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West Florida


Brandon Regional Hospital


Emergency Medicine

Document Type


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aortic dissection, risk stratification, quality improvement


Cardiology | Cardiovascular Diseases | Emergency Medicine | Health Services Administration


Aortic dissection (AD) is part of a group of acute aortic syndromes consisting of intramural aortic hematoma, penetrating aortic ulcer, and aortic rupture. On its own, the incidence is ~3 to 8 cases per 100,000 per year, and up to 25% of cases are missed. The in-hospital mortality when treated is 27%, and with a 2% increase in mortality/hour. Imaging modalities like CT angiography, TEE, and MRA have made improved diagnosis of the disease, but are costly, potentially harmful, time consuming, and require patient stability when in use (1). The key question we have as emergency department providers is if there is a way to risk stratify patients for AD and if so, is there a test with high enough sensitivity and negative likelihood ratio (-LR) to rule out aortic dissection. Smooth muscle myosin heavy chain is a proposed modality, which is released from injured aortic media at the start of AD but there is a lack of observational studies testing its efficacy as biomarker in making the diagnosis (2). Hence, algorithms to aid physician in reducing both misdiagnosis and overtestingis much needed.

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