Acute aortic syndrome

Acute aortic syndrome (AAS) describes a range of severe, painful, potentially life-threatening abnormalities of the aorta.cite journal |author=Ahmad F, Cheshire N, Hamady M |title=Acute aortic syndrome: pathology and therapeutic strategies |journal=Postgrad Med J |volume=82 |issue=967 |pages=305–12 |year=2006 |month=May |pmid=16679467 |doi=10.1136/pgmj.2005.043083 |url=http://pmj.bmjjournals.com/cgi/pmidlookup?view=long&pmid=16679467] These include aortic dissection, intramural thrombus, and penetrating atherosclerotic aortic ulcer.cite journal | last=Macura | first=KJ | coauthors=Corl FM, Fishman EK, Bluemke DA | title=Pathogenesis in acute aortic syndromes: aortic dissection, intramural hematoma, and penetrating atherosclerotic aortic ulcer | journal=American Journal of Roentgenology | volume=181 | issue=2 | pages=309–316 | date=August 2003 | pmid=12876003 | url=http://www.ajronline.org/cgi/content/full/181/2/309 | accessdate=2008-05-28 ] AAS can be caused by a lesion on the wall of the aorta that involves the tunica media, often in the descending aorta.cite journal |author=Evangelista Masip A |title= [Progress in the acute aortic syndrome] |language=Spanish; Castilian |journal=Rev Esp Cardiol |volume=60 |issue=4 |pages=428–39 |year=2007 |month=April |pmid=17521551 | url=http://www.revespcardiol.org/cgi-bin/wdbcgi.exe/cardio/mrevista_cardio.pubmed_full?inctrl=05ZI0113&vol=60&num=4&pag=428] It is possible for AAS to lead to acute coronary syndrome.cite journal |author=Manghat NE, Morgan-Hughes GJ, Roobottom CA |title=Multi-detector row computed tomography: imaging in acute aortic syndrome |journal=Clin Radiol |volume=60 |issue=12 |pages=1256–67 |year=2005 |month=December |pmid=16291307 |doi=10.1016/j.crad.2005.06.011 |url=] The term was introduced in 2001.cite journal |author=van der Loo B, Jenni R |title=Acute aortic syndrome: proposal for a novel classification |journal=Heart |volume=89 |issue=8 |pages=928 |year=2003 |month=August |pmid=12860875 |doi= |url=http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=12860875] cite journal |author=Vilacosta I, Román JA |title=Acute aortic syndrome |journal=Heart |volume=85 |issue=4 |pages=365–8 |year=2001 |month=April |pmid=11250953 |doi= |url=http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=11250953]

Causes

Causes can include aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer or a thoracic aneurysm that has become unstable.cite journal |author=Smith AD, Schoenhagen P |title=CT imaging for acute aortic syndrome |journal=Cleve Clin J Med |volume=75 |issue=1 |pages=7–9, 12, 15–7 passim |year=2008 |month=January |pmid=18236724 |doi= |url=] The potential causes of AAS are life-threatening and present with similar symptoms, making it difficult to distinguish the ultimate cause, though high resolution, high contrast computerised tomography can be used.cite journal |author=Marijon E, Vilanculos A, Tivane A, "et al" |title=Thoracic aortic aneurysm: direct sign of rupture |journal=Cardiovasc J Afr |volume=18 |issue=3 |pages=180–1 |year=2007 |pmid=17612751 |doi= | format = pdf | |url=http://blues.sabinet.co.za/WebZ/Authorize?sessionid=0:autho=pubmed:password=pubmed2004&/AdvancedQuery?&format=F&next=images/ejour/cardio/cardio_v18_n3_a10.pdf]

Diagnosis

The condition can be mimicked by a ruptured cyst of the pericardium,cite journal |author=Nishigami K, Hirayama T, Kamio T |title=Pericardial cyst rupture mimicking acute aortic syndrome |journal=Eur. Heart J. |volume= |issue= |pages= |year=2008 |month=February |pmid=18296680 |doi=10.1093/eurheartj/ehn038 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=18296680] ruptured aortic aneurysm and acute coronary syndrome.cite journal |author=Hansen MS, Nogareda GJ, Hutchison SJ |title=Frequency of and inappropriate treatment of misdiagnosis of acute aortic dissection |journal=Am. J. Cardiol. |volume=99 |issue=6 |pages=852–6 |year=2007 |month=March |pmid=17350381 |doi=10.1016/j.amjcard.2006.10.055 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(06)02407-6]

Misdiagnosis is estimated at 39% and is associated with delays correct diagnosis and improper treatment with anticoagulants producing excessive bleeding and extended hospital stays.cite journal |author=Hansen MS, Nogareda GJ, Hutchison SJ |title=Frequency of and inappropriate treatment of misdiagnosis of acute aortic dissection |journal=Am. J. Cardiol. |volume=99 |issue=6 |pages=852–6 |year=2007 |month=March |pmid=17350381 |doi=10.1016/j.amjcard.2006.10.055 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(06)02407-6]

Management

AAS is life-threatening, with a high mortality rate if appearing acutely, reduced only when diagnosed early and treated by a surgeon with considerable expertise. If patients survive acute presentation, within three to five years 30% will develop complications and require close follow-up. Early diagnosis is essential for survival and management is challenging though greater awareness of the syndrome and improving management strategies are improving patient outcomes.cite journal |author=Ince H, Nienaber CA |title= [Management of acute aortic syndromes] |language=Spanish; Castilian |journal=Rev Esp Cardiol |volume=60 |issue=5 |pages=526–41 |year=2007 |month=May |pmid=17535765 |doi= |url=http://www.revespcardiol.org/cgi-bin/wdbcgi.exe/cardio/mrevista_cardio.pubmed_full?inctrl=05ZI0113&vol=60&num=5&pag=526]

References