TABLE 22.

Signs and Symptoms of AAS

Clinical Signs and Symptoms	Cause
Asymmetric blood pressure (>20 mm Hg) between limbs	Compromise of branch artery flow
Bowel ischemia or gastrointestinal bleed	Malperfusion of the celiac or superior mesenteric artery
Dysphagia	Compression of the esophagus
Dyspnea	Compression of trachea or bronchus, congestive heart failure from aortic regurgitation, or cardiac tamponade
Hemoptysis	Vascular rupture into lung parenchyma
Hoarseness	Compression recurrent laryngeal nerve
Horner’s syndrome	Compression of sympathetic chain
Myocardial ischemia or myocardial infarction	Coronary artery involvement by dissection or compression by aneurysm
New murmur of aortic regurgitation	Incomplete aortic valve closure secondary to leaflet tethering by the dilated aorta or cusp prolapse because of dissection into the aortic root
Oliguria or hematuria (gross)	Malperfusion of 1 or both renal arteries
Paraplegia	Spinal malperfusion attributable intercostal artery involvement
Lower extremity ischemia	Malperfusion of iliac artery
Shock	Cardiac tamponade, hemothorax, frank aortic rupture, acute severe aortic regurgitation, severe myocardial ischemia
Shortness of breath	Pericardial effusion, congestive heart failure from acute severe aortic regurgitation, or hemothorax
Stroke symptoms	Carotid or vertebral artery involved
Superior vena cava syndrome	Compression of the superior vena cava
Syncope	Carotid artery involvement or cardiac tamponade

AAS indicates acute aortic syndrome.