Diagnosis and management of acute aortic dissection in the emergency department

Acute aortic dissection (AAD) is often misdiagnosed due to its atypical presentations. It affects 4,000 patients a year in the UK of all ages, not just the elderly, with increasing cases expected in future due to the aging population. Dissection of the aortic wall leads to sudden, severe pain, and commonly endorgan symptoms which must be recognised. AAD can be challenging to diagnose in the ED due to the multitude of possible presentations and the need for selective testing with CT angiography (CTA). Clinicians often miss AAD because it's not considered in the differential diagnosis, and when considered, the challenge lies in identifying AAD in a sea of chest, back, and abdominal pain complaints. To improve diagnosis, awareness campaigns, better education on whom to consider AAD in, and improved detection strategies including who to CTA, are needed. Clinical decision tools and biomarkers could help, but further research is required and is a current Emergency Medicine research focus. Once diagnosed, blood pressure control, analgesia and urgent surgery or transfer to enable this to occur with minimal delay is required.