scholarly journals EP.TU.888Aortic dissection: Causes of delay in diagnosis and transfer, implications for patients, and how to improve

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Megan Blakley ◽  
Catherine Poots ◽  
Alsir Ahmed ◽  
Jijin Joseph
Keyword(s):  
Chest Pain ◽  
Northern Ireland ◽  
Aortic Dissection ◽  
Initial Presentation ◽  
Time Of Arrival ◽  
Delay In Diagnosis ◽  
Presentation Time ◽  
Delays In Diagnosis ◽  
Work Up ◽  
Surgical Unit

Abstract Background Aortic dissection is a common differential in patients presenting with chest pain. In Northern Ireland, there is one hospital with a cardiac surgical unit. Therefore, patients are diagnosed in district general hospitals and then transferred for intervention. Over the past number of years it has been noted that there can be delays in the diagnosis and transfer of patients with aortic dissection to the cardiac surgery service. This study aims to identify any common reasons for this and develop a way to improve. Methods Patients operated on for aortic dissection from 2014-2019 in the Royal Victoria Hospital Belfast were included. Their notes and electronic care records were analysed, looking at time of initial presentation, time of diagnosis, and time of arrival to theatre. Results 61 cases were analysed. Among those with delays in diagnosis, many were initially admitted medically or to cardiology wards for work up of their chest pain. When a medical cause was not found, scans were performed demonstrating aortic dissection. Some patients were discharged from ED after initial presentation and the diagnosis was found on re-presentation. There were delays in reports of some scans. Delay in diagnosis was a more common feature than delay in transfer. Implications Delay in diagnosis or transfer of these patients affects their prognosis. As a result of this study a pathway has been developed regarding diagnosis, initial medical management, and transfer of these patients and it is hoped this will be implemented in hospital departments in Northern Ireland in the future.

scholarly journals Aortic Dissection in a Healthy Male Athlete: A Unique Case with Comprehensive Literature Review

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Balraj Singh ◽  
Jennifer M. Treece ◽  
Ghulam Murtaza ◽  
Samit Bhatheja ◽  
Steven J. Lavine ◽  
...  
Keyword(s):  
Chest Pain ◽  
Aortic Dissection ◽  
Anabolic Steroids ◽  
Venous Pressure ◽  
Ascending Aorta ◽  
Type I ◽  
Delay In Diagnosis ◽  
Long Time ◽  
Aortic Root Dilatation ◽  
History Of

A young otherwise healthy 27-year-old male who has been using anabolic steroids for a long time developed Type I aortic dissection associated with heavy weightlifting. The patient did not have a recent history of trauma to the chest, no history of hypertension, and no illicit drug use. He presented with severe chest pain radiating to back and syncopal event with exertion. Initial vitals were significant for blood pressure of 80/50 mmHg, pulse of 80 beats per minute, respirations of 24 per minute, and oxygen saturation of 92% on room air. Physical exam was significant for elevated jugular venous pressure, muffled heart sounds, and cold extremities with diminished pulses in upper and absent pulses in lower extremities. Bedside echocardiogram showed aortic root dilatation and cardiac tamponade. STAT computed tomography (CT) scan of chest revealed dissection of ascending aorta. Cardiothoracic surgery was consulted and patient underwent successful repair of ascending aorta. Hemodynamic stress of weightlifting can predispose to aortic dissection. Aortic dissection is a rare but often catastrophic condition if not diagnosed and managed acutely. Although rare, aortic dissection needs to be in the differential when a young weightlifter presents with chest pain as a delay in diagnosis may be fatal.

scholarly journals Diagnostic markers for discriminating between acute aortic dissection and acute myocardial infarction during the pre-hospital phase: analysis of 3,195 cases

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Watanabe ◽  
H Yoshino ◽  
T Takahashi ◽  
M Usui ◽  
K Akutsu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Back Pain ◽  
Chest Pain ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Diagnostic Markers ◽  
Network Database ◽  
History Of ◽  
First Contact

