Aortic Dissection - Diagnosis

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How is aortic dissection diagnosed?

The health care professional should always be suspicious of aortic dissection as one of the three major causes of chest pain that can cause death, in addition to 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 trying to make the diagnosis. It is important to consider not only the symptoms but also the risk factors of high blood pressure, genetic or family history, and the presence of other medical conditions that may predispose the patient to aortic dissection.

Physical examination may show potential complications of the aortic aneurysm and allow the health care professional 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 or for a new heart murmur that 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 an aortic angiogram using computerized tomography of the chest and abdomen. This test requires a contrast dye injection and visualizes the aorta and other blood vessels that branch off from it. Alternatively, for those people who cannot undergo computerized tomography, transesophageal echocardiography is an option. 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 and takes much longer to perform than a CT scan.

Return to Aortic Dissection

See what others are saying

Comment from: Tom, 55-64 Male (Caregiver) Published: March 25

On 11/24/14, I was at work when I felt an intense tearing sensation/chest pain with near syncope. It somewhat resolved but I did not feel very good and continued working for about 3 more hours before I collapsed. I work in a cardiovascular clinic in one of the best heart hospitals and was evaluated by our staff and transferred to the emergency room. I had a CTA and was diagnosed with a Stanford type A, DeBakey type 1 aortic dissection. I was immediately taken to the operation room for an aneurysmal ascending aortic repair. I have a long history of hypertension. I am recovering well and monitoring my blood pressure closely.

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Comment from: Kathy, 55-64 Female (Patient) Published: October 07

My pain started in my back at my waist. It radiated up my back in a rolling motion till it reached my armpits on both sides, then radiating to the front of the chest. The pain increased as it rose to the front. I could not speak nor breathe. Paramedics arrived and quickly gave me an aspirin which helped a little with the pain. Also I was given 2 nitroglycerines and they helped with the pain. I had a CT of the heart and it showed I had an aortic dissection. I spent 5 days in ICU and 2 days on monitoring floor before going home. I'm still having frequent back pain but not as severe. I'm scared this might happen again. The doctors lowered my blood pressure dramatically, changed my diet, and I have quit smoking. But the fear is still there.

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