Acute aortic syndrome

### What you need to know A healthy woman in her mid 50s experiences sudden, tearing pain, like a lightning bolt from her neck to her chest, radiating to her back, coming in waves, with severity fluctuating over subsequent hours. At times she is able to talk and even walk, but she feels that her consciousness level is mostly reduced, and she has difficulty breathing. She feels dizzy and nauseous. Her mother survived a type A aortic dissection, three years previously, at the age of 77. An ambulance is called and arrives 90 minutes later. A paramedic makes a tentative diagnosis of aortic dissection based on the presenting features. The woman is given oral morphine and transported to hospital, arriving 45 minutes later. In the emergency department she receives an initial diagnosis of panic attack and is managed conservatively, until reassessment some hours later triggers computed tomography angiography, which shows an aortic dissection. Acute aortic syndrome (AAS) is a life threatening condition where a tear in the thoracic aorta can lead to rupture of the aorta and death. It encompasses three conditions: acute aortic dissection; intra-mural haematoma; and penetrating ulcer,1 and is commonly classified into Stanford type A (involving the ascending aorta) and type B (sparing the …