Failure to Diagnose Aortic Dissection
I’ve written before about a specific form of doctor negligence: medical malpractice from misdiagnosis. One of the most basic 
rules of emergency department medicine is for doctors and other healthcare providers to consider all possible causes of a patient’s complaints and rule out the most dangerous conditions first. This is called a differential diagnosis. Until a dangerous condition is ruled out by the available evidence, a doctor must assume that the most dangerous and urgent condition may be causing the patient’s problems.
Some of the most dangerous conditions that can arise in an emergency room are serious heart conditions. Medical malpractice claims can arise as a result of these, such as when doctors and nurses have a failure to diagnose aortic dissection. When doctors misdiagnose aortic dissection and believe that the patient has a much less serious or different condition, the consequences are likely disastrous.
What is aortic dissection?
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The aorta is the large blood vessel that leads blood away from the heart. The aorta has walls or layers surrounding it, and the inner most layer, called the intima, is the layer of lining that surrounds the blood in the vessel. Some individuals may develop a tear in the intima, also known as an aneurysm, which allows blood to pass beyond the tear in the first layer. [i] If left untreated, blood pressure may cause the outer walls of the aorta to rupture. This is called an aortic dissection, and it can lead to the patient’s death.
There are two different types of aortic dissection, known as Type A and Type B. Knowing some basic anatomy is necessary to understand these types. To explain, the aorta first goes upward when it leaves the heart, in what is called the ascending aorta.[ii] Then, the aorta heads downward in the descending aorta into the abdomen. An aorta dissection can occur either in the ascending or descending portion of the aorta.
A Type A aortic dissection occurs in the ascending portion of the aorta. Type A aortic dissection is both more common and much more dangerous than Type B aortic dissection. It is typically the case that medical malpractice occurs with a misdiagnosis of a Type A aortic dissection. This prevents the patient from receiving adequate medical care for this emergency condition.
Symptoms of Aortic Dissection
The symptoms of aortic dissection often mimic those of other heart conditions. The telltale signs of an aortic dissection, however, are chest pain and pain in the back, combined with a feeling like something is tearing in the patient’s chest.[iii] Other symptoms include shortness of breath, fainting or loss of consciousness, a weak pulse in one arm compared to the other, confusion, sweating, sudden difficulty speaking, loss of vision, and weakness or paralysis on one side of the body similar to a stroke.
Risks of Aortic Dissection
One of the main causes and risk factors of aortic dissection is uncontrolled high blood pressure, also called hypertension. If left uncontrolled over time, high blood pressure can tear the aorta wall, leading to aortic dissection.[iv] Other causes of aortic dissection include atherosclerosis, which is hardening of the arteries.[v]
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Aortic dissection can also be caused by genetic conditions. This can include a bicuspid aortic valve, an aortic coarctation (narrowing of the aorta at birth), or a pre-existing aortic aneurysm.[vi] Other conditions may include Marfan Syndrome, Turner’s Syndrome, connective tissue disorders like Ehlers-Danlos syndrome and Loeys-Dietz syndrome.[vii]
It is possible that trauma, such as motor vehicle accidents, can cause aortic dissection.[viii] Men are twice as likely as women to develop an aortic dissection.
How Medical Malpractice Occurs with Aortic Dissection
The main medical malpractice concern with aortic dissection is that doctors will not correctly diagnose the condition. An aortic dissection is not a common condition, and it may have varying symptoms. To properly diagnose aortic dissection, a competent physician should look for the telltale signs, such as the patient’s complaints of a tearing or ripping sensation with chest or back pain; a widening of the aorta on a chest x-ray; and a difference in blood pressure in the patient’s arms.
But that is not enough. A doctor following the standard of care will not just rely on a patient’s complaints and should use available imaging procedures to correctly diagnose the condition, such as:
- Electrocardiogram (EKG). An EKG test examines the electric activity of your heart to determine if the heart is beating correctly.
- Echocardiogram (EEG). An EEG test will produce an image of the heart and aorta by using high-pitch sound waves.
- Computerized tomography (CT) scan. A CT scan produces cross-sectional images of the body and can diagnose an aortic dissection.
- Magnetic resonance angiogram (MRA). An MRI takes pictures of the body, and an MRA takes pictures of blood vessels.
In addition to these steps, it is important that doctors, nurses, and healthcare providers act quickly to make their diagnosis. Once doctors have correctly diagnosed that a patient is suffering from an aortic dissection, timely surgical intervention can save the patient in a large number of cases.
Contact a Virginia Medical Malpractice Attorney
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If your family member or loved one experienced a case involving an undiagnosed or misdiagnosed aortic dissection, you should have the case evaluated by an experienced Virginia medical malpractice attorney. Robert E. Byrne, Jr. serves clients throughout Virginia from his Charlottesville office with MartinWren, P.C., and he would be happy to give you a free consultation to see if you have a medical malpractice case. To reach Bob, please call him at (434) 817-3100, or feel free to contact him by email at [email protected].
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