The aorta is the largest artery in the human body. It rises out of the left ventricle of the heart, supplies blood to the heart itself, to the brain, to the upper limbs, and then takes a downward turn and runs near your spine, supplying blood to your abdominal organs before branching into the arteries that supply your legs. It is a big artery. So, when a patient suffers an aortic dissection, misdiagnosis of the condition may lead to death.
For many of us, ‘dissection’ sends us back to memories of 7th grade and a frog or a worm at our lab tables. Medically speaking, though, “dissection” is the separation of layers of a vein. You see, veins are made of multiple layers of muscle. Sometimes, due to a number of factors, an inner flap of muscle tissue will separate. And bad things can happen. For example, blood will often then pool in this new obstruction, and, given enough time, will clot; if the clot then migrates down stream, it may slow or stop the flow of blood to parts of vital organs. Alternatively, blood may force its way into the tear, continually expanding the separation and creating, ultimately, a hemorrhage. This is what happens in an aortic dissection.
Symptoms of aortic dissection typically include pain, with abrupt onset, commonly described as severe, in the chest or back region. Some describe the pain as a “tearing” sensation. Hypertension is found in ¾ of aortic dissection patients. The thing is, many patients present with AD have no significant medical history, so many clinicians reach other diagnoses. One paper following emergency room patients found that 16% of patients with the condition were initially misdiagnosed. The paper considered the diversity of symptoms and variability of the severity of AD symptoms significant enough for emergency room physicians to keep it on their differential diagnosis until they can affirmatively rule it out.
So, if the symptoms are varied and often present in patients with insignificant medical histories, how might there be a malpractice claim? Emergency room doctors have a multitude of useful imaging modalities that, if interpreted properly, will reveal the presence of a dissection. And, of course, timely intervention is necessary to reduce the patient’s blood pressure or surgically address certain acute aortic dissections.
