If there is a sudden tearing pain that moves from the chest to the back and down to the lower back, call 120 (China's ambulance number) and say clearly that it "feels like tearing"

In a real emergency, call 911 first, then read this.

Cost

Free.

What you get

The International Registry of Acute Aortic Dissection (IRAD) enrolled 464 cases from 12 centers. Aortic dissection is the illness with tearing pain in the chest and back. Among the symptoms patients reported first, the most common was a sudden severe sharp pain. But the presentation varies widely, and typical signs such as a pulse that can't be felt on one side appeared in only 15.1% of people. The overall death rate in hospital was 27.4%. For type A dissection treated with medicine alone and no surgery, the death rate was 58%. The 2022 aortic disease guideline of the American Heart Association and the American College of Cardiology uses a scoring chart to judge how likely a dissection is. High-risk conditions include connective tissue diseases such as Marfan syndrome, a family history of aortic disease, and a known thoracic aortic aneurysm. The high-risk kind of pain is in the chest, back or abdomen, with sudden onset, very severe, tearing in quality. The high-risk sign is a pulse that can't be felt on one side, or a large difference in systolic (upper) blood pressure between the two arms. The guideline also states that poorly controlled blood pressure is a known risk factor for aortic rupture and dissection

Notes

On arrival at the hospital, say on your own initiative "tearing pain, the pain is moving downward," so the doctor thinks of dissection and orders a contrast CT. A heart attack is often treated with anticoagulants and clot-dissolving drugs, which keep blood from clotting. The author infers that these drugs would worsen bleeding in a dissection, so the doctor needs to rule out dissection first. A big blood pressure difference between the two arms, or a pulse that can't be felt on one side, is a hint. People with poorly controlled blood pressure, people with Marfan syndrome, and people whose family has had aortic disease are at higher risk. Likewise, don't drive yourself, and don't put up with it until the next day.

Evidence grade

B : Supported by research but without a precise number, or based on small or single studies.

Sources

1. Hagan PG, Nienaber CA, Isselbacher EM, et al. (2000). The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA, 283(7), 897-903. https://doi.org/10.1001/jama.283.7.897
2. Isselbacher EM, Preventza O, Hamilton Black J, et al. (2022). 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease. Circulation, 146(24), e334-e482, Table 24 (ADD-RS): "Marfan syndrome or other connective tissue disease" "Family history of aortic disease" "Ripping or tearing in quality" "Pulse deficit or systolic blood pressure differential"
3. "Uncontrolled hypertension is a known risk factor for aortic rupture and dissection". https://doi.org/10.1161/CIR.0000000000001106

Translated from the Chinese original. Original book, section 13, tip 8. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer