Phys · cardiovascular
Aortic Disease
Also known as Aortic Disease · aortic disease
Consultant-physician depth guide to Aortic Disease for FRACP DWE/DCE preparation — presentation, differentials, investigations, management, complications and exam angles.
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Red flags
- Missed urgency or delayed escalation in Aortic Disease turns a salvageable presentation into preventable harm
- Treating the label without confirming the mechanism leads to wrong therapy in Aortic Disease
- Ignoring multimorbidity and drug interactions while managing Aortic Disease is a classic exam and clinical trap
- Failing to document the shared plan and safety-net advice after Aortic Disease loses follow-through
- Using recalled thresholds without a cited source is forbidden — verify before acting
Meet the patient
A 65-year-old hypertensive smoker arrives with sudden, severe, tearing chest pain radiating straight through to the back, and a blood-pressure differential of 35 mmHg between his arms. The registrar reaches for aspirin and a troponin. Stop — because if this is dissection rather than ACS, those antithrombotics can kill him.[3][9]
Two questions decide the next hour of every suspected aortic presentation: is the ascending aorta involved (type A — surgery), and is the patient perfusing his brain, gut, kidneys, and legs? Hold those two and the algorithm writes itself.[1][4]
References10ShowHide
- [1]Isselbacher EM, Preventza O, Hamilton Black J 3rd et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines Circulation, 2022.PMID 36322642
- [2]Mazzolai L, Teixido-Tura G, Lanzi S et al. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases European heart journal, 2024.PMID 39210722
- [3]Vilacosta I, San Román JA, di Bartolomeo R et al. Acute Aortic Syndrome Revisited: JACC State-of-the-Art Review Journal of the American College of Cardiology, 2021.PMID 34794692
- [4]Czerny M, Grabenwöger M, Berger T, et al. EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ The Annals of thoracic surgery, 2024.PMID 38416090
- [5]Erbel R, Aboyans V, Boileau C et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC) European heart journal, 2014.PMID 25173340
- [6]Sakalihasan N, Michel JB, Katsargyris A et al. Abdominal aortic aneurysms Nature reviews. Disease primers, 2018.PMID 30337540
- [7]Keisler B, Carter C Abdominal aortic aneurysm American family physician, 2015.PMID 25884861
- [8]Senser EM, Misra S, Henkin S Thoracic Aortic Aneurysm: A Clinical Review Cardiology clinics, 2021.PMID 34686263
- [9]Ohle R, Yan JW, Yadav K et al. Diagnosing acute aortic syndrome: a Canadian clinical practice guideline CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2020.PMID 32690558
- [10]Malaisrie SC, Szeto WY, Halas M et al. 2021 The American Association for Thoracic Surgery expert consensus document: Surgical treatment of acute type A aortic dissection The Journal of thoracic and cardiovascular surgery, 2021.PMID 34112502