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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.
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
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.