A 91 yo female presents with sudden onset right arm pain with decreased pulses. Since arrival to the ED, her mental status has also progressively decreased. Her blood pressure is 170/60, HR 60, T97.8, RR20, sats 100% RA. You suspect she has had an aortic dissection and indeed a CTA of her chest / abdomen / pelvis reveals a type A dissection involving her R subclavian and internal carotid artery. You wonder how many other patients present without the classic ‘tearing’ ‘ripping’ chest pain radiating to the back.
A: 83% of type A dissections and 71% of type B dissections present with chest pain.
Starting in 1995, the International Acute Aortic Dissection registry began to enroll all patients that were diagnosed acute aortic dissection at one of the 28 hospitals across Europe, North America, and Asia. An interim analysis by Pape et al. looked at the data from 1995 – 2013.
During this time a total of 4428 patients were enrolled.
Most patients had Type A dissections: Type A: 2,952 (67%), Type B: 1,476 (33%).
Chest pain was the most common symptom: Type A: 83%, Type B: 71%
Back pain was more common with type B dissections: Type A: 43%, Type B: 70%
Patients presenting with hypertension was low amongst type A dissections: Type A: 28%, Type B: 66%.
Pulse deficits on presentation was low: type A: 31%, Type B: 19%.
CXR with mediastinal widening: Type A: 61% in ‘95 decreased to 52% in ‘13, Type B: 56% in ‘95 and decreased to 39% in ‘13.
Pape LA. Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection: 17-Year Trends From the International Registry of Acute Aortic Dissection. J Am Coll Cardiol. 2015 Jul 28;66(4):350-8. doi: 10.1016/j.jacc.2015.05.029.