Une femme en bonne santé, âgée d’une cinquantaine d’années, hypertendue chronique et traitée, ressent une douleur brutale et déchirante, décrite comme un éclair partant du cou vers la poitrine et irradiant dans le dos.
Cette douleur survient par vagues, avec des fluctuations d’intensité au fil des heures.
Par moments, elle peut parler et marcher, mais elle se sent principalement confuse, avec une diminution de son niveau de conscience et des difficultés respiratoires.
Elle se sent étourdie et nauséeuse.
Une ambulance est appelée et arrive 90 minutes plus tard.
La PA? est de 170/110 mmHg, la FC 100 bpm.
Un ambulancier pose un diagnostic présomptif d’infarctus du myocarde sur la base des signes cliniques.
La patiente reçoit de la morphine par voie orale et est transportée à l’hôpital, où elle arrive 45 minutes plus tard.
Aux urgences, un premier diagnostic de crise de panique est posé et une prise en charge conservatrice est initiée.
Une réévaluation quelques heures plus tard conduit à la réalisation d’une angio-TDM, révélant une dissection aortique.
Vignaraja V, Thapar A, Dindyal S. Acute aortic syndrome. In : StatPearls.StatPearls Publishing, 2024, https://www-ncbi-nlm-nih-gov/books/NBK576402/
Gouveia E Melo R, Mourão M, Caldeira D, et al. A systematic review and meta-analysis of the incidence? of acute aortic dissections in population-based studies. J Vasc Surg2022 ;75:709-20. doi:10.1016/j.jvs.2021.08.080IF : 3.9 Q1 pmid:34560218
NHS Digital. Hospital episodes statistics 2022-23. https://digital.nhs.uk/data-and-information/publications/statistical/hospital-admitted-patient-care-activity/2022-23
Nazerian P, Mueller C, Soeiro AM, et al., ADvISED Investigators. Diagnostic accuracy of the aortic dissection detection risk score plus D-dimer for acute aortic syndromes : the ADvISED prospective multicenter study. Circulation2018 ;137:250-8. doi:10.1161/CIRCULATIONAHA.117.029457IF : 35.5 Q1 pmid:29030346
Erbel R, Aboyans V, Boileau C, et al., ESC? Committee for Practice Guidelines, The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases : document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. Eur Heart J2014 ;35:2873-926. doi:10.1093/eurheartj/ehu281IF : 37.6 Q1 pmid:25173340
NHS Digital. Hospital accident and emergency activity 2022-23. https://digital.nhs.uk/data-and-information/publications/statistical/hospital-accident--emergency-activity/2022-23
Alter SM, Eskin B, Allegra JR. Diagnosis of aortic dissection in emergency department patients is rare. West J Emerg Med2015 ;16:629-31. doi:10.5811/westjem.2015.6.25752IF : 1.8 Q2 pmid:26587083
Lovatt S, Wong CW, Schwarz K, et al. Misdiagnosis of aortic dissection : a systematic review of the literature. Am J Emerg Med2022 ;53:16-22. doi:10.1016/j.ajem.2021.11.047IF : 2.7 Q1 pmid:34968970
Ohle R, Savage DW, McIsaac S, Yadav K, Caswell J, Conlon M. Epidemiology, mortality and miss rate of acute aortic syndrome in Ontario, Canada : a population-based study. CJEM2023 ;25:57-64. doi:10.1007/s43678-022-00413-xIF : 2.0 Q2 pmid:36627470
Pourafkari L, Tajlil A, Ghaffari S, et al. The frequency of initial misdiagnosis of acute aortic dissection in the emergency department and its impact on outcome. Intern Emerg Med2017 ;12:1185-95. doi:10.1007/s11739-016-1530-7IF : 3.2 Q1 pmid:27592236
Matthews CR, Madison M, Timsina LR, Namburi N, Faiza Z, Lee LS. Impact of time between diagnosis to treatment in Acute Type A Aortic Dissection. Sci Rep2021 ;11:3519. doi:10.1038/s41598-021-83180-6IF : 3.8 Q1 pmid:33568755
Nejim B, Mathlouthi A, Naazie I, Malas MB. The effect of intravenous and oral beta-blocker use in patients with type B thoracic aortic dissection. Ann Vasc Surg2022 ;80:170-9. doi:10.1016/j.avsg.2021.07.056IF : 1.4 Q3 pmid:34656722
Resolution NHS. Clinical negligence claims in emergency departments in England : High value and fatality-related claims.NHS Resolution, 2022.Google Scholar
Palaniappan A, Sellke F. Medical malpractice litigations involving aortic dissection. J Thorac Cardiovasc Surg2022 ;164:600-8. doi:10.1016/j.jtcvs.2020.10.064IF : 4.9 Q1 pmid:33229180
