The initial chest X-ray may be abnormal in 60-90% of cases and is often the essential first step in making the diagnosis (Figure 3.2; Table 3.5). A widened mediastinum occurs in 62.6% of type A dissection and 56% of type B dissection. An abnormal aortic counter occurs in 45-55% of cases (46.6% type A and 53% type B patients. Other abnormalities include abnormal cardiac contour, displacement/calcification of aorta, and pleural effusion.
The ECG examination is normal in less than a third of the patients. Nonspecific ST-segment or T-wave changes occurs in about 42% of patients with type A or type B dissection. Left ventricular hypertrophy occurred in 25% of type A and 32.2% of type B patients. Coronary compromise from an acute ascending dissection may cause ECG features of ischemia.
There is promising news on the development of quick bedside tests that may prove confirmatory in the setting of acute aortic dissection, such as soluble elastin compounds and smooth muscle myosin heavy chain15. The bedside
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