We present a case of aortic dissection with an atypical presentation in a peritoneal dialysis patient, and the challenges met with peritoneal dialysis. [ncbi.nlm.nih.gov]

Three of the 10 presented as the sudden onset of fatal electromechanical dissociation, 6 presented with hypotension, and 1 was normotensive on presentation. [web.archive.org]

• Severe Pain

  PAIN: Severe pain is the #1 symptom. Seek immediate emergency medical care for a sudden onset of severe pain in the chest, stomach, back or neck. The pain is likely to be sharp, tearing, ripping, moving. [web.archive.org]

  […] radiates to back AND Pulse deficit or difference in upper extremity Blood Pressure >20 mmHg AND Mediastinal Widening or aortic knob widening on Chest XRay Timing Sudden onset: 85% Severity Severe pain: 90% Characteristics Pain: 95% Type A: 94% Type B [fpnotebook.com]

  […] ischaemia and acute kidney injury. [ 1 ] Aortic dissection often presents in two phases: After a first event with severe pain and pulse loss, the bleeding stops. [patient.info]

• Dyspnea

  We recently encountered a case of a patient with PAoD presenting with dyspnea; the clue to diagnosis was the presence of a loud aortic diastolic murmur. [ncbi.nlm.nih.gov]

  […] often sudden pain in the chest ( angina ), shoulders, back, abdomen, arms, neck, hips, or legs Stroke-like symptoms Difficulty swallowing Sweating Anxiety Decreased sensation Nausea Pale skin (pallor) Rapid heart rate (tachycardia) Shortness of breath (dyspnea [utswmedicine.org]

• Abdominal Pain

  Abstract A 52-year-old man presented with sudden abdominal pain and intermittent vomiting. [ncbi.nlm.nih.gov]

  98% Sharp pain: 64% Tearing/ripping: 50% Type A: 49% Type B: 52% Distribution: Typically involves both above and below the diaphragm Anterior Chest Pain : 61% Type A: 71% Type B: 44% Back pain: 53% Type A: 46% Type B: 64% Abdominal Pain : 35% Type A [fpnotebook.com]

  They include: Sudden severe chest or upper back pain, often described as a tearing, ripping or shearing sensation, that radiates down the back Loss of consciousness (fainting) Abdominal pain Sudden onset of leg pain with compromised blood flow Which diagnostic [inovaheart.org]

• Nausea

  We report a previously healthy 58-years old female, admitted because of nausea, dizziness, somnolence, a left-sided hemiparesis and arterial hypotension. The electrocardiogram showed atrial fibrillation with ST-elevations and ST-depressions. [ncbi.nlm.nih.gov]

  Additional symptoms may include the following: Anxiety Difficulty swallowing Dizziness or fainting Nausea and vomiting Pain in the abdomen Pale skin Rapid, weak pulse Shortness of breath or trouble breathing when lying flat Stroke-like symptoms Sweating [houstonmethodist.org]

  […] accident or a gunshot wound Symptoms of aortic dissection can include: Severe, often sudden pain in the chest ( angina ), shoulders, back, abdomen, arms, neck, hips, or legs Stroke-like symptoms Difficulty swallowing Sweating Anxiety Decreased sensation Nausea [utswmedicine.org]

  Symptoms are caused by a decrease of blood flowing to the rest of the body, and can include: Anxiety and a feeling of doom Fainting or dizziness Heavy sweating (clammy skin) Nausea and vomiting Pale skin ( pallor ) Rapid, weak pulse Shortness of breath [nlm.nih.gov]

  There may be associated nausea, sweating, shortness of breath, and weakness. The patient may pass out (syncope). [medicinenet.com]

• Hypertension

  KEYWORDS: Cardiovascular System; Drug Misuse (including Addiction); Hypertension [ncbi.nlm.nih.gov]

  Risk factors Approximately 50-75% of patients with dissection will have evidence of hypertension or a previous diagnosis. [ 2 ] Other risk factors include smoking and raised cholesterol. The most common risk factor is hypertension. [patient.info]

• Chest Pain

  We present a case of a young recreational cocaine user with uncontrolled hypertension who presented to hospital with acute chest pain and was diagnosed with an acute aortic dissection. The patient's last use of powdered cocaine was 3 days prior. [ncbi.nlm.nih.gov]

  Have a heightened level of suspicion for patients who present with chest pain and hypertension or chest pain and drug use or chest pain that is tearing and radiating to the back or a pulse deficit between arms. [hippoed.com]

  pain + vomiting Chest pain or back pain with neurologic findings (may be due to dissection into the carotid arteries) Cardiac tamponade Any patient that generally “looks bad” Only 49% of AD patients have the classic tearing chest pain Presenting blood [coreem.net]

