Guidelines aim to prevent unnecessary death from thoracic aortic disease

Clinical guidelines offer new recommendations to diagnose and manage thoracic aortic disease (TAD), based on earlier detection and treatment, consideration of varied presentation of the condition, and a new understanding of risk factors such as family history.

Recent scientific and clinical advances drove the development of guidelines to help physicians diagnose and manage forms of TAD. Also, noninvasive imaging and medical therapy have improved, as has the understanding of genetics and family history.

Guidelines developed by a multidisciplinary group that included ACP appear in the April 6 Journal of American College of Cardiology.

Physicians should ask patients not only about close relatives with aortic aneurysm, dissection or rupture, but also about any family history of unexplained sudden death. Risk factors for TAD include poorly controlled high blood pressure, advancing age, male gender, atherosclerosis, inflammatory diseases that damage the blood vessels, and genetic conditions that weaken connective tissue, such as Marfan syndrome. Pregnancy, intense weight lifting and cocaine use increase the risk of aortic dissection.

Additional guidelines include:Imaging of the thoracic aorta by computed tomography, magnetic resonance imaging or echocardiography is the best way to detect TAD and determine future risk. A chest X-ray alone is not sufficient.Patients with genetic conditions that increase the risk of TAD should have aortic imaging at the time of diagnosis to establish the size of the aorta, with periodic follow-up imaging thereafter.All patients with a bicuspid aortic valve should be evaluated to determine whether the aorta is dilating.Symptoms of acute aortic dissection can mimic those of a heart attack. Physicians should keep aortic dissection in mind when asking questions about medical history, family history and the type and pattern of pain when examining the patient.All immediate relatives of a patient with thoracic aortic aneurysm or dissection, or a bicuspid aortic valve, should be evaluated by a cardiovascular physician and undergo aortic imaging to measure the size of the aorta and identify asymptomatic disease.