Numerous deaths because illness is recognized too late or treated incorrectly
According to health experts, hundreds of people die each year in Germany because they realize too late that they are suffering from an aortic dissection or because the malicious illness is treated wrongly.
Twice as many aortic dissection sufferers
Physicians have recently highlighted the importance of taking sudden onset chest pain seriously. Because these can be a first indication of severe heart disease such as an acute myocardial infarction or tears in the main artery (aortic dissection). Because the symptoms of these diseases are similar, a reliable diagnosis is often not easy. A new study by the German Heart Center Berlin (DHZB) concludes that probably twice as many people as previously thought contract a life-threatening aortic dissection.
Inner wall layer of the main artery rips
Behind the complicated term "acute type A aortic dissection" is an equally life-threatening as treacherous disease: The inner wall layer of the main artery (aorta) tears directly at the heart and dissolves.
Blood flows into the interstice and continues to enlarge it along the aorta. This way, branches - for example to the brain - can be closed. The biggest danger of aortic dissection, however, is the hemorrhage into the pericardium, which can quickly lead to cardiac arrest.
An aortic dissection must therefore be operated as soon as possible in a specialized heart center, writes the DHZB in a statement. Left untreated, in most cases it is fatal within 48 hours.
Fast and reliable diagnosis is not easy
However, a quick and safe diagnosis of acute aortic dissection is not easy. The symptoms - especially the severe chest pain - can also be misinterpreted by experienced emergency physicians as a sign of the much more common heart attack.
Often, a scan with the computed tomography (CT) provides clarity, but not everywhere and quickly enough available.
Even worse: treating the aortic dissection like a heart attack can have dire consequences, according to Stephan Kurz, cardio-anesthesiologist and emergency physician at the DHZB:
"Simply put, a heart attack is the result of a blood clot and is therefore treated with drugs that dilute the blood. In aortic dissection, the bleeding is thereby accelerated and the further supply considerably more difficult ".
Eight hours from the first symptoms to the operation
A team from the Department of Cardiothoracic and Vascular Surgery at the DHZB (Director: Prof. Dr. Volkmar Falk) under the direction of Stephan Kurz has analyzed the patient records and emergency medical records of more than 1,600 patients due to an acute type A dissection on the DHZB were treated.
In addition, more than 14,000 autopsy reports from the Institute of Legal Medicine of the Charité and the Department of Pathology of the Vivantes Network were evaluated in order to record how many patients in Berlin and Brandenburg had died of an aortic dissection.
The results have now been published in the journal "International Journal of Cardiology" and show an urgent need for action.
It was found that the median time from the onset of the first symptoms to the beginning of surgery is more than eight hours.
Furthermore, it was found that the aortic dissection is likely to occur much more frequently than previously assumed: The Federal Statistical Office assumes 4.6 cases a year for every 100,000 inhabitants, and the extrapolation of the data collected in the study is more than twice as high ( 11.9 cases).
"Based on our data, we have to assume that there are more than 200 people who died in Berlin and Brandenburg every year because an acute aortic dissection was detected too late or treated incorrectly," says Kurz.
Sensitize medical professionals
For this reason, the DHZB worked out the concept of an "aortic telephone" years ago: a medical hotline that coordinates and advises all Berlin and Brandenburg doctors around the clock. The time from the event to the surgery is so significantly shortened.
A specialist in anesthesia or cardiac surgery is available round the clock as a point of contact for the personnel of the regional emergency services. He provides medical as well as organizational support for the colleagues on site, but also coordinates the preparation of the intervention at the DHZB itself.
For this purpose, standard procedures for diagnostic imaging and medication were developed and coordinated with rescue services, emergency medical officers and the rescue centers of the clinics in Berlin and Brandenburg.
"We also wanted to further sensitize our colleagues to a disease that is far less common, but no less serious than a heart attack."
Processes have been improved
The processes of admission, anesthesia, operative care and further treatment in the intensive care unit at the DHZB itself were further improved and standardized.
The concept has already led to a significant improvement in diagnostics and primary care: The number of patients operated on at the DHZB for acute type A dissection increased from an average of 80 in previous years to 138 in 2016, ie by more than 70 percent.
The period from the onset of the first symptoms to the start of surgery has also been reduced by an average of 20 percent.
"Many of these patients would not have survived without the speedy and efficient transfer to the DHZB," explained clinic director Prof. Dr. med. Volkmar Falk: "The best incentive for us to expand the project and push ahead". (Ad)