Ĭhest pain is more commonly reported among patients with type A dissections (85% vs 67% for type B), while back pain is more common in type B dissections (70% vs 43% for type A). Other classic descriptors such as sharp, tearing/ripping, and migrating were less reliable.
In one study of 464 patients with confirmed type A dissection, 90% of patients reported severe or worst ever pain, with abrupt onset reported in 85%. Ībrupt onset chest/back/abdominal pain that is severe or “worst ever” should raise your suspicion for dissection. Ĭonnective tissue diseases, such as Marfan’s, represent a minority of dissection cases overall but notably account for as many as 50% of cases presenting before the age of 40. Cocaine use and strenuous activity that may result in abrupt increases in blood pressure (ie weight lifting) have also been implicated. Other major risk factors include atherosclerosis (31%), prior cardiac surgery (18%), and known aortic aneurysm (16%). Īpproximately 77% of patients with aortic dissection have a history of hypertension, which is the most common risk factor. Type A dissections have an in-hospital mortality rate exceeding 50% if managed medically.
While relatively rare, dissection represents a “can’t-miss-diagnosis” with an overall mortality rate of 1-2% per hour immediately after symptom onset if untreated. By comparison, acute MI’s occur at a rate of roughly 4400 per 1,000,000 people per year. Tear in the layers of the aorta separating the intimal and medial layers with blood entering between the two, creating a true lumen and false lumenĪortic dissection has a reported incidence of 5-30 per 1,000,000 people per year, most commonly occurs in the 7th decade of life with a 1.5:1 male predominance.