Diagnosing Aortic Dissestion

Recommendations for Health Care Providers

After Tyler Kahle’s death, Methodist Health System implemented the following three-question bundle, requiring just a minute or two of a care provider’s time, to identify chest pain patients with the highest pretest probability of aortic dissection.

Methodist Aortic Dissection Bundle:

  • Does the patient have a personal or family history of aortic aneurysm or aortic dissection?
  • Does the patient have a personal or family history of a condition that predisposes individuals to aortic aneurysm or dissection, including Marfan syndrome, Ehlers-Danlos syndrome, Loeys-Dietz syndrome, Turner syndrome or bicuspid aortic valve disease?
  • Do the patient’s physical features suggest the presence of undiagnosed Marfan, Ehlers-Danlos, Loeys-Dietz or Turner syndromes?            

Regardless of the patient’s age, a single "yes" answer means that aortic dissection may be cause of the patient’s pain, and the diagnosis should be excluded by emergent CT scan, MRI or transesophageal echocardiogram.

2010 ACCF/AHA/AATS/ACR/ASA/SCA/1 SCAI/SIR/STS/SVM

Guidelines for the Diagnosis and Management of Patients with Thoracic Aortic Disease

Then in 2010, the American Heart Association and the American College of Cardiology released “Guidelines for the Diagnosis and Management of Patients with Thoracic Aortic Disease.”

Please review and implement these clinical guidelines, which are more comprehensive. The full 108-page text and free copies of the pocket version of the aortic dissection clinical guidelines are available through the TAD Coalition. 

The new guidelines appeared in the April 6, 2010, issues of the Journal of American College of Cardiology (JACC) and Circulation: Journal of the American Heart Association, as well as on web sites of the ACC (www.acc.org) and the AHA (www.americanheart.org).

They were developed in collaboration with the American Association for Thoracic Surgery (AATS), American College of Radiology (ACR), American Stroke Association (ASA), Society of Cardiovascular Anesthesiologists (SCA), Society for Cardiovascular Angiography and Interventions (SCAI), Society of Interventional Radiology (SIR), Society of Thoracic Surgeons (STS), and Society for Vascular Medicine (SVM).

The American College of Emergency Physicians (ACEP) and the American College of Physicians (ACP) were also represented on the writing committee.