Aortic dissection: chest pain and history of hypertension were common.

Clinical bottom line (level 4)

  1. Chest pain followed by a history of hypertension were the commonest findings in aortic dissection.
  2. About a third of patients with aortic dissection had aortic regurgitation or a pulse deficit.
Slater and DeSanctis: American Journal of Medicine 1976; 60: 625-633
Expires December 2004

The study

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

Setting: general hospital, USA

124 patients (aged range 19 to 81 years; mean 59, 73% male) with aortic dissection, diagnosed by angiography



Outcomes studied:
  • clinical finding: proximal dissection: history of hypertension
  • distal dissection: history of hypertension
  • proximal: pain
  • distal: pain
  • proximal: pain over anterior chest
  • distal: pain over anterior chest
  • proximal: pain over posterior chest
  • distal: pain over posterior chest
  • proximal: bp 150/ 90 or more
  • distal: bp 150/ 90 or more
  • proximal: patients with a pulse deficit
  • distal: patients with a pulse deficit
  • proximal: aortic regurgitation
  • distal: aortic regurgitation
  • proximal: neurological manifestation (CVA, ischaemic peripheral neuropathy, ischaemic spinal cord damage, coma, altered consciousness)
  • distal: neurological manifestation (CVA, ischaemic peripheral neuropathy, ischaemic spinal cord damage, coma, altered consciousness)
  • proximal:LVH on ECG
  • distal: LVH on ECG
  • proximal: abnormal aortic contour on CXR
  • distal: abnormal aortic contour on CXR

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    clinical finding: proximal dissection: history of hypertension ? / 49%
    (% to %)
    distal dissection: history of hypertension ? / 77%
    (% to %)
    proximal: pain ? / 89%
    (% to %)
    distal: pain ? / 97%
    (% to %)
    proximal: pain over anterior chest ? / 66%
    (% to %)
    distal: pain over anterior chest ? / 28%
    (% to %)
    proximal: pain over posterior chest ? / 11%
    (% to %)
    distal: pain over posterior chest ? / 57%
    (% to %)
    proximal: bp 150/ 90 or more ? / 9.4%
    (% to %)
    distal: bp 150/ 90 or more ? / 56%
    (% to %)
    proximal: patients with a pulse deficit ? / 51%
    (% to %)
    distal: patients with a pulse deficit ? / 15%
    (% to %)
    proximal: aortic regurgitation ? / 68%
    (% to %)
    distal: aortic regurgitation ? / 5.6%
    (% to %)
    proximal: neurological manifestation (CVA, ischaemic peripheral neuropathy, ischaemic spinal cord damage, coma, altered consciousness) ? / 36%
    (% to %)
    distal: neurological manifestation (CVA, ischaemic peripheral neuropathy, ischaemic spinal cord damage, coma, altered consciousness) ? / 5.6%
    (% to %)
    proximal:LVH on ECG ? / 42%
    (% to %)
    distal: LVH on ECG ? / 43%
    (% to %)
    proximal: abnormal aortic contour on CXR ? / 93%
    (% to %)
    distal: abnormal aortic contour on CXR ? / 97%
    (% to %)

    • clinical finding in all patients:
      • history of hypertension: 65%
      • history of excitement of effort triggering pain: 14%
      • pain: 94%
      • pain over anterior chest: 68%
      • pain over posterior chest: 38%
      • bp 150/ 90 or more: 36%
      • patients with a pulse deficit: 31%
      • aortic regurgitation: 32%
      • neurological manifestation (CVA, ischaemic peripheral neuropathy, ischaemic spinal cord damage, coma, altered consciousness): 19%
      • LVH on ECG: 27%
      • abnormal aortic contour on CXR: 96%

    Citation

    1. Slater EE, and DeSanctis RW: Clinical recognition of dissecting aortic aneurysm. American Journal of Medicine 1976; 60: 625-633
    Contributor: Chris Ball and Clare Wotton, December 2000
    Reviewer:

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