Aortic syndromes

Acute aortic syndrome (AAS) describes a range of severe, painful, potentially life-threatening abnormalities of the aorta: aortic dissection, intramural thrombus, and penetrating atherosclerotic aortic ulcer.

It can be caused by a wall of the aorta that involves the tunica media, often in the descending aorta.

These are life-threatening emergencies associated with significant in hospital mortality.

It is life-threatening, with a high mortality rate if appearing acutely.

AAS to lead to acute coronary syndrome.

Causes can include aortic dissection,  intramural hematoma, penetrating atherosclerotic ulcer or a thoracic aneurysm that has become unstable.

Almost 75% of patients have a history of hypertension.

Associated with blunt trauma, hyperlipidemia, tobacco abuse, cocaine use and pregnancy.

Iatrogenic causes include cardiac procedures, open heart surgery and intraaortic balloon pump insertion and are more common in the elderly with co morbid diseases such as diabetes, chronic hypertension and or atherosclerosis.

5% of cases are iatrogenic.

Differential diagnosis: 

ruptured cyst of the pericardium, ruptured aortic aneurysm and acute coronary syndrome.

Misdiagnosis is estimated at 39% and is associated with delays in diagnosis.

Misdiagnosis can lead to,improper treatment with anticoagulants producing excessive bleeding.

Requires early diagnosis and treatment by an experienced surgeon.

 If patients survive acute presentation, 30% will develop complications.

Patients who have atrial fibrillation have a higher frequency of hospital mortality.

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