Acute aortic syndromes: An internist's guide to the galaxy

Area of Science:

• Cardiology
• Vascular Surgery
• Internal Medicine

Background:

• Acute aortic syndromes (AASs) encompass critical conditions like aortic dissection, hemorrhage, ulceration, or rupture.
• These syndromes share underlying causes, including chronic aortic tissue degeneration and acute injury mechanisms.
• AASs present with non-specific and varied symptoms, complicating diagnosis and necessitating broad differential considerations.

Purpose of the Study:

• To highlight the diagnostic challenges and key management strategies for acute aortic syndromes.
• To emphasize the importance of integrating clinical assessment, point-of-care ultrasound, and biomarkers like d-dimer.
• To underscore the role of internal medicine in the non-surgical management and prognostication of AASs.

Main Methods:

• Clinical probability assessment for patients presenting with AAS-compatible symptoms.
• Utilization of bedside imaging, specifically point-of-care ultrasound.
• Inclusion of laboratory findings, such as d-dimer levels, in the diagnostic workup.

Main Results:

• The natural course of AASs involves activation of ischemic, coagulative, and inflammatory pathways.
• Multiorgan damage is a common consequence of these activated pathways.
• Effective management requires a multidisciplinary approach focusing on medical treatment, organ monitoring, and prognosis.

Conclusions:

• Accurate diagnosis of AASs relies on a comprehensive approach combining clinical acumen, rapid imaging, and biomarker analysis.
• Internal medicine plays a crucial role in the non-operative management, monitoring, and predicting outcomes for AAS patients.
• Understanding the pathophysiological mechanisms is key to optimizing patient care and improving outcomes in acute aortic syndromes.