Transthoracic Echocardiogram (TTE) excludes risk or presence of aortic dissection
TTE is unable to assess the whole aorta accurately, and thus misses syndromes in the lower / descending aortic segments. Imaging needs to assess the whole aorta from the chest to the abdomen.
Lack of aortic dilation or aneurysm excludes risk of aortic dissection.
While aortic size is the biggest risk factor for progression to dissection or rupture, unfortunately, it does not account for the 50% of patients for whom an aortic dissection occurs at aortic diameters that are considered 'normal'.
Aortic Dissection is extremely rare.
In the UK (like ANZ), Aortic Dissection kills more people than road traffic accidents. It is the third most commonly misdiagnosed condition in emergency departments, and even the most experienced clinicians miss it.
Acute aortic dissection always presents with ripping or tearing chest pain.
The key defining feature of acute aortic dissection is sudden onset, severe pain which may be maximal at onset and then subside. Pain can be transient and migratory, occurring in the chest, neck, back, jaw, or abdomen. Other non-specific symptoms include stroke-like symptoms, dizziness, or cold limbs.
Acute aortic dissection is not a genetic condition.
Up to 30% of acute aortic dissections are caused by
hereditary syndromic or non-syndromic aortic diseases. The remaining are predominantly high blood pressure and cholesterol.
Acute aortic dissection is a condition affecting individuals over 65.
Acute aortic dissection occurs in all genders and ages. Well-known genetic conditions like Marfan syndrome, Loeys-Dietz, and vascular Ehlers-Danlos syndrome more commonly affect younger people and in whom misdiagnosis is most common. It is also a leading cause of maternal cardiac death.
Acute aortic dissection patients always have poor outcomes.
Patient survival and outcomes improve with early diagnosis and prompt intervention. Acute aortic dissection is treatable and there is now a large community of survivors with normal life expectancy, thanks to advances in modern medicine and surgery.
You cannot CT scan everyone with suspected acute aortic dissection.
Definitive diagnosis of aortic dissection requires a
CT angiogram or MRI imaging of the whole aorta.
Blood tests, chest x-ray, ECG, or echocardiogram cannot exclude an acute aortic dissection.
We need to reduce the number of CT Aorta scans
because they are costly and have radiation exposure.
THINK AORTA’s diagnostic strategy of increasing the index of suspicion for aortic dissection and lowering the barrier to CT Aorta is endorsed by cross-speciality collaboration of specialists and radiology colleges, and is only chosen in clinical scenarios where the benefit of CT far outweighs any risk.
Algorithmic approaches are best for diagnosing acute aortic dissection.
Clinician gestalt, informed by THINK AORTA, has been
credited with improving aortic dissection diagnosis
in the UK by 68%. The optimum diagnostic strategy currently is: THINK AORTA – CT scan to confirm.
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