13-008 · EVIDENCE B · SOURCE-SENSITIVE
Sudden tearing pain that spreads from the chest to the back and waist — call 120 and describe it as “pain moving downward”
突然像被撕开一样的剧痛，从胸口往后背、往腰一路挪，打 120 并说清「疼在移动」
No cost at all.
This condition causes a tearing-like pain that starts in the chest and travels down the back and waist. When calling 120, simply describe it as “a tearing pain that’s moving 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.
B
Move “Sudden tearing pain that spreads from the chest to the back and waist — call 120 and describe it as “pain moving downward”” to Future Me's calendar
The excuse
There is no immediate alarm, so the sensible choice can wait for a less busy week.
What feels good now
Today I keep a few minutes and avoid interrupting my default routine.
What the source says
The source summarizes the return this way: “This condition causes a tearing-like pain that starts in the chest and travels down the back and waist. When calling 120, simply describe it as “a tearing pain that’s moving 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.” Evidence grade B. The original states the population, caveats, and sources; this is not a personal forecast.
Use the original facts and limits. For an urgent medical, safety, financial, or legal issue, contact a qualified local professional or service.
THE ENGLISH EDITION
Original recommendation and evidence
8. Sudden tearing pain that spreads from the chest to the back and waist — call 120 and describe it as “pain moving downward”
Cost: No cost at all.
In plain terms: This condition causes a tearing-like pain that starts in the chest and travels down the back and waist. When calling 120, simply describe it as “a tearing pain that’s moving 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.
Benefit: 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%.
Evidence grade: B
Sources: 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>
Notes: 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.
Read the complete Chinese source and notes
8. 突然像被撕开一样的剧痛，从胸口往后背、往腰一路挪，打 120 并说清「疼在移动」
成本: 不花钱。
说人话: 撕裂一样的剧痛从胸口往后背、往腰一路挪，打 120 时直接说「像撕开一样，疼在往下走」。这病不手术、光吃药的死亡率 58%。它的处理和心梗正相反：医生想到它，才会去做增强 CT，而不是给你抗凝溶栓。两条胳膊血压差很多、一侧摸不到脉，也一起说出来。
收益: 国际急性主动脉夹层登记（IRAD）收了 12 家中心的 464 例。主动脉夹层就是胸背撕裂样剧痛那种病。病人最先说出来的症状里，最常见的是突然发作的剧烈锐痛。住院期间总死亡率 27.4%。A 型夹层没做手术、只吃药的，死亡率 58%
证据等级: B
来源: 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>
备注: 夹层和心梗的处理正好相反。心梗要用抗凝、溶栓这类让血别凝住的药，用在夹层上等于给撕口放血。所以到医院要主动说「撕裂样，疼在往下走」，让医生想到查增强 CT。两条胳膊血压差很多、一侧摸不到脉搏，是提示。血压控制不好的、有马凡综合征的、家里得过主动脉瘤或者夹层的，风险高。同样不要自己开车，不要忍到第二天
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