• Back Pain

  Even in the absence of chest or back pain, the initial urgent care doctor needs to immediately perform chest contrast CT if suspecting aortic dissection from blood pressure laterality or upper mediastinal widening on chest X-ray. [ncbi.nlm.nih.gov]

• Paresis

  Monitoring for limb ischemia via peripheral pulses and cyanosis, limb weakness or paresis, or continued pain is worrisome for a complicated type B dissection requiring surgical intervention. C. [clinicaladvisor.com]

  Both patients showed no pure TGA, but showed TGA-plus-syndrome with additional focal neurological signs such as mild left-side motor deficit, slight anisocoria, and mild facial paresis; therefore, they were classified as having ischemic stroke. [dx.doi.org]

A workup for secondary hypertension was negative and no other risk factors for aortic dissection were determined. [ncbi.nlm.nih.gov]

Workup for aortic dissection in STEMI patients should be reserved for those patients with a significant pretest probability of dissection. [emergencymedicinecases.com]

Patients who present to the outpatient setting need to be quickly identified for expeditious transfer for further workup and treatment. Miz and Sam Ashoo discuss both typical and atypical presentations for aortic dissection. [hippoed.com]

Diagnostic Workup In the setting of suspected aortic disease, the diagnostic workup may include ECG, chest radiography, myocardial markers, transthoracic echocardiogram, transesophageal echocardiogram, CT, and MRI. [doi.org]

However, the results of this treatment may improve when associated with other imaging tests. [ncbi.nlm.nih.gov]

Endovascular stenting remains an option for treatment of some type B dissections. [emedicine.com]

CT scanning may be used to confirm the diagnosis but is less helpful in complications and prognosis. [patient.info]

The patient obtained favorable clinical prognosis and was smoothly discharged. During subsequent follow-up, he remained physically stable. [ncbi.nlm.nih.gov]

The etiology could not be reversed and the patient died. Critical care ultrasound is an important skill that intensivists should master for fast screening of life-threatening complications in patients with AAAD. [ncbi.nlm.nih.gov]

In young patients, an underlying etiology (i.e. Marfan’s) should be explored. E. Common Pitfalls and Side-Effects of Management. [clinicaladvisor.com]

Type of Dissection, Predisposing Conditions, and Etiology All patients had Stanford type A dissection; DeBakey type I was identified in 60.8% of patients. [dx.doi.org]

The etiology may differ depending on the location of the aneurysm. [omicsonline.org]

Epidemiology and clinicopathology of aortic dissection. Chest. 2000 ; 117 :1271–1278. Crossref Medline Google Scholar 3. Feldman M, Shah M, Elefteriades JA. Medical management of acute type A aortic dissection. [dx.doi.org]

Epidemiology: 10,000 deaths in the US annually Incidence 16/100,000 for men, 9/100,000 for women ( Milewicz 2011 ) Ratio of Aortic Dissection (AD) to Acute Coronary Syndrome is 1:600 22% of cases undiagnosed prior to death (Cline 2012) Predisposing Factors [coreem.net]

Aortic dissection: epidemiology, pathophysiology, clinical presentation, and medical and surgical management. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 9th ed. Philadelphia, PA: Elsevier; 2019:chap 81. [nlm.nih.gov]

The objective of the present study was to reappraise epidemiology and long-term outcomes in subjects with thoracic aortic disease in a large contemporary population. [web.archive.org]

The Stanford classification: Type A: Dissection involving any part of the ascending aorta Type B: Dissection remaining confined to the descending thoracic aorta Pathophysiology When the intima becomes compromised, a tear can occur leading to dissection [healio.com]

Aortic dissection: epidemiology, pathophysiology, clinical presentation, and medical and surgical management. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 9th ed. Philadelphia, PA: Elsevier; 2019:chap 81. [nlm.nih.gov]

Endovascular fenestration on the abdominal aorta is effective for preventing visceral malperfusion in aortic dissection. [ncbi.nlm.nih.gov]

How to prevent an aortic dissection Manage your blood pressure. To manage your blood pressure, it is recommended to diet and stay away from foods with high sodium. [keckmedicine.org]

PREVENTION: Medical management is essential to preventing aortic dissection. If you have thoracic aortic disease, medical management that includes optimal blood pressure control, aortic imaging and genetic counseling is strongly recommended. [web.archive.org]