Better understanding of thoracic aortic disease leads to new guidelines
New strides in managing and diagnosing the serious effects of the rare, but deadly thoracic aortic disease (TAD) have pushed the American College of Cardiology (ACC) and the American Heart Association (AHA) to offer new guidelines for the prevention of TAD, a disease almost 10,000 Americans die from each year.
Aortic dissection and aortic aneurysms are both forms of TAD. In cases of thoracic aortic aneurysm, patients generally do not exhibit symptoms until the aneurysm ruptures. In cases of thoracic aortic dissection, symptoms include intense chest, back, shoulder or abdomen pain, but most of the time patient’s exhibit minute symptoms.
According to ACC/AHA, risk factors for TAD stem from uncontrolled high blood pressure, older age, atherosclerosis and inflammatory disease, damage to blood vessels, male gender and genetic conditions such as Marfan syndrome. Additionally, those who have an aortic valve with a bicuspid valve (two leaflets rather than three) could be at increased risk.
ACC/AHA guidelines recommend that physicians ask patients to explain any family history that contains aneurysm, dissection, rupture or sudden death in hopes to better diagnose or prevent TAD.
Some of the TAD guidelines spearheaded by the ACC/AHA include:
“If thoracic aortic disease can be detected early and managed, it gives us the opportunity to select patients for surgical or endovascular repair when the patient is stable,” said Loren F. Hiratzka, MD, chair of the guideline writing committee and medical director of cardiac surgery for TriHealth in Cincinnati. “The results of treatment for stable disease are far better than for acute—and often catastrophic—aortic rupture or dissection.”
The complete guidelines will appear in the April 6 issue of the Journal of the American College of Cardiology and Circulation: Journal of the American Heart Association.
Collaborating with ACC and AHA were: American Association for Thoracic Surgery; American College of Radiology; American Stroke Association; Society of Cardiovascular Anesthesiologists; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology; Society of Thoracic Surgeons; Society for Vascular Medicine; the American College of Emergency Physicians; and the American College of Physicians.
Aortic dissection and aortic aneurysms are both forms of TAD. In cases of thoracic aortic aneurysm, patients generally do not exhibit symptoms until the aneurysm ruptures. In cases of thoracic aortic dissection, symptoms include intense chest, back, shoulder or abdomen pain, but most of the time patient’s exhibit minute symptoms.
According to ACC/AHA, risk factors for TAD stem from uncontrolled high blood pressure, older age, atherosclerosis and inflammatory disease, damage to blood vessels, male gender and genetic conditions such as Marfan syndrome. Additionally, those who have an aortic valve with a bicuspid valve (two leaflets rather than three) could be at increased risk.
ACC/AHA guidelines recommend that physicians ask patients to explain any family history that contains aneurysm, dissection, rupture or sudden death in hopes to better diagnose or prevent TAD.
Some of the TAD guidelines spearheaded by the ACC/AHA include:
- Use of CT, MRI or echocardiography to image the thoracic aorta is the best way to detect TAD and future risks; chest x-ray is not sufficient;
- Patients with genetic conditions that increase the risk of TAD should undergo baseline aortic imaging to establish the size of the aorta and undergo periodic follow-up imaging;
- Patients with bicuspid aortic valve should be evaluated in order to assess whether the aorta is widening;
- Physicians should keep aortic dissection in mind when talking to patients about medical history, family history and the type and pattern of pain. Early prevention could help to make prompt diagnosis and provide better treatment;
- Aortic dissection that involves the ascending aorta should be treated surgically as it is a life-threatening emergency;
- Aortic dissection that involves the descending thoracic aortic could be best managed with medications that control blood pressure and heart rate. This could include statins to lower blood cholesterol levels;
- Invasive endovascular techniques could be feasible in patients with aneurysm or dissection of the descending thoracic aorta; and
- Immediate relatives of patients with thoracic aortic aneurysm or dissection or bicuspid aortic valve should be evaluated by a cardiovascular physician and undergo aortic imaging to identify asymptomatic disease.
“If thoracic aortic disease can be detected early and managed, it gives us the opportunity to select patients for surgical or endovascular repair when the patient is stable,” said Loren F. Hiratzka, MD, chair of the guideline writing committee and medical director of cardiac surgery for TriHealth in Cincinnati. “The results of treatment for stable disease are far better than for acute—and often catastrophic—aortic rupture or dissection.”
The complete guidelines will appear in the April 6 issue of the Journal of the American College of Cardiology and Circulation: Journal of the American Heart Association.
Collaborating with ACC and AHA were: American Association for Thoracic Surgery; American College of Radiology; American Stroke Association; Society of Cardiovascular Anesthesiologists; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology; Society of Thoracic Surgeons; Society for Vascular Medicine; the American College of Emergency Physicians; and the American College of Physicians.