Acute aortic syndrome

Among the non-ischaemic cardiovascular causes of thoracic pain that should be ruled out, some present a benign prognosis as pericarditis, while others, in turn, point to a much serious prognosis, such as an acute aortic syndrome (dissecting aneurysm or other aortic pathologies) and a pulmonary embolism. On the whole, these account for 5-10% of all cases of thoracic pain. 

Vascular emergencies play an important role amongst the various differential diagnoses for acute chest pain. Pulmonary embolism, acute aortic syndromes as well as acute coronary artery disease have to be considered.The latest scanner technology available (> 64-slice multi-detector-row spiral CT platforms) allows for a straight-forward work-up in the emergency situation. A dedicated triage based on a sophisticated clinical assessment, however, ist required. 

Acute chest pain is one of the major clinical emergency conditions. Various differential diagnoses have to be considered, some of them are potentially life-threatening. CT assessment for vascular pathologies of the chest can be split up into three major categories. Pulmonary embolism, acute aortic syndromes and coronary artery disease (CAD) require a rapid, reliable and effective diagnostic pathway allowing for an immediate therapeutic decision thereafter. A simple and objective cross-sectional modality should ideally be available on a 24/7 basis. 

MDCT has become the first-line imaging test in the assessment of acute aortic syndromes. A sudden onset... 

Suspected cardiac source at high risk of recurrent embolism prosthetic mechanical heart valve, endocarditis, aortic dissection, acute coronary syndrome, overt congestive heart failure... 

Figure 7.4 (A) A patient with thoracic pain due to a dissecting aortic aneurysm. An ST-segment elevation in V1-V3 can be explained by the mirror pattern of an evident LVE (V6) due to hypertension. This ST-segment elevation has been erroneously interpreted as due to an acute coronary syndrome. As a consequence, fibrinolytic...

Markers of inflammation, especially CRP (measured with a highly sensitive technique, referred to as hs-CRP), have become the center of attention in recent years (22). This increased interest stems from several important observations made by Ridker and co-workers. Serum CRP has been shown to be an independent cardiovascular disease risk factor (23,24). High levels predict CAD death in healthy middle-aged men (25) and in patients with unstable CAD (26). In acute coronary syndromes, serum CRP concentrations correlate with the severity of endothelial dysfunction (27). In the CARE trial, subjects with elevated markers of inflammation (CRP and serum amyloid A > 90th percentile) were at high cardiovascular risk and responded best to pravastatin treatment in terms of cardiovascular risk reduction (28). The statin also reduced serum CRP concentrations (29). CRP co-incubated with LDL is readily taken up by macrophages, in contrast to native LDL, suggesting that CRP could promote foam cell formation (30). A link with endothelial dysfunction may be related to the fact that CRP decreases endothelial nitric oxide synthase (eNOS) expression and bioactivity in human aortic endothelial cells (31). 

Acute myocardial infarction Angiopathy Aortic aneurysm Aortic balloon assist devices Giant hemangiomas Peripheral vascular disease Postcardiac arrest Prosthetic devices Raynaud s syndrome Infectious Arbovirus Aspergillus Candida albicans Cytomegalovirus Ebola virus... 

A 49-year-old woman who took low-dose per-golide (0.625 mg/day) daily for 5 years for restless legs syndrome developed chronic and then acute heart failure and had moderate to severe aortic and mitral regurgitation, requiring replacement of both valves [101 ]. 

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