Physical Examination
The physical examination of these patients needs to be thorough but must also be done quickly.
What signs should be sought specifically in a patient whom you suspect has AAD?
You should look for the following signs:
1. Signs of haemopericardium
- Faint or absent heart sounds
- Pulsus paradoxus
- Distended neck veins
- Presence of shock
2. Signs of branch vessel occlusion
- A difference of >20 mmHg in the blood pressure of each arm
- A weaker central or peripheral pulse compared to the contralateral side
- A palpable thrill or audible bruit over any of the pulses or the abdominal aorta
- Any neurological deficit or clinical features of stroke
3. Signs of aortic root dilatation
- A wide pulse pressure
- A diastolic murmur over the aortic valve area