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Aortic dissection in young patients with chronic hypertension
B A Vogt1, P E Birk, V Panzarino
1Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH 44106, USA. bxv10@po.cwru.edu
Insights
Young patients with chronic hypertension face a high risk of fatal acute aortic dissection. This rare condition demands physician awareness for prompt diagnosis in adolescents with unexplained pain.
Area of Science:
- Cardiology
- Nephrology
- Vascular Medicine
Background:
- Acute aortic dissection is a rare but life-threatening cardiovascular emergency.
- Systemic hypertension is a known risk factor, but dissection is uncommon in young individuals.
Observation:
- Four patients aged 14-21 years developed acute aortic dissection.
- All patients had sustained systemic hypertension secondary to chronic renal insufficiency.
- No other typical risk factors for aortic dissection were identified.
Findings:
- Three out of four patients experienced a fatal outcome despite aggressive treatment.
- Sustained hypertension in young patients with chronic renal insufficiency is a significant risk factor for aortic dissection.
Implications:
- Highlights a rare but critical complication of hypertension in adolescents and young adults.
- Emphasizes the need for considering aortic dissection in the differential diagnosis of chest, abdominal, or back pain in this demographic.
- Underscores the importance of managing hypertension in young patients with renal insufficiency to mitigate cardiovascular risks.
Abstract:
We describe four patients aged 14 to 21 years who developed acute aortic dissection. In three of the four patients, the course was fatal, despite aggressive medical and surgical intervention. All four patients had sustained systemic hypertension related to chronic renal insufficiency. The patients had no other identifiable risk factors for aortic dissection, including congenital cardiovascular disease, advanced atherosclerosis, vasculitis, trauma, pregnancy, or family history of aortic dissection. Although aortic dissection is rare in individuals younger than 40 years of age, young patients with sustained systemic hypertension are at increased risk for this serious and often fatal condition. Physicians must be aware of this rare complication of hypertension and consider aortic dissection in the differential diagnosis of unusual chest, abdominal, and back pain in hypertensive children, adolescents, and young adults.