Abstract   Both acute aortic dissection (AAD) and acute myocardial infarction (AMI) present with chest pain and are life-threatening diseases that require early diagnosis and treatment for better clinical outcome. However, two critical diseases in the very acute phase are sometimes difficult to differentiate, especially prior to arrival at the hospital for urgent diagnosis and selection of specific treatment. The aim of our study was to clarify the diagnostic markers acquired from the information gathered from medical history taking and physical examination for discriminating AAD from AMI by using data from the Tokyo Cardiovascular Care Unit (CCU) Network database. We examined the clinical features and laboratory data of patients with AAD and AMI who were admitted to the hospital in Tokyo between January 2013 and December 2015 by using the Tokyo CCU Network database. The Tokyo CCU Network consists of >60 hospitals that fulfil certain clinical criteria and receive patients from ambulance units coordinated by the Tokyo Fire Department. Of 15,061 patients diagnosed as having AAD and AMI, 3,195 with chest pain within 2 hours after symptom onset (537 AAD and 2,658 AMI) were examined. The patients with out-of-hospital cardiac arrest were excluded. We compared the clinical data of the patients with chest pain who were diagnosed as having AAD and AMI. The following indicators were more frequent or had higher values among those with AAD: female sex (38% vs. 20%, P<0.001), systolic blood pressures (SBPs) at the time of first contact by the emergency crew (142 mmHg vs. 127 mmHg), back pain in addition to chest pain (54% vs. 5%, P<0.001), history of hypertension (73% vs. 58%, P<0.001), SBP ≥150 mmHg (39% vs. 22%, P<0.001), back pain combined with SBP ≥150 mmHg (23% vs. 0.8%, P<0.001), and back pain with SBP <90 mmHg (4.5% vs. 0.1%, P<0.001). The following data were less frequently observed among those with AAD: diabetes mellitus (7% vs. 28%, P<0.001), dyslipidaemia (17% vs. 42%, P<0.001), and history of smoking (48% vs. 61%, P<0.001). The multivariate regression analysis suggested that back pain with SBP ≥150 mmHg (odds ratio [OR] 47; 95% confidence interval [CI] 28–77; P<0.001), back pain with SBP <90 mmHg (OR 68, 95% CI 16–297, P<0.001), and history of smoking (OR 0.49, 95% CI 0.38–0.63, P<0.001) were the independent markers of AAD. The sensitivity and specificity of back pain with SBPs of ≥150 mmHg and back pain with SBPs <90 mmHg for detecting AAD were 23% and 99%, and 4% and 99%, respectively. In patients with chest pain suspicious of AAD and AMI, “back pain accompanied by chest pain with SBP ≥150 mmHg” or “back pain accompanied by chest pain with SBP <90 mmH” is a reliable diagnostic marker of AAD with high specificity, although the sensitivity was low. The two SBP values with back pain are markers that may be useful for the ambulance crew at their first contact with patients with chest pain. Funding Acknowledgement Type of funding source: None

AORTIC DISSECTION: WHEN CHEST PAIN IS NOT ACS

2017 ◽  
Vol 33 (10) ◽  
pp. S216
Author(s):  
L. Poirier ◽  
K. Then ◽  
T. VanZalingen
Keyword(s):  
Chest Pain ◽  
Aortic Dissection

Unusual Nasogastric Tube Position Leading to Delay in Diagnosis of Tracheoesophageal Fistula

2021 ◽  
pp. 097321792110367
Author(s):  
Monika Kaushal ◽  
Saima Asghar ◽  
Ayush Kaushal
Keyword(s):  
Early Diagnosis ◽  
Nasogastric Tube ◽  
Common Type ◽  
X Ray ◽  
Delay In Diagnosis ◽  
Atypical Symptoms ◽  
Tube Position ◽  
Esophageal Pouch ◽  
High Index Of Suspicion ◽  
Surgical Unit

Aim: This case highlights the importance of high index of suspicion for early diagnosis and thorough clinical examination of a newborn with tracheoesophageal atresia and fistula. Case Report: We report a case of most common type of tracheoesophageal atresia with fistula where diagnosis was missed due to unusual gastric position of nasogastric tube. Nasogastric tube reached stomach in esophageal atresia with fistula, delaying the diagnosis and management of condition. After accidental removal of tube and failure to pass again raised suspicion and was confirmed with coiled tube in esophageal pouch in X-Ray chest. Baby shifted to surgical unit for treatment, fortunately baby recovered and discharged home after surgical correction. Conclusion: Tracheoesophageal atresia with fistula can present with atypical symptoms and unusual events, challenging the early diagnosis and treatment of common types of conditions. Other association like VACTERL should be looked for, in patients.

scholarly journals Diagnóstico precoce de dissecção aórtica em pacientes com dor torácica: uma revisão integrativa da literatura

