Chest
Quality of History Taking in Patients With Aortic Dissection
Section snippets
MATERIALS AND METHODS
We reviewed the medical records of 83 patients diagnosed as having aortic dissection between January 1985 and December 1994. The diagnosis of dissection was confirmed by autopsy in 4 patients, by surgery in 38 patients or by CT scan, echocardiogram and/or angiogram in 41 patients.
The history obtained at the initial clinical evaluation was reviewed for inquiries concerning the following three descriptions of pain: quality, rather than just presence; radiation; and sudden intensity at onset. A
Demographics and Predisposing Factors
More women than men were affected with average age near 60 years in both proximal and distal dissections (Table 1). Hypertension was the most common risk factor present in most patients with both proximal and distal dissection. Connective tissue disease, including Marfan's syndrome, trauma, bicuspid aortic valve, and prior surgery to the aorta were more common in patients with proximal dissection.
Methods of Diagnosis
After completion of the initial history, physical examination, ECG, and chest radiograph, the
DISCUSSION
Aortic dissection has a distinctive clinical presentation. It is a catastrophic disorder with rapid death if untreated. Diagnosis can often be made readily with noninvasive techniques. Treatment is of proven benefit. Therefore, it is critical that the initial history be of sufficient quality to raise suspicion of dissection.
Prior to the advent of therapy for dissection and prior to the development of excellent noninvasive modalities for diagnosis, clinicians routinely took meticulous histories.
CONCLUSION
Despite important advances in diagnostic imaging for aortic dissection, accurate diagnosis still requires an accurate history. The selection of tests, their interpretation, and subsequent therapy necessarily rely on the initial clinical suspicion generated in large part by a carefully elicited history.
REFERENCES (15)
- et al.
Treatment of dissecting aneurysm of the aorta without surgery.
J Thorac Cardiovasc Surg
(1965) - et al.
The clinical recognition of dissecting aortic aneurysm.
Am J Med
(1976) - et al.
Clinical features and differential diagnosis of aortic dissection: experience with 236 cases (1980 through 1990).
Mayo Clin Proc
(1993) - et al.
Management of acute aortic dissection.
Ann Thorac Surg
(1970) De sedibus et causis morborum, 1761.
Classics of cardiology.
(1983)- et al.
Surgical considerations of dissection aneurysm of the aorta.
Ann Aurg
(1955) - et al.
Problems in the aortographic diagnosis of dissecting aneurysm of the aorta.?
Engl J Med
(1969)
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Manuscript received August 28, 1997; revision accepted February 19, 1998.