Mahase E. Half of patients with acute aortic dissection in England die before reaching a specialist centre. BMJ2020 ;368:m304. doi:10.1136/bmj.m304IF : 93.6 Q1 pmid:31974270l
Gouveia E Melo R, Machado C, Caldeira D, et al. Incidence of acute aortic dissections in patients with out of hospital cardiac arrest : a systematic review and meta-analysis of observational studies. Int J Cardiol Heart Vasc2021 ;38:100934. doi:10.1016/j.ijcha.2021.100934IF : 2.5 Q2 pmid:35005212
Ranasinghe AM, Strong D, Boland B, Bonser RS. Acute aortic dissection. BMJ2011 ;343:d4487. doi:10.1136/bmj.d4487IF : 93.6 Q1 pmid:21803810
Ren S, Essat M, Pandor A, et al. Diagnostic accuracy of the aortic dissection detection risk score alone or with D-dimer for acute aortic syndromes : systematic review and meta-analysis. PLoS One2024 ;19:e0304401. doi:10.1371/journal.pone.0304401IF : 2.9 Q1 pmid:38905181
Wren J, Goodacre S, Pandor A, et al. Diagnostic accuracy of alternative biomarkers for acute aortic syndrome : a systematic review. Emerg Med J2024 ;emermed-2023-213772. doi:10.1136/emermed-2023-213772IF : 2.7 Q1 . pmid:39107052
Essat M, Pandor A, Ren S, Ren K, Goodacre S, Clowes M. Systematic review and meta-analysis of D-dimer for acute aortic syndrome. Ann Emerg Med2024. doi:10.1016/j.annemergmed.2024.05.001IF : 5.0 Q1 . pmid:38888529
Stein PD, Hull RD, Patel KC, et al. D-dimer for the exclusion of acute venous thrombosis and pulmonary embolism : a systematic review. Ann Intern Med2004 ;140:589-602. doi:10.7326/0003-4819-140-8-200404200-00005IF : 19.6 Q1 pmid:15096330
Otani T, Abe T, Ichiba T, Kashiwa K, Naito H. D-dimer measurement is useful irrespective of time from the onset of acute aortic syndrome symptoms. Am J Emerg Med2023 ;71:7-13. doi:10.1016/j.ajem.2023.05.044IF : 2.7 Q1 pmid:37315439
Thomas W, Henry J, Chew JE, Premaratne M, Blecher G, Haji DL. Review article : accuracy of emergency physician performed point-of-care ultrasound of the thoracic aorta : a systematic review and narrative synthesis of the literature. Emerg Med Australas2023 ;35:720-30. doi:10.1111/1742-6723.14262IF : 1.7 Q2 pmid:37364927
Gibbons RC, Smith D, Feig R, Mulflur M, Costantino TG. The sonographic protocol for the emergent evaluation of aortic dissections (SPEED protocol) : a multicenter, prospective, observational study. Acad Emerg Med2024 ;31:112-8. doi:10.1111/acem.14839IF : 3.4 Q1 pmid:38010071
McLatchie R, Reed MJ, Freeman N, et al., DAShED investigators. Diagnosis of Acute Aortic Syndrome in the Emergency Department (DAShED) study : an observational cohort study of people attending the emergency department with symptoms consistent with acute aortic syndrome. Emerg Med J2024 ;41:136-44. doi:10.1136/emermed-2023-213266IF : 2.7 Q1 pmid:37945311
Acute Aortic Dissection Pathway Toolkit NHS. 2022. https://www.vascularsociety.org.uk/professionals/news/191/the_acute_aortic_dissection_toolkitGoogle Scholar
Isselbacher EM, Preventza O, Hamilton Black J 3rd., et al., Peer Review Committee Members. 2022 ACC?/AHA? Guideline for the Diagnosis and Management of Aortic Disease : a Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation2022 ;146:e334-482. doi:10.1161/CIR.0000000000001106IF : 35.5 Q1 pmid:36322642
Czerny M, Grabenwöger M, Berger T, et al., EACTS/STS Scientific Document Group. EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ. Eur J Cardiothorac Surg2024 ;65:ezad426. doi:10.1093/ejcts/ezad426IF : 3.1 Q1 pmid:38408364
Evangelista A, Isselbacher EM, Bossone E, et al., IRAD Investigators. Insights from the International Registry of Acute Aortic Dissection : a 20-year experience of collaborative clinical research. Circulation2018 ;137:1846-60. doi:10.1161/CIRCULATIONAHA.117.031264IF : 35.5 Q1 pmid:29685932
Royal College of Emergency Medicine and Royal College of Radiologists. Diagnosis of Thoracic Aortic Dissection in the Emergency Department. November 2021. https://rcem.ac.uk/wp-content/uploads/2021/12/Diagnosis_of_Thoracic_Aortic_dissection.pdf
Ohle R, Yan JW, Yadav K, et al. Diagnosing acute aortic syndrome : a Canadian clinical practice guideline. CMAJ2020 ;192:E832-43. doi:10.1503/cmaj.200021IF : 9.4 Q1 pmid:32690558