Acute Aortic Syndrome

Let’s be honest – acute aortic syndrome is the absolute bane of the emergency physician’s existence. A rare, but incredibly dangerous diagnostic needle in a chest pain haystack. Currently, our only really reliable diagnostic test is a CT aorta angiogram, but just how many of these do we need to do to pick up one case of dissection? - Iain Beardsell

Acute Aortic Syndrome

image by: Think Aorta

HWN Suggests

The DAShED Study – Diagnosis of Acute Aortic Syndrome in the Emergency Department

Diagnosing acute aortic syndrome is really hard. Like really tricky. We ‘overinvestigate’ to try to pick up a vanishingly small number of cases. Under 3% of all the CT aortograms done in this study looking for AAS were positive. Not wishing to state the obvious, but that means that 97% of these scans are negative. It’s clear that plenty of people are indeed ‘thinking aorta’. It is a diagnosis that seems to haunt us all. Of course, this study doesn’t tell us about ‘missed’ cases – those where the diagnosis was not considered.

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 The DAShED Study – Diagnosis of Acute Aortic Syndrome in the Emergency Department

Acute aortic syndrome (AAS) includes not just aortic dissection, but also intramural haematoma, and penetrating aortic ulcers. Chest pain is the most common presenting symptom (in 80%), which itself accounts for 7.6 million visits to Emergency Departments in the UK. There are about 4000 cases of AAS in the UK per year. Even the less able statisticians amongst us can see the numerical challenge this represents. However, I can pretty much guarantee that every ED up and down the country has at least one tale of AAS being ‘missed’ and a patient coming to harm. It’s right up there with pulmonary embolism and subarachnoid haemorrhage as diagnoses we hate and sometimes (often) lose sleep over.

All About Cardiovascular System and Disorders

Acute aortic syndromes include aortic dissection, intramural hematoma of the aorta and penetrating ulcer of the aorta. The concept of acute aortic syndrome was introduced by Vilacosta et al in an editorial which appeared in Heart in 2001. The nature and location of pain are important in the diagnosis of acute aortic syndrome.

BC Emergency Medicine Network

Aortic dissection may be missed if only ordering CT PE studies. If clinical suspicion, need to order Aortic Dissection specific CT protocol.


Acute aortic syndromes encompass three life-threatening conditions, including acute aortic dissection (AAD), intramural hematoma (IMH), and penetrating aortic ulcer (PAU). This activity reviews the interprofessional team's common presentations, evaluation, and management of this deadly trifecta of conditions.

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