Aortic Dissection
International Registry for Aortic Dissection (IRAD):
- Descriptive case study by Hagan et al of 464 patients with aortic dissection from 12 international centers
Patient History
| Factor |
Incidence |
| Marfan syndrome |
4.9% |
| Hypertension |
72.1% |
| Atherosclerosis |
31.0% |
| Known aortic aneurysm |
16.1% |
| Prior aortic dissection |
6.4% |
| Diabetes mellitus |
5.1% |
Iatrogenic
| Factor |
Incidence |
| Catheterization/PTCA |
2.2% |
| Cardiac surgery |
2.2% |
Presenting Symptoms
| Factor |
Incidence % |
| Pain, |
|
| - Any |
95.5% |
| - Abrupt onset |
84.8% |
| - Chest |
72.7% |
| - Anterior chest |
60.9% |
| - Posterior chest |
35.9% |
| - Back |
53.2% |
| - Abdomen |
29.6% |
| - Severe or worst ever |
90.6% |
| - Tearing or ripping quality |
50.6% |
| - Radiating |
28.3% |
| - Migrating |
16.6% |
| Syncope |
9.4% |
Physical Exam
| Factor |
Incidence |
| SBP ≥150 mmHg |
49.0% |
| SBP 100-149 mmHg |
34.6% |
| SBP <100 mmHg |
8.0% |
| SBP ≤ 80 mmHg |
8.4% |
| Mumur of aortic insufficiency |
31.6% |
| Pulse deficit |
15.1% |
| CVA |
4.7% |
| CHF |
6.8% |
Chest X-Ray Findings
| Factor |
Incidence |
| Normal |
12.4% |
| Widening mediastinum or abnormal aortic contour |
78.7% |
| Pleural effusion |
19.2% |
ECG Findings
| Factor |
Incidence |
| Normal |
31.3% |
| Nonspecific ST-T wave changes |
41.4% |
| Left ventricular hypertrophy |
26.1% |
| Ischemia |
15.1% |
Overall hospital mortality: 26.4%
Abbrevations
- CHF = congestive heart failure
- CVA = cerebrovascular accident
- PTCA = percutaneous transluminal coronary angioplasty
References
- Hagan PG. et. al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000 Feb 16;283(7):897-903. [PubMed]
