Test Your Knowledge: Thoracic Aortic Syndromes in the Emergency Department

Acute aortic syndromes include aortic dissection, penetrating atherosclerotic ulcer, and intramural hematomas, but aortic dissection is the most common and the deadliest. 

Our recent issue Thoracic Aortic Syndromes in the Emergency Department: Recognition and Management summarizes the latest evidence on developing a differential for aortic dissection when common complaints, such as chest pain, abdominal pain, and syncope are also present. 

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Here are a few key points:

  • Acute aortic syndromes (AAS) include aortic dissection (AoD), intramural hematoma (IMH), and penetrating atherosclerotic ulcer (PAU).
  • AoD is the most prevalent, accounting for 85%-95% of AAS; IMH 5%-25%; and PAU 2%-7%.
  • The mortality rate of AoD is 1%-2% per hour after onset of symptoms; untreated, mortality is 90% at 3 months.
  • Two-thirds of patients who present with AoD are males aged 50 to 70 years.

Read the full issue and earn 4 CME credits!

Last Updated on December 13, 2021

2 thoughts on “Test Your Knowledge: Thoracic Aortic Syndromes in the Emergency Department

  1. With this history, a real world emergency medicine practitioner should proceed to a definitive test. If the patient strokes, becomes paraplegic, or dies while awaiting D-dimer results, the physician as well as the patient will suffer.

    I am wary of these statistically derived algorithms.

    1. Thanks for the comment Louis. I think your point matches what the authors of the Thoracic Aortic Syndromes issue wrote. They specifically cautioned against reliance on a d-dimer assay as a “rule-out” test. You can find more on this topic on page 9 “D-Dimer” and page 15 of “Controversies and Cutting Edge” of the issue. You might also take a listen to my discussion with Dr. Hackett, one of the authors, who was the EMplify podcast guest for December. We discussed D-Dimer assays there as well.

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