Aortic dissection and other acute aortic syndromes in the emergency department

Area of Science:

• Cardiology
• Emergency Medicine
• Vascular Surgery

Background:

• Acute aortic syndromes (AAS) are life-threatening emergencies with challenging incidence determination.
• Untreated AAS carries a high and progressive mortality rate, underscoring the need for rapid diagnosis and intervention.
• Current management protocols in the Czech Republic and Europe are based on the 2014/2018 European Society of Cardiology guidelines.

Purpose of the Study:

• To summarize the emergency department approach to patients presenting with acute aortic syndromes.
• To focus on aortic dissection, the most frequent type of AAS, and its diagnostic and therapeutic strategies.
• To highlight the importance of early risk stratification and diagnostic modalities in managing AAS.

Main Methods:

• Initial assessment includes patient history, physical examination, ECG, vital signs, and hemodynamic status evaluation.
• Aortic dissection detection risk score (ADD-RS) is employed for diagnostic probability stratification.
• Key diagnostic tools include D-dimer testing, CT aortography, and echocardiography; emerging biomarkers and MRI are under investigation.

Main Results:

• Combination of ADD-RS with D-dimer or echocardiographic measurement of ascending aorta diameter shows promising diagnostic benefits.
• Initial therapy is guided by the patient's hemodynamic status, followed by definitive treatment.
• Advances in imaging technology, such as MRI, may offer future diagnostic potential.

Conclusions:

• Prompt diagnosis and initiation of therapy are paramount in managing acute aortic syndromes to reduce mortality.
• A systematic approach integrating clinical evaluation, risk stratification, and appropriate imaging is essential.
• Adherence to established guidelines and exploration of novel diagnostic tools are crucial for optimizing patient outcomes in AAS.