Aortic dissection: the commonest findings were hypertension and pain.

Clinical bottom line (level 4)

  1. The commonest findings in aortic dissection were hypertension and pain.
  2. Around half of all patients had some difference in their pulses.
Lindsay and Hurst: Circulation 1967; 35: 880-887
Expires December 2004

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, validated in an independent set of patients.

Setting: university hospital, USA

62 patients (aged range 31 to 83 years, 65% male) dissecting aortic aneurysm proven by autopsy, surgery or aortogram (1949-66)



Outcomes studied:
  • history of pain
  • hypertension
  • alteration in pulses any detectable change in the peripheral arterial pulse
  • aortic regurgitation
  • neurological findings decrease in consciousness, hemiparesis, paraparesis, ischaemic paralysis)
  • intracapsular pain

    • 84% of patients were black.

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    history of pain ? 56/62 90%
    (83% to 98%)
    hypertension ? 50/62 81%
    (71% to 90%)
    alteration in pulses ? 28/62 45%
    (33% to 58%)
    aortic regurgitation ? 22/62 35%
    (24% to 47%)
    neurological findings ? 26/62 42%
    (30% to 54%)
    intracapsular pain ? 8/62 13%
    (4.6% to 21%)

    Comments

    1. Probably not a consecutive series- overestimates sensitivity of signs. No information was given on specificity.

    Citation

    1. Lindsay J, and Hurst JW: Clinical features and prognosis in dissecting aneurysm of the aorta: A re-appraisal. Circulation 1967; 35: 880-887
    Contributor: Chris Ball and Clare Wotton, December 2000
    Reviewer:

    Clinical Question.
    Patient aortic dissection
    Intervention or Exposure prevalence
    Outcome pain, hypertension, pulse changes