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(Circulation. 2005;112:3802-3813.)
© 2005 American Heart Association, Inc.

Contemporary Reviews in Cardiovascular Medicine

Acute Aortic Syndromes

Thomas T. Tsai, MD; Christoph A. Nienaber, MD; Kim A. Eagle, MD

From the Department of Internal Medicine, Division of Cardiology, University of Michigan Medical Center, Ann Arbor (T.T.T., K.A.E.), and Department of Internal Medicine, Division of Cardiology, University Hospital Rostock, Rostock, Germany (C.A.N.).

Reprint requests to Kim A. Eagle, MD, Albion Walter Hewlett Professor of Internal Medicine, Clinical Director, Cardiovascular Center, University of Michigan, 300 N Ingalls, 8B02 Ann Arbor, MI 48109-0477. E-mail keagle@umich.edu

Key Words: aorta • blood pressure • diagnosis • echocardiography • imaging

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
In 1760, Dr Nicholls, physician to King George II, first described on necropsy an acute aortic dissection. Over the course of more than 200 years, we have developed a growing awareness and understanding of acute and chronic aortic syndromes. Recent advances in imaging and therapeutic techniques have further emphasized the importance of early diagnosis of acute aortic syndromes, which continues to be crucial to survival. However, we continue to be uncomfortable in the diagnosis and management of this highly lethal disorder. In the present report, we review the etiology, pathophysiology, clinical presentation, outcomes, and therapeutic approaches to acute aortic syndromes. In each section, we summarize the most clinically relevant issues as "take home points" (THPs) to affirm their importance in the diagnosis and management of this disorder.

	Pathophysiology

 
Acute aortic syndrome is the modern term that includes aortic dissection, intramural hematoma (IMH), and symptomatic aortic ulcer. In the classic sense, acute aortic dissection requires a tear in the aortic intima that commonly is preceded by medial wall degeneration or cystic media necrosis.¹ Blood passes through the tear separating the intima from the media or adventitia, creating a false lumen. Propagation of the dissection can proceed in anterograde or retrograde fashion from the initial tear involving side branches and causing complications such as malperfusion syndromes, tamponade, or aortic valve insufficiency.^2–5

Both acquired and genetic conditions share a common pathway leading to the breakdown in the integrity of the intima. All mechanisms that weaken the media layers of the aorta will eventually lead . . . [Full Text of this Article]

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