Clinical Presentation

The clinical presentation of acute aortic aneurysm dissection encompasses a range of signs and symptoms that require prompt recognition for timely diagnosis and management. Key signs and symptoms include:

• Sudden-onset severe chest or back pain:
  • The hallmark symptom of acute aortic aneurysm dissection is intense and often excruciating pain. Patients commonly describe the pain as tearing or ripping, which can be debilitating.
• Radiation of pain:
  • The pain may radiate to various areas, including the neck, jaw, or abdomen. The location of the pain can provide clues about the extent and involvement of the dissection.
• Hypertension:
  • High blood pressure is frequently observed in patients with acute aortic aneurysm dissection. The elevation in blood pressure may be related to the release of stress hormones or impaired blood flow due to compromised aortic branches.
• Syncope or altered mental status:
  • In some cases, aortic dissection can lead to decreased blood flow to the brain, resulting in syncope (fainting) or altered mental status.
• Focal weakness or neurologic deficits:
  • Depending on the location and extent of the dissection, patients may experience symptoms such as focal weakness, paralysis, or changes in sensation due to compromised blood flow to specific regions of the brain.
• Signs of cardiac tamponade:
  • When the dissection involves the aortic root, bleeding into the pericardium can occur, leading to cardiac tamponade. Signs of cardiac tamponade include jugular venous distention, muffled heart sounds, tachycardia, and hypotension.
• Pulse deficits or discrepancies in blood pressure between limbs:
  • Involvement of branch vessels or obstruction of blood flow to the arterial system can lead to pulse deficits or variations in blood pressure between the upper and lower extremities.
• Symptoms suggestive of organ malperfusion:
  • Aortic dissection can compromise blood flow to various organs, resulting in symptoms such as mesenteric ischemia (abdominal pain, nausea, vomiting), renal failure (decreased urine output, flank pain), or limb ischemia (pain, pallor, pulselessness).

Risk Factors

Several risk factors contribute to the development of acute aortic aneurysm dissection. Hypertension is the most common risk factor associated with this condition.

Other risk factors include:

• Connective tissue disorders: Patients with conditions such as Marfan syndrome and Ehlers-Danlos syndrome have an increased risk of aortic dissection due to weakened connective tissue in the aortic wall.
• Bicuspid aortic valve: Individuals with a bicuspid aortic valve, a congenital abnormality where the aortic valve has two instead of three leaflets, are at higher risk of aortic dissection.
• Family history: A positive family history of aortic dissection increases the risk of developing the condition.
• Aging: The incidence of aortic dissection increases with age.
• Atherosclerosis: Although less common, atherosclerosis can contribute to the development of aortic dissection.
• Trauma or prior cardiac surgery: Blunt trauma or previous cardiac surgery can weaken the aortic wall and increase the risk of dissection.

A high index of suspicion is required, especially in patients >60 years old presenting with sudden-onset chest, back or abdominal pain and history of hypertension. Pain is the most common symptom but clinical presentations vary based on extent of dissection. Aortic regurgitation, pulse deficit, hypotension and cardiac tamponade indicate ascending (type A) dissection.