Clinical presentation of patients with chest pain and acute aortic dissection admitted in the chest pain unit

Background

Chest pain (CP) is one of the most common symptoms of presentation in emergency rooms around the world. Although uncommon, acute aortic dissection (AAD) is a life-threatening medical emergency that is difficult to diagnose and so requires a high clinical index of suspicion. The objective was to evaluate the characteristics of CP in patients with AAD admitted in a chest pain unit (CPU).

Patients and methods

We evaluated in a cross-sectional and prospective study patients admitted in a CPU, between March 1997 and May 2001, with diagnosis of AAD. The authors carried out a descriptive analysis in the sample and they compared the proportions of the categorical variables between the types A and B (Fisher Test). Values of P < 0.05 were considered significant.

Results

Were evaluated 34 patients with diagnosis-confirmed AAD, 26 (76.5%) being of type A and eight (23.5%) of type B Stanford. Eighteen patients (52.9%) were male and 33 (97.1%) were blacks, presenting an average age of 63.5 ± 13.5 years. CP was the most common symptom presented in 28 (82.4%) patients, and 75% of these were of type A dissection. The most common site of pain was the anterior chest, occurring in 82.2% of the patients with a prevalence of precordial CP in type A dissection (P = 0.065). Back pain was observed only in 21.4% of the cases. The tearing and ripping pain was not described and the constrictive quality of pain was most described in type A dissection (90%). The radiated pain was shown in 82.3% of patients, with most frequency for the back (42.9%). Associated with CP, syncope was observed in two patients (11.1%), everybody of type A dissection, and disturbance of conscience and seizures in four patients (22.2%).

Conclusions

The typical characteristics of CP as described in the past was less frequent. A meticulous medical history and clinical examination must be carried out to increase clinical suspicion. Although CP is the most common symptom, syncope and disturbance of conscience should be valued, mainly when associated with the CP.