Aortic dissection

J Clin Hypertens (Greenwich). 2005 Jun;7(6):367-71. doi: 10.1111/j.1524-6175.2005.04116.x.


Aortic root enlargement is generally asymptomatic, with few clinical clues, but may be observed as an incidental finding on a chest x-ray, echocardiogram, or contrast-enhanced computerized tomogram of the chest. Aortic dissection is one of the most feared complications of hypertension. A history of hypertension is commonly present, but the systolic blood pressure in type A dissection (proximal to the left subclavian artery) has been found to be less than 150 mm Hg in 64% of patients. However, 71% of type B dissections (distal to the left subclavian artery) present with a systolic blood pressure 150 mm Hg or higher (International Registry of Acute Aortic Dissection). Most frequently, onset of symptoms is in the daytime, especially between 6 a.m. and noon. Severe sharp chest pain that is abrupt in onset is the most likely presentation. Migrating pain is uncommon. Although a pulse deficit with decreased or absent carotid, brachial, or femoral pulses occurs in only 30% of patients, three or more deficits predict an in-house mortality of about 60%. A chest x-ray finding of a widened mediastinum is present in 62.6% of type A and 56% of type B dissections. Contrast-enhanced computerized tomography or transesophageal echocardiography is the most commonly performed procedure for diagnosis. In-house mortality has been found to be 32.5% in type A dissections and 13% in type B dissections.

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Aortic Aneurysm* / diagnosis
  • Aortic Aneurysm* / epidemiology
  • Aortic Aneurysm* / etiology
  • Aortic Dissection* / diagnosis
  • Aortic Dissection* / epidemiology
  • Aortic Dissection* / etiology
  • Diagnostic Imaging
  • Humans
  • Hypertension / complications
  • Incidence
  • Risk Factors
  • Survival Rate
  • United States / epidemiology