**4. Clinical features of aortic dissection**

The signs and symptoms of aortic dissection depends upon the extent of dissection and compression of adjacent vascular structures.

### **4.1 Symptoms**

### *4.1.1 Chest pain*

The most common symptom is severe pain of sudden onset, described by patient as sharp stabbing or tearing type. When pain localized to anterior chest wall, neck, or jaw, the point of origin of the aortic dissection is from the ascending aorta, and when it is localized to the interscapular area, abdomen, and back, the descending aorta is usually involved.

Pain that is localized to the abdomen must raise the possibility of involvement of the mesenteric artery.

In few cases the patient may present with pleuritic pain if pericardial hemorrhage occurs.

Dissection may present rarely without pain only and mostly in older patients in cases that involve the ascending aorta. Such patients also have more instances of stroke, heart failure, and syncope.

#### *4.1.2 Syncope*

Usually happens in aortic dissection presenting with cardiac tamponade or brachiocephalic vessel involvement and occurs in up to 10% of patients.

#### **4.2 Signs**

#### *4.2.1 Hypertension*

Seen in 30% of type A and 70% of type B disease.

#### *4.2.2 Hypotension*

Seen with ascending aortic dissection and may be due to aortic rupture leading to carotid tamponade (more in females), acute aortic regurgitation, acute MI, hemothorax ,or hemoperitoneum.

#### *4.2.3 Transient pulse deficits*

This results from the intimal flap or hematoma blocking or compressing the artery. It is common in dissection involving the aortic arch and thoracic and abdominal aorta.

Patients who presented with pulse deficits had more chances of having hypotension, coma, or neurological deficits. Such patients also had higher rates of complications and mortality.

**69**

*Aortic Dissection*

*4.2.4 Cardiac murmurs*

Also seen are:

• Collapsing pulse

• Wide pulse pressure

• Congestive cardiac failure

• Pulsating neck swelling

suggestive of aortic dissection:

**5. Work-up/diagnosis**

**5.1 Electrocardiography**

**5.2 Blood investigations**

chest pain.

infarction.

• Pleural effusion (commonly left-sided)

*4.2.5 Focal neurological deficits*

• Stroke/altered consciousness

*DOI: http://dx.doi.org/10.5772/intechopen.89210*

50–75% of all ascending aortic dissections.

compression of adjacent structures. The deficits may be:

Aortic dissection involving the aortic valve results in aortic regurgitation and an early diastolic murmur in the Erb's point (Austin Flint murmur). It occurs in about

Occurs when the aortic dissection involves the proximal branch arteries and

• Horner Syndrome (compression of cervical sympathetic ganglia)

• Hoarseness of voice (compression of the left recurrent laryngeal nerve)

• Acute paraplegic (spinal cord ischemia from intercostal vessel compression)

In chronological order as the patient is admitted into ER with a clinical picture

ECG changes may mimic acute cardiac ischemia, which make it further difficult to distinguish aortic dissection from acute myocardial infarction in the presence of

If the dissection involves the coronary ostia, the right coronary artery can be affected, which will lead to ST segment elevation in a similar pattern to inferior wall

In most cases, there will be non-specific ECG changes, or ECG can be normal.

CBC: there may be **leukocytosis** due to stress state. **Low hemoglobin** and

**Elevated creatinine and BUN** may indicate involvement of renal arteries (in such scenario you would expect hematuria, oliguria, or anuria), or it may indicate dehydration due to pre-renal blood loss (dissection is leaking or has ruptured).

hematocrit suggests bleeding (dissection is leaking or has ruptured).
