Clinical, Electrocardiographic and Imaging Features of Acute Aortic Syndromes: A Retrospective Study

Introduction: Acute aortic syndromes (AAS) relate to a range of different entities, including aortic dissection (AD), intramural haematoma (IMH), penetrating atherosclerotic ulcers (PAU) and traumatic or iatrogenic aortic dissection. They require rapid diagnosis and a high level of clinical suspicion to identify thier symptoms.

The aim of this study was to define the range of clinical presentations, electrocardiographic and imaging findings, in patients presenting with AAS.

Materials and Methods: This study was a retrospective study of the clinical, electrocardiographic and imaging data in patients hospitalized for acute aortic syndromes from December 2021 to December 2024. Patients with traumatic or iatrogenic aortic dissection were excluded.

Results: A total of 10 patients were included, with a mean age of 45 years, and 70% of patients were male.

The most frequent symptoms were chest pain alone (50%) or chest pain associated with back pain (40%). Classical “tearing” pain, often associated with aortic dissection, was less frequently reported. Differential blood pressure was observed in 30% of cases.

The electrocardiogram showed ST-segment depression in the apical, lateral and inferior leads, as well as ST-segment elevation in the AVR lead and T-wave changes, which were the most frequently observed abnormalities.

The most frequent diagnosis was type A aortic dissection (TAAD) (70%), followed by type B aortic dissection (TBAD) (20%) and intramural hematoma (IMH) (10%).

The initial diagnosis was made primarily by computed tomography angiography (CTA) in 70% of cases, and by transthoracic echocardiography (TTE) in 30%. Magnetic Resonance Imaging (MRI) was not performed in any of these patients.

A diagnostic discordance was found between CTA and TTE in two patients, particularly in one patient with IMH and aortitis. In addition to one case of false-positive TAAD.

Conclusions: In conclusion, this study is a reminder that patients with acute aortic syndromes have diverse clinical presentations and may not present with the symptoms typically reported. Relying on classical signs can lead to misdiagnosis. A well-structured approach combining imaging techniques improves diagnostic accuracy, reduces errors and improves patient outcomes.