Aortic pain: the renaissance of cardiovascular pain and the detection of aortopathy.

Our 19th century predecessors considered the aorta as a source of cardiovascular pain associated with inflammatory aortitis, arterial hypertension, aortic aneurysms, aortic dissection, and aortic valve disease. However, during the 20th century epidemic of coronary artery disease clinicians became concerned with the syndromes associated with myocardial ischemia and infarction, relegating aortic pain syndromes to the role of a differential, "rule out", or diagnosis of exclusion rather than a primary diagnosis. We re-focus attention on a more global approach to cardiovascular pain, approaching thoracic aortic pain syndromes as primary diagnoses, while considering the dynamics and various stages of development of aortic pain syndromes, set within the clinical environment in which these syndromes arise. The central role of aortopathy is our underlying theme since the detection and clinical recognition of aortopathic disorders provide the template for identification of the population at risk for aortic pain syndromes. Clinical history, pedigree development, phenotype recognition, analysis of the elastic properties of the aorta, use of the wide range of sophisticated imaging techniques, and phenotype-genotype correlations provide the bases for the recognition, diagnosis, and management of aortopathy within the clinical setting. A futuristic anticipatory approach towards the diagnosis of aortopathy is outlined with emphasis on earlier recognition and informed clinical management ultimately leading to prevention of the acute and dynamic aortic complications.