Printed on: September 17th, 2026
Acute aortic syndrome (aortic dissection)
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Statistics |
Acute aortic syndrome (AAS) is an umbrella term for a number of conditions affecting the aorta. It encompasses:
- Acute aortic dissection (accounts for around three-quarters of AAS (BMJ 2024;386:e080870)).
- Intra-mural haematoma.
- Penetrating aortic ulcer.
This article focuses on the emergency presentation of acute aortic syndrome from a primary care perspective, drawing on a Lancet review and a BMJ Easily Missed article (Lancet 2023;401:773, BMJ 2024;386:e080870).
This article was updated in January 2025.
When to suspect acute aortic syndrome
Think of acute aortic syndrome in patients with:
- Chest, back or abdominal pain.
- Syncope.
- Features of malperfusion, e.g. limb, mesenteric or renal ischaemia.
It is more likely in:
- Males >50y (but can occur in younger patients).
- Those with high-risk features (see below).
Around one-third of patients with AAS will initially be misdiagnosed, which is associated with a doubling of mortality (BMJ 2024;386:e080870).
High-risk presenting features
The aortic dissection detection risk score provides a structured algorithm for assessing AAS risk, and may be used in secondary care as part of the assessment of patients with possible aortic dissection symptoms (BMJ 2024;386:e080870).
Those without any of the high-risk features below have a low risk of acute aortic syndrome. However, if we suspect acute aortic syndrome in primary care (even without high-risk features), we should arrange urgent transfer to secondary care (999).
| Aortic dissection detection risk score (ADD-RS) | |
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High-risk conditions |
Score 1 point for EACH. |
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High-risk pain features Chest, back or abdominal pain that is described as: |
Score a total of 1 point if ANY are present. |
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High-risk examination findings |
Score a total of 1 point if ANY are present. |
| Scores ≥2 indicate higher risk. A score of 0 is low risk and may not need further imaging. For those with a score of 1, the score may be combined with D-dimer testing to increase specificity. | |
The Lancet review highlights some additional factors not considered in the ADD-RS (Lancet 2023;401:773):
- Medications: quinolones, glucocorticoids, immunosuppressants, cytotoxic medication.
- Some vascular subtypes of Ehlers-Danlos syndrome.
- Obstructive sleep apnoea.
- Certain hereditary cardiovascular malformations such as coarctation and Turner’s syndrome.
- Acute limb, renal or mesenteric ischaemia.
Management
- Arrange urgent hospital transfer via 999 ambulance.
- Oxygen and advanced life support (if equipped/skilled to provide this) while waiting.
- Complications can include: aortic rupture/death; pericardial effusion/cardiac tamponade; aortic regurgitation; renal, mesenteric or limb ischaemia.
Secondary care treatment
- Type A aortic dissection (ascending aorta or arch): always needs urgent surgical repair.
- Type B aortic dissection (descending aorta): if stable, medical management to reduce BP and/or heart rate. Surgery may be considered if the patient is unstable/experiencing pain or ischaemia.
Long-term management
- Surveillance imaging at 1, 3, 6 and 12m, then annually.
- Control other cardiovascular risk factors with tight blood pressure control (systolic <120mmHg).
- Screen relatives if appropriate (secondary care will decide this).
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Acute aortic syndrome |
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