How early diagnosis saves lives: case study on aortic dissection

Summary

In this blog, The Aortic Dissection Charitable Trust explains why timely and accurate diagnosis of aortic dissection is critical for saving lives. By sharing Martin’s recovery story, they illustrate the positive impact of prompt testing and treatment.

The blog highlights the need to improve patient safety relating to aortic dissection, calling for:

• increased education and awareness among healthcare professionals
• improved clinical guidelines and protocols
• heightened vigilance in recognising and responding to the symptoms of aortic dissection. 

This blog has been published as part of a series for World Patient Safety Day 2024 and the theme of Improving diagnosis for patient safety. #WPSD24, World Patient Safety Day 2024, WPSD 2024.

Content

At the Aortic Dissection Charitable Trust, our mission is to save lives through increased awareness, education and support for those affected by aortic dissection. This case study highlights a real-life instance where early diagnosis of aortic dissection led to positive outcomes, offering valuable insights for clinicians, patient safety managers and NHS leaders.

What is aortic dissection?

Aortic dissection is a serious condition where the inner layer of the aorta tears, causing blood to flow between the layers of the wall of the aorta and forcing the layers apart. This can lead to aortic rupture or decreased blood flow to vital organs, and if not diagnosed and treated promptly, it can be fatal. The importance of early and accurate diagnosis cannot be overstated; statistics indicate that the mortality rate increases by 1-2% per hour after the onset of symptoms if untreated.

Importance of timely and accurate diagnosis

Timely and accurate diagnosis of aortic dissection is crucial due to the condition's high mortality rate and the potential for catastrophic outcomes if left undiagnosed. Research shows that up to 40% of patients with aortic dissection die instantly, and for those who reach the hospital, the mortality rate remains high without swift intervention. Prompt diagnosis and treatment significantly improve survival rates, making it essential for healthcare professionals to recognise and respond to symptoms promptly.

Martin’s Story

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Photo shows Martin with his wife Fiona Martin and Fiona plan to walk the 630 miles South West Coast Path over 47 consecutive days for aortic dissection in 2024.

Martin, a 52-year-old avid athlete, experienced an aortic dissection during a morning run. Despite his peak physical condition, he suddenly felt an unusual sensation in his chest and throat. Initially dismissing it as indigestion, he completed the run with his wife. Once home, Martin's condition deteriorated, prompting his wife to call an ambulance. The first responder's initial blood pressure readings were alarmingly low, indicating a serious issue. Emergency responders quickly took Martin to the hospital.

Outcome

Upon arriving at Chester hospital, Martin underwent a series of ultrasound scans by a cardiologist who quickly identified the aortic dissection. Given the severity, the medical team transferred Martin to Wythenshawe Hospital for emergency surgery. He was operated on by a skilled surgeon, and after a gruelling fourteen-hour operation, Martin's life was saved. Post-surgery, he spent several days in intensive care and later the regular ward, focusing on recovery and gradually regaining his strength.

Lessons Learned

Martin's case highlights the importance of quick decision-making and thorough medical assessment. His initial symptoms were not typical, and the rapid response of both emergency services and hospital staff was crucial. The experience also stresses the significance of considering aortic dissection in young, physically fit individuals who present with atypical chest pain. Education and awareness among both the public and healthcare providers can significantly impact patient outcomes in such critical conditions.

"To be told that something had happened that was worse than a heart attack was simply staggering. I think it's really important for people to be aware of the clinical process and the good practices that I experienced, which are happening in pockets around the country." Martin Hilton, an Aortic Athlete

"Martin's case was a stark reminder that aortic dissection can occur in even the fittest individuals. Early recognition and swift action are vital." – Mr Graham Cooper, Consultant Cardiac Surgeon.

Essential Takeaways

Martin’s story demonstrates the lifesaving potential of early and accurate diagnosis of aortic dissection. Clinicians must remain vigilant and consider this diagnosis, particularly in patients presenting with characteristic symptoms and risk factors. Education and awareness can improve patient outcomes, emphasising the importance of protocols and readiness to act swiftly.

However, the reality remains that the majority of aortic dissection cases are not diagnosed in time, often leading to disastrous outcomes. Sharon’s story is an important reminder of the tragic consequences of delayed diagnosis and inadequate care. Sharon Goddard, a vibrant 53-year-old woman, passed away due to systemic failures in promptly recognising and treating her aortic dissection. Despite presenting with severe chest pains, she faced significant delays in the Emergency Department, ultimately costing her life.

Similarly, Chloe's case highlights the fatal consequences of misdiagnosis. Chloe Lumb, a 24-year-old woman with a genetic predisposition to aortic dissection, presented alarming symptoms at A&E but was misdiagnosed. Four days later, she tragically died due to a missed opportunity for correct diagnosis and timely intervention. The Coroner's report on her case emphasised the critical need for clear clinical guidance and pathways in handling suspected aortic dissection cases.

Women, in particular, have worse outcomes from aortic dissection. Sharon and Chloe's cases underline the urgent need for systemic improvements in healthcare, from timely recognition and appropriate care to clear protocols and patient engagement. Their stories highlight the necessity of learning from past failures to prevent future tragedies.

Together, through shared learning and proactive patient safety measures, we can save lives and improve outcomes for those impacted by aortic dissection.

More information

• Improving the Diagnostic Detection of Thoracic Aortic Dissection in the Emergency Department. Hull Royal Infirmary's innovative approach has significantly improved aortic dissection diagnosis, reducing missed cases and enhancing patient outcomes.
• Aortic Dissection HCP eLearning Resources

The photo at the top of the page is Martin speaking at the inaugural Aortic Nurses Symposium hosted by The King’s Fund, London 2024.

Share your experience

Have you been affected by a late diagnosis? Or perhaps you have insights to share on diagnostic safety through the work that you do. If you would like to write a blog or share your thoughts, experiences or resources through the hub please get in touch with our team at [email protected] or add your comments to our community forum page.