I vividly remember seeing an aortic artery for the first time during a gross anatomy dissection in medical school. The aorta was so large that it reminded me of a garden house. As the largest artery in the body, the aorta is around a foot long and over one inch in diameter.
The aorta fills the significant role of transporting blood from the heart’s pumping chamber, the left ventricle, and supplying major parts of the body with blood, including the head, neck, arms, and most vital organs.
Like other arteries, the aortic artery is made up of three layers compressing its wall. The innermost layer is called the intima, a thin cellular structure that provides a smooth surface through which blood can flow.
When the intimal layer of the aorta is compromised or torn, it’s called an aortic dissection. An aortic dissection allows blood to flow between the other layers of the aortic wall—the media and adventitia—which pulls them apart. Given the critical role of the aorta, it’s easy to understand that an aortic dissection is a medical emergency.
Patients experiencing in aortic dissection will often have symptoms including:
• A sudden onset of intense chest or upper back pain. Many patients describe the pain as a ripping or tearing sensation.
• A sudden onset of severe abdominal pain.
• Shortness of breath or loss of consciousness.
• Other symptoms including leg pain or paralysis on one side, or similar stroke-like symptoms such as aphasia (speech difficulty) and one-sided motor weakness.
The most common patients presenting with aortic dissection are men in their 60s and 70s, but this serious medical condition can affect anyone. Other risk factors include chronic uncontrolled high blood pressure (hypertension), connective tissue disease, past history of aortic aneurysm, a genetic/congenital condition called Marfan syndrome, being born with a defective bicuspid aortic valve, atherosclerosis (hardening of the arteries), and traumatic injury (for example, from sports or a car wreck).
Patients who experience these symptoms should be seen in a hospital emergency room. Emergency room physicians or providers should recognize the possibility of aortic dissection and perform an appropriate workup, which could include diagnostic imaging studies beginning with a chest x-ray, which could show widening of the aorta. Additional diagnostic radiography options include a transesophageal echocardiogram (TEE), CT scan, CT angiogram (CTA), And magnetic resonance angiogram (MRA), which should be ordered for appropriate patients.
When a diagnosis of aortic dissection is confirmed, emergency medical treatment is necessary. Many patients require surgery to place remove and reconstruct the damaged portion of the aortic artery that was affected by dissection, or stent placement. Medical therapy is used to stabilize blood pressure and heart rate to prevent the aortic dissection from expanding.
Unfortunately, aortic dissection or sometimes misdiagnosed in emergency room settings. That’s what happened to a man who presented to a hospital emergency room (ER) with the classic symptoms of stomach pain and a tight chest. Throughout his evaluation in the ER, he described additional symptoms of neck pain, cough, and chest congestion.
The ER team ordered an EKG and troponin levels, which were interpreted as normal. He was kept in the ER, without hospital admission, for around seven hours. At that point, the ER physician felt that he had improved in discharged him to home with instructions to follow-up with his primary care provider the next day, and to consult the cardiologist.
The man went home and died less than eight hours later from the aortic dissection that had been causing his problems in the emergency room, which the ER providers misdiagnosed. A medical malpractice lawsuit followed, and the medical expert for the plaintiffs was critical of the ER physicians and team for failing to recognize the significance of physical exam findings, including aortic regurgitation, an abnormally low pulse, neurological deficit, hypotension (low blood pressure), and pericardial effusion.
The cardiology expert felt that the emergency room provider violated the standard of care by failing to order D-dimer testing or appropriate advanced radiographic studies, such as a MR angiogram (MRA) or CT angiogram (CTA).
If you or someone you care for has been seriously injured because of aortic dissection misdiagnosis or care in Texas, then contact a top-rated experienced medical malpractice lawyer.