Aortic dissection: many patients had hypertension and pain.

Clinical bottom line (level 4)

  1. The commonest findings in aortic dissection were hypertension and pain.
Spittell et al: Mayo Clinic Proc 1993; 68: 642-651
Expires December 2004

The study

Case series with ?objective ?blinded outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital, USA

235 patients (aged range 17 to 94 years; mean 64, 67% male) dissecting aortic aneurysm proven by autopsy, surgery, CT, MRI, echocardiography or aortogram (1980-90)


97% followed for unclear
Outcomes studied:
  • hypertension
  • Marfan's syndrome
  • finding: pain
  • abnormal chest x-ray, no pain
  • absent pulse
  • syncope
  • heart failure
  • paraplegia
  • stroke
  • claudication

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    hypertension unclear / 78%
    (% to %)
    Marfan's syndrome unclear / 6.0%
    (% to %)
    finding: pain unclear 168/227 74%
    (68% to 80%)
    abnormal chest x-ray, no pain unclear 33/227 15%
    (10% to 19%)
    absent pulse unclear 18/217 8.3%
    (4.6% to 12%)
    syncope unclear 12/227 5.3%
    (2.4% to 8.2%)
    heart failure unclear 12/227 5.3%
    (2.4% to 8.2%)
    paraplegia unclear 5/227 2.2%
    (0.29% to 4.1%)
    stroke unclear 3/227 1.3%
    (0.0% to 2.8%)
    claudication unclear 2/227 0.88%
    (0.0% to 2.1%)

    • 67% of patients had acute onset. 63% proximal in origin.
    • Only 40% diagnosed following history, physical, ECG and chest x-ray (14% mistaken for ischaemic heart disease, 14% for other aortic disease, 7% heart failure).
    • Distal dissection: 73% of patients had some pain posteriorly.

    Comments

    1. No information given on patients who were thought to have aortic dissection on clinical examination and subsequently found not to.

    Citation

    1. Spittell PC, Spittell JA, Joyce JW, et al: Clinical features and differential diagnosis of aortic dissection: Experience with 236 cases (1980 through 1990). Mayo Clinic Procl 1993; 68: 642-651
    Contributor: Chris Ball and Clare Wotton, December 2000
    Reviewer:

    Clinical Question.
    Patient aortic dissection
    Intervention or Exposure prevalence
    Outcome clinical features