Synopsis
Recognise thoracic aortic dilatation, identify heritable and valve-associated disease, plan imaging surveillance and know when urgent or surgical review is needed.
- Thoracic aortic aneurysm is usually silent and found on echocardiography, CT or MRI; symptoms may reflect compression, valve disease or impending complication.
- Confirm the involved segment and obtain reproducible orthogonal measurements; echocardiography assesses the root/ascending aorta and valve, while CT or MRI maps the whole thoracic aorta.
- At diagnosis, look for bicuspid aortic valve, coarctation, syndromic features and a family history of thoracic aneurysm, dissection or sudden unexplained death.
Key red flags
Abrupt maximal-at-onset chest/back pain, migrating pain, pulse deficit, focal neurology, syncope, shock or new diastolic murmur requires emergency assessment.
Investigation priorities
Measure the root/proximal ascending aorta and assess aortic valve morphology, regurgitation and LV response.
Management branches
Sudden severe chest/back pain or aneurysm plus neurological, perfusion, valve or shock features.
- First: immediate ABC assessment, monitoring, IV access, analgesia and senior cardiothoracic/vascular contact.
- Next: urgent ECG-gated CTA from chest through the aorta when feasible; use TOE/MRI only when clinically appropriate and without harmful delay.
Below an intervention threshold and without acute features.
Key medicines
Beta-blocker (example: bisoprolol)For the licensed hypertension indication, a typical bisoprolol regimen starts at 5 mg orally once daily; the usual dose is 10 mg once daily and the SmPC maximum is 20 mg once daily. An aortopathy specialist may select a lower start according to heart rate and BP.
Losartan50 mg orally once daily, increased to 100 mg once daily if required and tolerated.