic dissection (AAD) is important for diagnosis and treatment. However, identification of biomarkers for AAD in blood is a challenging task. The aim of this study is to search for new potentially microRNA (miRNAs) biomarkers in AAD.MethodsThe miRNAs expression profiles in ascending aortic tissue and plasma were examined by microarray analysis in two sets or groups. The tissue group was composed of four patients with AAD and four controls of healthy male organ donors. The plasma group included 20 patients with AAD and 20 controls without cardiovascular disease. Bioinformatics was used to analyze the potential targets of the differentially expressed miRNAs.ResultsOur study revealed that in AAD patients, the aortic tissue had 30 differentially expressed miRNAs with 13 up-regulated and 17 down-regulated, and plasma had 93 differentially expressed miRNAs, of which 33 were up-regulated and 60 were down-regulated. Four miRNAs were found to be up-regulated in both aortic tissue and plasma in AAD patients. The predicted miRNA targets indicated the four dysregulated miRNAs mainly targeted genes that were associated with cell-cell adhesion, extracellular matrix metabolism, cytoskeleton organization, inflammation, and multiple signaling pathways related to cellular cycles.ConclusionsFour miRNAs, which are up-regulated both in aortic tissue and in plasma in AAD patients, have been identified in this study. These miRNAs might be potential diagnostic biomarkers for AAD. Larger sample investigations are needed for further verification.

Early rapid diagnosis and rational choice of the first-line agents for acute aortic dissection in the emergency department: ses

Objective To explore the rapid diagnosis and the rational chice of the first-line agents for acute aortic dissection (AAD) in the emergency department. Methods The clinical data of 360 patients with AAD treated at our hospital from March 2007 to March 2013 were retrospectively analyzed. Of them, 338 patients with suspected AAD were examined by chest radiography, trans-thoracic echocardiography (TTE), and computed tomography angiography (CTA) successively. The reliabilities of results from each diagnostic method were verified by the gold standardof intra-operative findings and the comparisons of their diagnostic potential were carried out. Results The preoperative diagnostic sensitivity of chest radiography, TTE and CTA in the assessment of AAD were 64%, 77% and 100%, respectively; the specificity is 86%, 90% and 100%, respectively; the accuracy rats were 70%, 78% and 100%, respectively; the positive predictive values were 93%, 99% and 100%, respectively; the negative predictive values were 46%, 27% and 100%, respectively. In the work-up of any patient with suspected AAD, the emergency bedside non-invasive TTE or computed tomography was the first-line initial diagnostic screening, and the best method for the accurate diagnosis of AAD was CTA. Medical management included pain control and deliberate hypotension therapy by using rapidly short-acting vasodilator and beta blockers to lower heart rate, and the hibernation therapy in small dose of specific agents might serve as a useful adjuvant method, and the early combination of vasodilatation medicines was better than the single one. Of them, 242 patients fortunately survived on treatment, and 42 died of hypovolemic shock after rupture of AAD and multi- organ failure. Conclusions Acute aortic dissection is the most potentially life-threatening cardiovascular disease, though it is extremely rare in the hypertensive patients, attending doctors should pay more attention. Early rapid diagnosis is the key to AAD treatment. The best method for correctly diagnosing AAD is complementary use of TTE, CTA and magnetic resonance angiography (MRA). Correct and timely diagnosis and strictly deliberate hypotension treatment are the essential determinant of decreasing mortality and improving prognosis of AAD. Key words: Aortic dissection; Chest radiography; Transthoracic echocardiography; Computed tomography angiography; Magnetic resonance angiography; Diagnosis; Therapy; Hibernation

Epidemiology and Medication Utilization Pattern of Aortic Dissection in Taiwan: A Population-Based Study.

