Sudden tearing pain that spreads from the chest to the back and waist — call 120 and describe it as a "tearing, ripping sensation"

This condition causes a tearing-like pain that starts in the chest and travels down the back and waist. When calling 120, state clearly that it is "a tearing, ripping sensation, with pain traveling downward." Without surgery, treatment with medication alone results in a mortality rate of 58%. Its management is the exact opposite of that for heart attacks: doctors only order enhanced CT scans after suspecting this condition, not anticoagulant or thrombolytic therapy. Also mention any significant difference in blood pressure between both arms or absence of a pulse on one side.

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The International Registry of Acute Aortic Dissection (IRAD) includes data from 464 patients across 12 centers. Acute aortic dissection is precisely this disease marked by sudden, severe tearing pain in the chest and back. Among all symptoms reported by patients, sudden onset of intense sharp pain is the most common. Overall in-hospital mortality stands at 27.4%. For patients with type A dissection receiving only medication, mortality reaches 58%.

Management of aortic dissection is completely opposite to that of heart attacks. Heart attacks require anticoagulant and thrombolytic drugs to prevent blood clotting; applying such drugs to aortic dissection would essentially encourage bleeding at the tear site. Therefore, upon arriving at the hospital, patients must clearly state “a tearing pain that’s moving downward” to prompt doctors to order enhanced CT scans. A notable difference in blood pressure between arms or absence of a pulse on one side are also important warning signs. Individuals with poorly controlled blood pressure, Marfan syndrome, or a family history of aortic aneurysm or dissection are at higher risk. In such cases, driving oneself to the hospital is strongly discouraged; symptoms must be addressed immediately rather than waiting until the next day.

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；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，表 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」；「Uncontrolled hypertension is a known risk factor for aortic rupture and dissection」. https://doi.org/10.1161/CIR.0000000000001106