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Numerous deaths because illness is recognized too late or wrongly treated


Wicked illness: Hundreds of deaths due to incorrect treatment of aortic dissection
According to health experts, hundreds of people die in Germany every year because it is recognized too late that they have aortic dissection or because the insidious disease is treated incorrectly.

Twice as many aortic dissection sufferers
Medical professionals have recently highlighted the importance of taking sudden chest pain seriously. Because these can be a first indication of serious heart diseases such as an acute heart attack 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) has now come to the conclusion that twice as many people as previously assume ill life-threatening aortic dissection.

The inner wall layer of the main artery tears
Behind the complicated technical term "acute type A aortic dissection" is a life-threatening as well as insidious disease: The inner wall layer of the main artery (aorta) tears at the heart and detaches.

Blood flows into the space and enlarges it along the aorta. In this way branches - for example to the brain - can be closed. The greatest risk of aortic dissection, however, is bleeding into the pericardium, which can quickly lead to cardiac arrest.

Aortic dissection must therefore be operated on as soon as possible in a specialized heart center, the DHZB wrote in a message. In most cases, if left untreated, it is fatal within 48 hours.

Fast and reliable diagnosis is not easy
However, a quick and reliable diagnosis of acute aortic dissection is not easy. The symptoms - especially the severe chest pain - can also be misinterpreted by experienced emergency doctors as a sign of the much more common heart attack.

An examination with a computer tomograph (CT) often provides clarity, but it is not available everywhere and quickly enough.

Even worse: treating aortic dissection like a heart attack can have fatal consequences, says Stephan Kurz, cardio anesthesiologist and emergency doctor at the DHZB:

“Put simply, a heart attack is the result of a blood clot and is therefore treated with medicines that thin the blood. In aortic dissection, the bleeding is accelerated and further care is made considerably more difficult. ”

Eight hours from the first symptoms to surgery
A team from the Clinic for Cardiac, Thoracic and Vascular Surgery at the DHZB (Director: Prof. Dr. Volkmar Falk), headed by Stephan Kurz, analyzed the patient files and emergency doctor protocols of over 1,600 patients who had an acute type A dissection on DHZB were treated.

In addition, over 14,000 autopsy reports from the Charité Institute of Forensic Medicine and the Pathology department of the Vivantes network were evaluated to determine how many patients in Berlin and Brandenburg died of aortic dissection.

The results have now been published in the specialist journal "International Journal of Cardiology" and show an urgent need for action.

It was found that the mean time from the appearance of the first symptoms to the start of the operation was over eight hours.

In addition, it was found that aortic dissection is more likely to occur much more frequently than previously assumed: the Federal Statistical Office assumes 4.6 cases per 100,000 inhabitants per year; the extrapolation of the data collected in the study results in more than twice the value ( 11.9 cases).

"Based on our data, we have to assume that there are over 200 people who died each year in Berlin and Brandenburg because acute aortic dissection was detected too late or treated incorrectly," said Kurz.

Sensitize medical professionals to disease
That is why the DHZB developed the concept of an "aortic telephone" years ago: a medical hotline that is available to all Berlin and Brandenburg doctors around the clock in a coordinating and advisory capacity. The time from the event to the operation will be shortened significantly.

Under a uniform number, a specialist in anesthesia or cardiac surgery is available around the clock as a contact for the staff of the regional emergency services. He provides medical and 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 imaging diagnostics and medication were developed and coordinated with emergency services, senior emergency physicians and the emergency services of the clinics in Berlin and Brandenburg.

"It was also important for us to further sensitize our colleagues to a disease that is far less common, but therefore 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 due to an acute type A dissection increased from an average of 80 in previous years to 138 in 2016, i.e. by more than 70 percent.

The time 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 swift and efficient transfer to the DHZB," said clinical director Prof. Volkmar Falk: "The best incentive for us to expand the project and continue to push it forward". (ad)

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