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Risk factors for aortic dissection in patients aged <40

Published:January 11, 2020DOI:https://doi.org/10.1016/j.ajem.2020.01.023
      When a patient aged <40 presents with symptoms of aortic dissection(AD), in the absence of known risk factors [
      • Aalam A.
      • Lefleur J.
      Aortic dissection in a 19 year old male without risk factors, case report and selective review of the literature.
      ,
      • Hountis P.
      • Dedeilias P.
      • Bolos K.
      Acute aortic dissection in a young patient without Marfan fibrillinopathy: a case report.
      ,
      • Tsai S.-H.
      • Lin Y.-Y.
      • Hsu C.-W.
      • Chen Y.-L.
      • Liao M.-T.
      • Chu S.-J.
      The characteristics of acute aortic dissection among young Chinese patients: a comparison between Marfan syndrome and non-Marfan syndrome patients.
      ], acquired risk factors, 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” [
      • Singh B.
      • Treece J.M.
      • Murtaza G.
      • Bhatheja S.
      • Lavine S.J.
      • Paul T.K.
      Aortic dissection in a healthy male athlete: a unique case with comprehensive literature review.
      ]. 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 normotensive and without a history of anabolic drug use [
      • Singh B.
      • Treece J.M.
      • Murtaza G.
      • Bhatheja S.
      • Lavine S.J.
      • Paul T.K.
      Aortic dissection in a healthy male athlete: a unique case with comprehensive literature review.
      ]. It is also worth remembering that, even in a patient aged <40, AD can present with acute breathlessness with [
      • Lien W.-C.
      • Wang C.-H.
      • Chang W.-T.
      • Hsu R.-B.
      • Chen W.-J.
      Aortic dissection presenting with acute pulmonary edema.
      ] or without chest tightness [
      • Kaya A.
      • Aydin B.A.
      • Oz A.
      • Bozbeyoglu E.
      • Eren M.
      A patient presenting with acute heart failure: a dilemna of diagnosis.
      ], but in the absence of back pain.
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