We are currently working on claims for failures in the treatment of aortic dissection and here we discuss what the condition involves and why legal cases for medical negligence arise.

What is an aortic dissection?

The aorta is the main artery which carries oxygenated blood away from the heart to the rest of the body. It is a muscular tube that has three layers of tissue. An aortic dissection occurs when the inner layer of this artery tears, causing blood to leak, leading to the inner and middle layers separating. If the outer wall is ruptured then the condition is often fatal.

What are the symptoms?

Symptoms of aortic dissection include a sudden and severe pain across the chest, which can also radiate to the back, shortness of breath and feeling faint, along with pain in the jaw, face or abdomen. The pain can disappear and then recur. Blood tests can be normal as can an electrocardiogram (ECG). A definitive diagnosis requires specific imaging techniques, usually a CT aortogram (CTA).

What causes it?

High blood pressure can weaken the wall of the aorta over time so that it is more susceptible to tearing. If a person suffers an aortic aneurysm (a swelling or bulging in the aorta), this can make dissection more likely. There are other conditions which cause the aorta wall to weaken, including Turner syndrome, Ehlers-Danlos syndrome and Marfan Syndrome.

What are the different types of aortic dissection?

There are two types of aortic dissection, Type A and Type B. Type A is a tear in the upper aorta (known as the ascending aorta) and usually requires surgery. Type B is a tear in the lower aorta. Type B tears can carry lower risks and may not require surgery.

Immediate measures to control blood pressure and heart rate in patients diagnosed with an aortic dissection are recommended.

Is there a legal claim?

Unfortunately, aortic dissection is a condition which, if misdiagnosed, can have devastating consequences.

The Healthcare Safety Investigation Branch (HSIB), an organisation dedicated to improving patient safety in the NHS, published a report in 2020 called ‘Delayed Recognition of Acute Aortic Dissection’. This highlighted that staff in non-specialist hospitals may be unfamiliar with the condition and its presentation since acute aortic dissection is a rare cause of chest pain, particularly when compared to a heart attack (acute myocardial infarction), and symptoms can vary or be confusing.

The HSIB found that a delay in diagnosis occurs in around 16 to 40 percent of cases and is more likely if the patient walks into the hospital or where a cardiac cause for the chest pain (such as a heart attack) is initially suspected.

If there has been a misdiagnosis of an aortic dissection, or other delay in treatment, then there may be a claim for medical negligence. Many claims are against Accident and Emergency Departments which fail to correctly diagnose the symptoms of aortic dissection.

Raising awareness

In November 2021 the Royal College of Emergency Medicine and The Royal College of Radiologists published best practice guidelines – ‘Diagnosis of Thoracic Aortic Dissection in the Emergency Department’. These include a recommendation that all clinicians working in emergency departments should be made aware of the difficulties surrounding the diagnosis. The guidelines also make clear that it is the role of the emergency department to request a scan and act on the result. This responsibility should not be passed onto another clinical team. We hope that awareness of this rare but critical condition continues to be raised.