Aortic Dissection

Dissection Aortique

Aortic DissectionCLINICAL SIGNS:

* in an adult (3 men for 1 woman) between 40 and 70 years old, often hypertensive (70-90%).

* severe thoracic or dorsal or posterior pain , migrating to the abdomen in 90% of cases but also the loins.

* high blood pressure in 2/3 of cases, widening of the differential, asymmetry> 2 cmHg.

* disappearance or asymmetry of peripheral pulses.

* acute aortic insufficiency possible, often moderate, to look for the auscultation ( aortic diastolic murmur ).

* sometimes painless abdominal beating mass but no contracture or abdominal defense.

* complications:

– acute ischemia of a lower limb.

– stroke, paraparesis, paraplegia (10%).

– collapse, heart failure, congestive heart failure.

– acute renal failure with oligo-anuria.

– rupture of the dissection:

 it is extremely urgent: initial syncope, thoracic or posterior transfixing pain, circulatory failure, hemopericardium, abdominal defense.

– crack in the duodenum: digestive haemorrhage that makes the diagnosis err.


* myocardial infarction, (do not make heparin in the dissection!).

* pulmonary embolism.

* acute pericarditis.

* other chest pain.

* abdominal emergencies, renal colic.

* low back pain or acute sciatica.


* arterial hypertension .

* Marfan disease.

coarctation or congenital bicuspidia of the aorta.

* pregnancy.

* thoracic trauma.


* scope, SpO².

* ECG:

– normal, which must make evoke the diagnosis.

– or misleading : signs of ischemia-lesion, left ventricular hypertrophy, tachycardia.

* chest x-ray:

– sometimes widening of the right mediastinum if ascending aorta, left if aorta descending in 80% of cases.

transthoracic or transesophageal ultrasound .

* chest CT scan if transesophageal echography not performed.


* venous route, oxygen therapy mask.

* analgesic IV or analgesia.

* lower the systolic BP to about 120 mmHg:

– Loxen 20: 2 tablets.

– Loxen: 1 to 2.5 mg IV or Eupressyl: 25 mg IV then relay with the electric syringe.

* Lenitral : 1 mg / h IV continuous (max: 3 mg / h).

* if shock condition:

– macromolecules, Dobutrex: 10 μg / kg / min.

– anti-shock pants if abdominal aneurysm.

* if vital distress:

– intubation, assisted ventilation after sedation (Hypnovel + Fentanyl).

* Surgical treatment as soon as possible.