Acute aortic dissection (AD) is a catastrophic condition associated with a high rate of mortality. However, current epidemiological information regarding AD remains sparse. The objective of the present study was to investigate the current epidemiological profile and medication utilization patterns associated with aortic dissection in Taiwan.In this population-based study, we identified cases of AD diagnosed during 2005 to 2012 in the complete Taiwan National Health Insurance (NHI) Research Database. Patients with AD were identified using the International Classification of Disease, Ninth Revision (ICD-9) code 441.0, and surgical interventions were defined using NHI procedure codes.A total of 9092 individuals with a mean age of 64.4 ± 15.1 years were identified. The cases were divided into 3 groups: Group A included 2340 patients (25.74%) treated surgically for type A AD; Group B included 1144 patients (12.58%) treated surgically for type B AD, and Group C included 5608 patients (61.68%) with any type of AD treated with medical therapy only. The average annual incidence of AD was 5.6 per 100,000 persons, and the average prevalence was 19.9 per 100,000 persons. Hypertension was the most common risk factor, followed by coronary artery disease and chronic obstructive pulmonary disease. Within 1 year of AD diagnosis, 92% of patients were taking antihypertensive medication. Calcium channel blockers were the most frequently prescribed antihypertensive medication for long-term observation in Taiwan.The annual trends revealed statistically significant increases in the numbers and percentages of prevalence, incidence, and mortality. Changes in patients’ drug utilization in patterns were observed after AD diagnosis. Our study provides a local profile that supports further in-depth analyses in AD-affected populations.

Potential biomarkers for early diagnosis of acute aortic dissection

ObjectiveThe purpose of this study was to identify biological markers for early diagnosis of acute aortic dissection (AAD). Methods76 patients presented to the emergency room with acute chest pain within 6 h of occurrence were recruited for this study, and AAD diagnosed by aortic CTA. Biomarkers were measured by ELISA. ROC curve and Pearson correlation analysis were used to evaluate the sensitivity and specificity to diagnosis of AAD. ResultsThe serum levels of α-SMA, smMHC, sELAF, PC1 and D-dimer were significantly higher in AAD patients than in other groups (P < 0.05). Significant correlations between smMHC, sELAF, PC1, and D-dimer level were observed in AAD. Any combination of two markers showed good sensitivity (94.29%) and specificity (85.37%). ConclusionsmMHC, sELAF, PC1, or D-dimer alone is a biomarker for early diagnosis of AAD, but the combination of these markers has significantly higher diagnostic value.

Impact of Elevated D-Dimer on Diagnosis of Acute Aortic Dissection With Isolated Neurological Symptoms in Ischemic Stroke

Plasma D-dimer is known to be a useful clinical marker of thrombogenic status, and D-dimer is used as a diagnostic marker for acute aortic dissection (AAD). Little is known, however, regarding the clinical value of D-dimer for diagnosis of asymptomatic AAD in patients with ischemic stroke. We investigated whether D-dimer could be used for early diagnosis of AAD with isolated neurological symptoms in ischemic stroke patients. We evaluated a total of 1,236 consecutive patients with symptomatic ischemic stroke without chest or back pain who underwent either head computed tomography or magnetic resonance imaging. D-dimer was measured within 24 h after onset. There were 9 patients with Stanford type A AAD and they had significantly higher D-dimer than the patients without AAD (mean, 46.47±54.48 μg/ml; range, 6.9-167.1 μg/ml vs. 2.33±3.58 μg/ml, 0.3-57.9 μg/ml, P<0.001). When a cut-off of 6.9 μg/ml was adopted for d-dimer on the basis of receiver operating characteristics analysis, the sensitivity and specificity for AAD were 100% and 94.8%, respectively, while the positive and negative predictive values were 14.7% and 100%, respectively. D-dimer might be a useful marker for the early diagnosis of AAD with isolated neurological symptoms in ischemic stroke patients. Whole-body contrast-enhanced computed tomography should be performed in ischemic stroke patients who have high D-dimer.

D-dimer as a biomarker for acute aortic dissection: a systematic review and meta-analysis.

