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