Aortic dissection is a serious condition that can impact at any age.
It is essential that aortic dissection is detected early, as when treated quickly there is a very good chance of survival. Sadly, when delays in diagnosis happen it can lead to catastrophic outcomes.
Jacob Hassan was a father of two, who died after having an aortic dissection aged 62.
Jacob, a keen cyclist who regularly cycled 100 miles a week, had worked as a GP for over 30 years before taking early retirement. He lived in Cambridge with his wife, Sharon, and loved visiting his grandchildren in Indonesia and Australia.
His death followed a trip to A&E after Jacob had experienced intense chest pain. He was discharged with a diagnosis of “non-specific chest pain” without being offered the scan that would have saved his life.
What is aortic dissection?
Aortic dissection occurs when there is a partial tear in the aortic wall. The aorta is the main artery that carries blood away from the heart. If a tear develops, it can allow blood to leak into the aortic lining, which can create a false channel between the inner and outer layers.
Many of the symptoms of aortic dissection are similar to those of other heart problems like heart attacks. Usually, the first sign of an aortic dissection is abrupt and severe chest, back or abdominal pain. The sensation is often described as ripping or tearing.
How is aortic dissection diagnosed?
Aortic dissection is not common and it can also be difficult to diagnose. That’s why it’s so important to have a specialist CT scan. In Jacob’s case, this could have been performed on-site to provide a quick and definitive diagnosis. When diagnosed and treated quickly, the survival rate for aortic dissections is better than 80%.
According to the Aortic Dissection Charitable Trust, however:
- 33% of sufferers are misdiagnosed
- 2,000 people die each year from aortic dissection in the UK
Like Jacob, most patients with aortic dissection suffer sudden severe chest pain, which can settle completely after a few hours. Routine tests carried out in the Emergency Department can come back normal. Only a specialist CT aortogram can conclusively say one way or the other whether a patient has an aortic dissection.
Case study of failure to diagnose aortic dissection
Jacob’s story is tragic and his death avoidable.
On a cycle ride from Cambridge, Jacob had to pull over because he was breathless. For an experienced cyclist like Jacob, this was an unusual occurrence. That same evening, he complained of chest pains, telling his wife Sharon to call an ambulance.
By the time he arrived at Addenbrooke's Hospital’s A&E Department his chest pain was intense. The triage nurse noted the pain was stabbing in nature and radiated to the back – both classic symptoms which should have alerted staff to the need for a CT scan.
Jacob was given painkillers and a chest X-ray but was discharged without being offered a CT scan. A common scenario with aortic dissection is that it can be dismissed because patient doesn’t seem ill enough.
The pain subsided but Jacob continued to lack energy over the next few days. Then, one evening, his wife Sharon returned home to find Jacob collapsed and unresponsive. He died later that night.
Classic signs of aortic dissection missed
The decision to discharge Jacob without offering him a CT scan, despite his unexplained chest pains, was a tragic mistake. According to the coroner, a CT scan would have led to a diagnosis of aortic dissection and saved Jacob’s life.
The Coroner’s Record of Inquest noted that “The presentation of chest pain being severe, sharp, and radiating to his back was indicative of acute aortic syndrome… and should have triggered CT aortography at the hospital which would have confirmed the presence of such a dissection.
“This would have necessitated emergency cardio thoracic surgical intervention and on balance, Jacob would have survived such a procedure.”
Cambridge University Hospital NHS Foundation Trust failed to offer a CT scan and there was also a communication issue with the A&E department not being able to access to the electronic notes of the ambulance crew.
Seeking justice and raising awareness
With the help of Partner Tim Deeming in our medical negligence team, Sharon Hassan is proceeding with her case.
Once the Coroner commenced the inquest investigations, independent experts confirmed Jacob’s death could have been avoided if the cause of severe chest pain had been thoroughly investigated.
Through the case we aim to raise awareness of the effectiveness of CT scans in identifying aortic dissection.
As Sharon said: “Unless the Health Authority has a system to offer a scan to all those presenting with chest pain that cannot be explained by a heart attack, pneumothorax or pulmonary embolism, tragedies will continue” she said. “I just want to ensure no family has to go through what mine has.”
Tim Deeming, Partner acting for the family added: “It’s vital we raise awareness through shared knowledge. As a lawyer supporting families who have had such challenging circumstances, it is through shared experiences we can improve services and learn.”
“It’s about systems and it’s about support… we hope wider training can be provided about Jacob’s circumstances and we want to create a legacy so that CT investigations for aortic dissection are considered basic and fundamental to rule out.”
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