To perform a meta-analysis and examine the use of D-dimer levels for diagnosing acute aortic dissection (AAD).Medline, Cochrane, EMBASE, and Google Scholar were searched until April 23, 2014, using the following search terms: biomarker, acute aortic dissection, diagnosis, and D-dimer. Inclusion criteria were diagnosis of acute aortic dissection, D-dimer levels obtained, 2-armed study. Outcome measures were the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of D-dimer level for the diagnosis of AAD. Sensitivity analysis was performed using the leave-one-out approach.Of 34 articles identified, 5 met the inclusion criteria and were included in the analysis. The age of participants was similar between treatments within studies. The number of AAD patients ranged from 16 to 107 (total = 274), and the number of control group patients ranged from 32 to 206 (total = 469). The pooled sensitivity of D-dimer levels in AAD patients was 94.5% (95% confidence interval [CI] 78.1%–98.8%, P < 0.001), and the specificity was 69.1% (95% CI 43.7%–86.5%, P = 0.136). The pooled area under the receiver-operating characteristic curve for D-dimer levels in AAD patients was 0.916 (95% CI 0.863–0.970, P < 0.001). The direction and magnitude of the combined estimates did not change markedly with the exclusion of individual studies, indicating the meta-analysis had good reliability.D-dimer levels are best used for ruling out AAD in patients with low likelihood of the disease.

Acute Thoracic Aortic Dissection (Stanford B): Challenges in Early Detection and Management

Background: Diagnosis of acute thoracic dissection is crucial given its potential fatal complications in delayed treatment response. Early and appropriate intervention renders obviation of futile surgery. Case report: A 63 years old man with uncontrolled hypertension who presented to emergency department with sharp excruciating chest pain which radiated to the back. A Computed Tomography Angiography (CTA) was done which confirmed thoracic aortic dissection (Stanford type B) (Figures 1 and 2). An uneventful endovascular stent graft with Captivia system was done to contain the entry tear. The patient was doing well post procedure with wellcontrolled blood pressure. Conclusion: This case reports documents challenges in making immediate diagnosis of acute aortic dissection and in providing appropriate intervention to avert fatal outcomes.

The role of D-dimers in the diagnosis of acute aortic dissection.

Acute aortic dissection (AAD) is a life threatening cardiovascular medical emergency with a poor prognosis. To explore the utility of D-dimers (DD) in the diagnosis of AAD, we performed a prospective study and conducted a meta-analysis of previous studies. 368 suspected patients were enrolled, including AAD n = 89, PE n = 12, AMI n = 167, normal controls n = 100. All patients had a DD test immediately after admission. We then performed a comprehensive computer search to identify studies investigating using DD as a screening tool for AAD. Finally, we pooled these data to estimate sensitivity, specificity, positive and negative likelihood ratios (LRs) by using DerSimonian-Laird random-effects models. The DD concentrations in the AAD group were significantly higher than those in the AMI and normal control groups. However, the DD level of 500 ng/ml had a poor sensitivity of 51.7 % and specificity of 89.2 % in the diagnosis of AAD. Subgroup analyses found that DD only showed a well discriminative ability of distinguishing AAD patients from normal controls (specificity and positive LR was 97 % and 17.2, respectively). The pooled sensitivity, specificity, positive and negative LR in our meta-analysis was 89, 68 %, 2.71, 0.07, respectively. In conclusion, our results suggest that plasma DD levels cannot add to the certainty of AAD diagnosis and it is not a good biomarker for AAD. In the future, prospective research on patients from many parts of the world is warranted to validate our findings. In addition, different controls, methods of plasma DD assays and other factors should be considered.

Diagnostic Testing in Acute Aortic Dissection

Acute aortic dissection (AAD) is the most common catastrophe to involve the aorta, resulting in high morbidity and mortality. Delayed diagnosis can adversely affect patient outcome, therefore a high clinical index of suspicion is the first step. Absence of the classical signs such as pulse defecit and chest radiograph changes should not falsely reassure clinicians. Availability of a biomarker to expedite and improve diagnosis of AAD would greatly benefit emergency department clinicians. Some promising novel biomarkers include calponin and elastin, but their use in everyday practice is still some time away. Bedside imaging including transthoracic and transesophageal echo is being increasingly used in the unstable patient suspected of AAD, while computed tomography (CT) appears to be the most accurate rapid imaging modality for its diagnosis. Expeditious diagnosis is crucial to improve patient survival allowing for better outomes.

