Aortic Dissection: How It’s Diagnosed, Why It’s Missed
The aorta is the major artery carrying blood away from the heart. Aortic dissection is a life-threatening condition in which there is a tear in the innermost layer of the wall of the aorta. As the tear worsens, blood begins to flow between the layers of the aorta's wall. This is called "dissection," and can cause intense pressure on the aortic wall that causes the aorta to rupture, as well as causing decreased flow of blood to the body's organs, including the brain.
Many people who experience aortic dissection are unaware that there is a problem until it becomes catastrophic. However, aortic dissection can be detected before it causes severe injury or death. When a doctor has the ability to detect aortic dissection, but fails to do so, the failure may constitute medical malpractice.
Aortic dissection occurs in roughly two people out of every 10,000. Well-known victims of the condition include actors John Ritter and Lucille Ball.
What Causes Aortic Dissection?
It is not always clear what causes an aortic dissection, though there are a number of risk factors. Aortic dissection happens most frequently in those between the ages of 40 and 70. In addition to age, risk factors include:
- Blunt trauma to the chest, such as being hit with a baseball or contact with a car's steering wheel in a collision.
- High blood pressure
- Atherosclerosis (commonly known as hardening of the arteries)
- Narrowing of the aorta
- Bicuspid aortic valve (the aortic valve normally has three "leaflets;" a bicuspid valve has two)
- A history of heart surgery or related procedures
- Connective tissue disorders such as Marfan syndrome
- Swelling of the blood vessels secondary to another medical condition, such as syphilis
- Cocaine use
- Strenuous resistance training, like high-intensity weightlifting
- Certain rare genetic conditions.
How is Aortic Dissection Diagnosed?
The symptoms of aortic dissection often occur suddenly, and are similar to those of a heart attack. They may include sudden, severe pain in the chest or upper back, with pain radiating down the back or to the neck. Other symptoms include severe abdominal pain with a sudden onset, severe leg pain or even paralysis, shortness of breath, and loss of consciousness. Stroke-like symptoms like loss of vision or difficulty speaking may also be present. Any of these symptoms, especially in combination, warrant getting immediate medical attention.
When someone presents to a medical professional with symptoms of aortic dissection (or heart attack or stroke), they should be taken seriously.
Although symptoms of an aortic dissection may mimic those of a heart attack or stroke, there are a few signs that point in the direction of aortic dissection. If the patient describes the pain as “ripping” or “tearing,” a doctor should at least consider aortic dissection. Similarly, if the aorta appears wider than normal on an X-ray, or there is a difference in blood pressure between one arm and the other, aortic dissection should be on the doctor’s mind.
Tests used to diagnose aortic dissection include a computerized tomography (CT) scan. A CT scan creates images of the body in very thin cross-section. Using contrast dye can make the heart and blood vessels more visible in the images. A transesophageal echocardiogram uses high-pitched sound waves to create an image of the heart. As the name suggests, a probe is inserted into the esophagus, allowing a clearer image of the heart than a typical echocardiogram. A magnetic resonance angiogram uses radio wave energy pulses and a magnetic field to create images of blood vessels.
Why is the Diagnosis of Aortic Dissection Often Missed?
Because the symptoms of aortic dissection are similar to those of other, more common health problems, the diagnosis may be missed in as many as one out of six cases that show up in an emergency room. Doctors who ask the patient to describe the nature of the pain (e.g. “tearing”), its intensity when it began (severe and abrupt), and whether the pain is radiating, have been found to have correctly diagnosed the problem sooner and more often.
The medical tests to diagnose aortic dissection, and the condition is relatively uncommon compared with heart attack and stroke. But because it is so potentially lethal, doctors should, at a minimum, ask the questions that would suggest that further testing would be appropriate.
If you have lost a loved one due to undiagnosed aortic dissection, it is possible that there is nothing that could have been done to save them, but there is also a chance that their doctors missed signs that could have led to timely diagnosis and treatment. If you have questions about aortic dissection and missed diagnosis or misdiagnosis, we invite you to contact Huegli Fraser to schedule a consultation.
The information in this blog post is provided for informational purposes only and is not intended to be legal advice. You should not make a decision whether or not to contact a qualified medical malpractice attorney based upon the information in this blog post. No attorney-client relationship is formed nor should any such relationship be implied. If you require legal advice, please consult with a competent medical malpractice attorney licensed to practice in your jurisdiction.