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Related Concept Videos

Aortic Regurgitation II: Clinical Features and Diagnostic Tests01:22

Aortic Regurgitation II: Clinical Features and Diagnostic Tests

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Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
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Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

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Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
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Aortic Regurgitation I: Introduction01:15

Aortic Regurgitation I: Introduction

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IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
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Acute Coronary Syndrome I: Introduction01:30

Acute Coronary Syndrome I: Introduction

926
Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
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Aortic Regurgitation III: Medical Management01:25

Aortic Regurgitation III: Medical Management

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Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
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Aortic Regurgitation IV: Nursing Management01:17

Aortic Regurgitation IV: Nursing Management

310
A nurse managing a patient with aortic regurgitation begins with a comprehensive assessment, including a review of the patient's medical history, family history, and lifestyle factors. During the cardiac examination, the nurse listens for heart sounds and checks for signs of valve abnormalities. The nurse also observes for symptoms such as dyspnea, orthopnea, and paroxysmal nocturnal dyspnea and assesses the patient's endurance and daily activity tolerance.Based on the findings, the nurse...
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Related Experiment Video

Updated: Jan 27, 2026

Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
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d-Dimer With the Aortic Dissection Detection Risk Score May Improve Patient Selection for Acute Aortic Syndrome

Sameer Bhat1,2, Shreya Bhat3, Franco Schreve4

  • 1Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.

Emergency Medicine Australasia : EMA
|January 26, 2026
PubMed
Summary

A negative d-dimer test effectively rules out acute aortic syndrome (AAS) in low-risk patients. This finding supports using d-dimer to avoid unnecessary computerised tomographic aortography (CTA) scans for suspected AAS.

Keywords:
accuracyaortic dissectionaortic dissection detection risk scorecomputer assisted tomographyfibrin fragment d

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Area of Science:

  • Cardiovascular Medicine
  • Diagnostic Imaging
  • Emergency Medicine

Background:

  • Acute aortic syndrome (AAS) is a life-threatening condition requiring definitive diagnosis via computerised tomographic aortography (CTA).
  • Current risk-stratification tools for AAS, like the aortic dissection detection risk score (ADD-RS), lack validation in low-to-intermediate risk populations.
  • There is a need for effective methods to identify patients who do not require advanced imaging for suspected AAS.

Purpose of the Study:

  • To evaluate the diagnostic efficacy of d-dimer testing in identifying AAS in patients with low or intermediate pre-test probability.
  • To determine the sensitivity and negative predictive value (NPV) of a negative d-dimer result in ruling out AAS.
  • To analyze trends in d-dimer test utilization for suspected AAS over time.

Main Methods:

  • Retrospective analysis of atraumatic thoracic CTAs in adults suspected of AAS presenting to the emergency department.
  • Aortic dissection detection risk score (ADD-RS) was used to stratify patients into low/intermediate (ADD-RS ≤ 1) and high-risk groups.
  • Calculation of sensitivity and NPV for d-dimer (< 500 ng/mL) in the low/intermediate risk group.

Main Results:

  • In 181 low/intermediate risk patients, a negative d-dimer (< 500 ng/mL) demonstrated 100% sensitivity and 100% NPV for ruling out AAS.
  • A significant increase in annual d-dimer requests for patients undergoing CTA for suspected AAS was observed (p=0.0059).
  • The proportion of negative d-dimer results increased significantly (p=0.0036), while positive results remained stable.

Conclusions:

  • A d-dimer level below 500 ng/mL can reliably exclude AAS in low-to-intermediate risk patients.
  • This biomarker may help clinicians avoid unnecessary computerised tomographic aortography (CTA) scans in this patient cohort.
  • The findings support the judicious use of d-dimer as a rule-out test for AAS in selected emergency department presentations.