Aortic dissection hard to diagnose
DEAR DR. ROACH: My good childhood friend recently passed away from a hemopericardial aortic dissection at the age of 45.
He suffered for days and was in and out of the hospital during this period, complaining of abdominal pain with some rectal bleeding.
They looked at his gallbladder and appendix, and sent him home twice with pain meds. He died in his sleep following his second trip to the emergency room.
My question is, Would an EKG show an abnormality in this situation, as no imaging was ever done of the thoracic cavity?
Could rectal bleeding have thrown off the doctors? Autopsy determined the cause of death.
ANSWER: I am sorry to hear of your friend. Unfortunately, aortic dissection is an emergency that is sometimes hard to diagnose, and even when a diagnosis is made, it has a high mortality rate.
The aorta, the largest blood vessel in the body, comes off the left ventricle and goes all the way down to about your bellybutton, where it divides into the femoral arteries.
Like all arteries, it has three layers, and when the innermost layer (the intima) is torn, the blood can propagate along the space, tearing the intima from the middle layer, the media.
In most people, there is a sensation of tearing chest or back pain. The pericardium fills with blood about a quarter of the time (that’s called a hemoperi cardium).
An EKG is useful in that it can show a lack of evidence for a heart attack, with which dissection is often confused.
The diagnosis can be made by CT, MRI or a special echocardiogram done through the esophagus. Unfortunately, if you don’t think about it, you won’t find it.
I think the rectal bleeding probably did mislead his doctors, as did his young age. Most people with this condition are over 60.
It’s possible your friend had a collagen disease, such as Marfan’s syndrome, which predisposes a person to this condition. So can inflammation of the blood vessels and some congenital abnormalities.
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