Risk factors for aortic dissection in patients aged <40
American Journal of Emergency Medicine 38 (2020) 1942
Correspondence
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Risk factors for aortic dissection in patients aged
b40
When a patient aged b40 presents with symptoms of aortic dissec- tion(AD), in the absence of known risk factors [1-3], acquired risk fac- tors, such as weight lifting, use of anabolic steroids, and pregnancy should be investigated. In the case of weight lifting, hemodynamic changes raise aortic wall stress to a level that “begets aortic dissection” [4]. In a review of six male weight lifters, aged 18-37, who experienced AD, two had a history of hypertension and anabolic drug use; two others were normotensive but took anabolic drugs. Only two were both nor- motensive and without a history of anabolic drug use [4]. It is also worth remembering that, even in a patient aged b40, AD can present with acute breathlessness with [5] or without Chest tightness [6], but in the absence of back pain.
A report of 68 patients aged b40 with aortic dissection, culled from the International Registry of Aortic Dissection between1996 and 2001, revealed that 76% were male. Marfan’s syndrome was the most com- mon risk factor, seen in 50% of cases [7]. Other risk factors included hy- pertension and bicuspid aortic valve disease. Three percent of cases occurred in the peripartum context [7], where AD can occur in the ab- sence of other risk factors [8-10]. In pregnancy, hemodynamic changes as well as hormonal effects on the aorta [11], significantly increase the risk of AD. In pregnancy, as well as other conditions, the differential di- agnosis of AD includes pulmonary embolism (PE) [12], and normal breathlessness associated with pregnancy [13]. It should also be kept in mind that the risk of AD extends to the postpartum period [14]. Fi- nally, although the coexistence of AD and PE has not been reported in patients aged b40, it has been reported in a 47 year old with Marfan’s syndrome and hyperhomocysteinemia [15]. Accordingly, clinicians who evaluate patients aged b40 with symptoms common to AD and PE should remain vigilant of this rare possibility.
Declaration of competing interest
I have no funding and no conflict of interest.
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Oscar M.P. Jolobe MRCP
Medical Division, Manchester Medical Society, Simon Building, Brunswick
Street, Manchester M13 9PL, United Kingdom E-mail address: [email protected]
13 December 2019
https://doi.org/10.1016/j.ajem.2020.01.023
0735-6757/(C) 2020