Diagnostic performance of the aortic dissection detection risk score in patients with suspected acute aortic dissection

The aortic dissection detection (ADD) risk score has been proposed by guidelines to standardise the approach to patients with suspected acute aortic dissection (AD). However, the ADD risk score has not been validated so far. Patients with suspected AD from two clinical centres were prospectively enrolled in a registry from 2008 to 2012. The ADD risk score was calculated retrospectively by review of medical charts, according to the number of risk categories where patients met criteria. Of 1328 patients, 291 (21.9%) were diagnosed with AD. The ADD risk score was=0 in 439 (33.1%) patients, =1 in 646 (48.6%) patients and >1 in 243 (18.3%) patients. The incidence of AD was 5.9%, 27.3% and 39.1% respectively in patient groups identified by ADD risk score=0, =1 and >1. ADD risk score>0 had a sensitivity of 91.1% (95% confidence interval (CI) 87.2-94.1%) and a specificity of 39.8% (95% CI 36.8-42.9%) for the diagnosis of AD, while ADD risk score>1 had a sensitivity of 32.7% (95% CI 27.3-38.4%) and a specificity of 85.7% (95% CI 83.5-87.8%). Among patients with ADD risk score=0, mediastinum widening on chest X-ray had a sensitivity of 16.7% (95% CI 3.6-41.4%) and a specificity of 86.3% (95% CI 81.9-90.0%). The ADD risk score stratifies patients for the risk of AD. ADD risk score>0 is highly sensitive and poorly specific for the diagnosis in AD. The presence of ADD risk score=0 per se does not accurately exclude AD. In patients with ADD risk score=0, chest X-ray provides limited diagnostic information.

PT091 Mode of Presentation and Diagnosis of Acute Aortic Dissection: A Difficult Diagnosis That Doesn’t Read the Textbooks!

PT091 Mode of Presentation and Diagnosis of Acute Aortic Dissection: A Difficult Diagnosis That Doesn’t Read the Textbooks!

Impact of Fluoroscopically-Visible Fluttering Flap on Clinical Diagnosis of Acute Aortic Dissection

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4] A 71-year-old man with a previous history of hypertension presented to our clinic because of chest pain. The electrocardiogram showed ST-segment elevation in inferior leads with reciprocal ST-segment depression, consistent with

When does a D-dimer test help make the diagnosis of aortic dissection?

We present a case of an 84-year-old woman who presented with vague abdominal discomfort and syncope secondary to a type A acute aortic dissection. In pursuit of the diagnosis, multiple tests were ordered after the history and physical exam were complete. When the D-dimer levels were reported to be high, a bedside transthoracic ultrasound was performed which showed dilated aortic root and pericardial tamponade, leading us to order a computerized tomography to confirm the diagnosis of acute aortic dissection. A diagnostic testing algorithm being used in our institution using D-dimer, ultrasound, and other tests are provided in patients presenting with possible acute aortic dissection. In this case, bedside ultrasound helped us to rapidly make the diagnosis of acute aortic dissection and arrange for further inpatient care.

Have a novel guideline of American Heart Association outlived usefulness in early differentiated diagnosis of acute aortic dissection

Results Abrupt onset of pain was the most frequent symptom (67.4%). 6 patients (3.6%) were grouped under the low risk, 88 patients (53.0%) under the intermediate risk, and 72 patients (43.4%) under the high risk. 90 patients (54.2%) demonstrated a widened mediastinum in the chest X-rays. 3 patients showed a mediastinal widening among 6 patients with low risk. In 7 patients (4.2%), were initially diagnosed with acute myocardial infarction, 3 patients were categorized as intermediate risk group (risk score 1) and the others as a high risk of AAD (risk score 2).