2021 ◽  
Vol 10 (2) ◽  
pp. e28110212542
Author(s):  
Olívio Joaquim Fonseca Neto ◽  
Isabella Pires Gomes Mendes ◽  
Andressa Carvalho Pereira ◽  
Juliano Luiz de Souza ◽  
Brenda Larissa Andrade Viana ◽  
...  
Keyword(s):  
Chest Pain ◽  
Aortic Dissection ◽  
Google Scholar

Introdução: A Dissecção Aórtica Aguda (DAA) é definida como uma súbita ruptura da camada íntima da aorta, expondo a camada subjacente ao fluxo sanguíneo e criando um “falso lúmen” paralelo à parede aórtica. A DAA é um agravo extremamente letal e que requer rápida identificação para iniciar o tratamento cedo e evitar a morte do paciente. Esta revisão teve como objetivo descrever as principais manifestações clínicas da DAA e apresentar estratégias para a identificação precoce e eficiente desse agravo no departamento de emergência. Métodos: Foi realizada uma revisão integrativa de estudos publicados nas plataformas PubMed e Google Scholar com os descritores: “aortic dissection” AND “chest pain”. Foram selecionados 37 artigos, 12 foram excluídos e 25 estudos foram utilizados na revisão. Resultados e Discussão: Para diagnóstico precoce, além de análise de sinais e sintomas, podem ser úteis na investigação exames complementares como radiografia, tomografia computadorizada, ressonância magnética, ecocardiografia, eletrocardiograma, ultrassonografia cardíaca focalizada (FOCUS) e exame de sangue incluindo enzimas cardíacas. Conclusão: Os estudos analisados possibilitaram o entendimento patológico da DAA, bem como a apresentação de formas eficientes de diagnóstico e de tratamentos do agravo.

Aortic dissection in children and young adults: diagnosis, patients at risk, and outcomes

2003 ◽  
Vol 13 (4) ◽  
pp. 341-344 ◽  
Author(s):  
Eli Zalzstein ◽  
Robert Hamilton ◽  
Nili Zucker ◽  
Samuel Diamant ◽  
Gary Webb
Keyword(s):  
Chest Pain ◽  
Aortic Dissection ◽  
Marfan Syndrome ◽  
Medical Condition ◽  
Young Patients ◽  
Diagnostic Tools ◽  
Cardiac Defects ◽  
Congenital Cardiac Defects ◽  
Ischemic Bowel ◽  
Presenting Symptoms

Objective: To heighten the awareness of pediatricians and pediatric cardiologists to aortic dissection, a potentially dangerous medical condition. Methods: We reviewed the charts of 13 patients, seen in four medical centers, who suffered acute or chronic aortic dissection over the period 1970 through 2000 whilst under the age of 25 years. Results: There were seven male and six female patients, with the mean age at diagnosis being 12.1 years, with a range from one day to 25 years. Congenital cardiac defects were present in five patients, and Marfan syndrome in four. In three of the patients with congenital cardiac defects, aortic dissection developed as a complication of medical procedures. In three patients, dissection followed blunt trauma to the chest. We could not identify any risk factors in one patient. The presenting symptoms included chest pain in four patients, abdominal pain and signs of ischemic bowel in two, non-palpable femoral pulses in one, and obstruction of the superior caval vein in one. Angiography and magnetic resonance imaging were the main diagnostic tools. Overall mortality was 38%. Only six patients had successful surgical outcomes. Conclusion: Due to the rarity of aortic dissection a high index of suspicion is required to reach the diagnosis in a timely manner. It should be considered in young patients complaining of chest pain in association with Marfan syndrome, anomalies of the aortic valve and arch, and chest trauma.

Acute aortic syndrome: aortic dissection—ascending aortic dissection

ESC CardioMed ◽  
2018 ◽  
pp. 2594-2597
Author(s):  
Christoph T. Starck ◽  
Robert Hammerschmidt ◽  
Volkmar Falk
Keyword(s):  
Aortic Dissection ◽  
Imaging Method ◽  
Intramural Haematoma ◽  
Acute Aortic Syndrome ◽  
Penetrating Aortic Ulcer ◽  
Chest Computed Tomography ◽  
First Choice ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

Aortic dissection, intramural haematoma, and penetrating aortic ulcer can each present as an acute aortic syndrome. If left untreated, acute aortic syndrome carries a high mortality. Therefore, rapid diagnostic work-up and appropriate surgical therapy are of utmost importance. Chest computed tomography is the imaging method of first choice.

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