Thread by @ASTC108

Always a pleasure to see my first EM supervisor @mattreed73 on stage, and to talk about such an important topic. @AorticDissectCT #EUSEM2022 #aorticdissection

Sobering context to begin the session from Mrs Latham who sadly lost her son after a missed diagnosis several years ago.
She has clearly turned her grief and loss into a hugely positive thing in @AorticDissectCT and shares her story with us today at #EUSEM2022

A testament to the healthcare professionals and trustees invovled in this charity that they are able to recognise the shared burden of missed diagnoses and other failings in the healthcare system, despite their own personal involvements. It isn'teasy to see other sides #EUSEM2022

Of course, change is not something which happens by good will and awareness raising alone. High quality education is a curicial first step, and a healthy interest in systems and processes is vital to help best practice become basic standards. #EUSEM2022

Epi: 4k per year - making it as common as brain tumors at 6/100k

2.5k of these patients die.

In 65-75yos, 34/100k makes it as common as ruptured AAA and about 1/20th the prevalence of MI

#EUSEM2022

As we know, tearing of the initima allows blood to flow between it and the media, creating a false lumen which expands in systole and relaxes in diastole.

It moves faster than most CT scanners resolve, causing the wall to appear wiggly on slice images.

#EUSEM2022

Pressure builds until the aorta ruptures, or the wall of the false lumen ruptures back into the aorta.

Flow and pressure then balance over hours to days.

If it ruptures then you're highly likely to become one of the >50% who die prehospitally.

#EUSEM2022 i

In those with a "stable" second tear to relieve pressure back into the aorta.

This is not safe though, as the false lumen may block branch vessels either dynamically or permanently.

#EUSEM2022

Remember, it's a dynamic process which has symptoms from 3 main sequelae:
- Rupture
- Contained rupture (compressing the mediastinum)
- Malperfusion (of branch vessels at any level - brain, limbs, abdomen)
#EUSEM2022

Question about vasorpressors in malperfusion - vasorpressors likely to be counteractive, but IV beta blocker might help balance the flow.

Chest pain presentations are extremely common.
About 164/100k of these will be having an MI, and 6/100k an aortic dissection.

Misdiagnosis is common nationally in the UK, and research is difficult given the broad range of presentations