Aortic Dissection (cont.)
How is aortic dissection diagnosed?
The healthcare provider should be suspicious of aortic dissection as one of the
causes to be considered for chest pain, as well as for heart attack and
pulmonary embolism.
If the patient has unstable vital signs, poor breathing, abnormal pulse,
low
blood pressure, and/or a decreased level of consciousness, the ABCs of
resuscitation (Airway, Breathing, Circulation) need to be addressed while the
evaluation of the patient continues.
Patient History
The history is one of the important first steps in deciding upon the
diagnosis.
Physical examination may reveal the potential complications of the aortic
aneurysm to allow the healthcare provider to consider this as a potential diagnosis.
Again, the presenting symptoms will depend upon the location of the dissection
and what organs are involved. Symptoms, depending on the location of the
dissection, may include:
- Blood pressure discrepancy between the arms
- Pulse delay between arms and legs
- Listening for fluid in the lung and for a new heart murmur may help
assess the aortic valve
- New stroke symptoms
- Paraplegia
The initial tests for chest pain, an electrocardiogram, and a chest x-ray are
usually done. Unless the dissection involves the coronary arteries, the
electrocardiogram is usually normal. The chest x-ray may show an abnormal shape
to the aorta and a widened mediastinum (that space where the heart, aorta, vena
cava, trachea, and esophagus sit in the chest cavity).
The diagnostic test of choice is a computerized tomography aortic angiogram
of the chest and abdomen to visualize the aorta (this test requires a contrast
dye injection).
Alternatively, for those people who cannot undergo computerized tomography,
transesophageal echocardiography is an alternative. A cardiologist puts an
ultrasound probe through the mouth into the esophagus and can identify potential
problems with the heart, heart valves, and the aorta.
Magnetic resonance imaging (MRI) can also be used, but is not often
technically easily available with unstable patients.
Next: What is the treatment for aortic dissection? »
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