AORTIC DISSECTION IN THE THROMBOLYTIC ERA - EARLY RECOGNITION AND OPTIMAL MANAGEMENT IS A PREREQUISITE FOR INCREASED SURVIVAL

Based on two case reports, problems of diagnosis and treatment of aort ic dissection are discussed. Thrombolytic treatment given to patients with aortic dissection presenting symptoms mimicking acute MI seems to have a fatal outcome. Indications, as well as contra-indications, for thrombolytic therapy are therefore of great importance, when this tre atment is given to patients suspected of having acute myocardial infar ction, especially where diagnosis is uncertain or as prehospital treat ment. In patients with chest pain symptoms without typical history and electrocardiographic changes the diagnosis should be reconsidered wit hin a few hours and, if possible, together with echocardiographic find ings. In doing so patients with coronary heart disease will get all th e benefits of thrombolytic treatment. Furthermore the importance of qu ick accurate diagnosis, especially in type A aortic dissection is poin ted out, as emergency surgical intervention can be lifesaving. A more aggressive medical and surgical approach has contributed to the improv ed survival among patients with aortic dissections.