Acute Aortic Dissection

June 09 22:56 2019 Print This Article

Aortic dissection is a tear in the inner lining of the aorta (the main artery that carries oxygen rich blood from the heart to the rest of the body), creating a space between the inner and outer layers. Aortic dissection is a medical emergency and can quickly lead to death, even with optimal treatment. If the dissection tears the aorta completely open (through all three layers) massive and rapid blood loss occurs. Aortic dissections resulting in rupture have a 90% mortality rate even if intervention is timely.

There are two types of Aortic Dissections, although sometimes both conditions occur: Type A: A dissection to the ascending aorta is classified as a Type A dissection. These dissections can be treated medically (usually only briefly) or with interventional catheterization or open surgical techniques. Type B: A dissection of the descending aorta is classified as a Type B dissection. These dissections are most often treated medically with routine monitoring and prescribed medications. Although aortic dissection remains relatively rare, a number of conditions and diseases may put people at higher risk.

The leading risk factors are age and high blood pressure , which occur in more than 70 percent of people who suffer from an aortic dissection. Atherosclerosis  (hardening of the arteries) as well as a history of heart disease or aortic disease, also raise the risk of aortic dissection.

Aortic dissection occurs when the layers of the aorta separate. The aorta is the main artery leading from the heart. If blood leaks into that space, then a variety of potentially fatal conditions could result, including heart attack or stroke. The aortic dissection is defined as the longitudinal splitting of the aorta wall. It is a relatively rare but serious disease, because the natural evolution of an acute aortic dissection can lead to the complete rupture of the aorta, a situation non compatible with life. This is why the diagnosis of this disease must be the most precocious possible. The dissection is said acute if seen before the 14th day after its occurrence, and said chronic beyond.

Causes of Acute Aortic Dissection

They fall into two principle categories: hereditary, including conditions such as Marfan’s syndrome (an elongation of the long bones that shows up in some tall, lanky, hyperflexible individuals) and acquired (mostly conditions involving atherosclerosis or trauma, particularly chest injury).

  • Pregnanc.
  • Cocaine use, which stimulates a rapid increase in blood pressure.
  • Marfan’s syndrome.
  • Hereditary connective tissue disorders such as Marfan’s syndrome and Ehlers-Danlo syndrome.
  • Trauma or injury to the chest, such as that experienced in a motor vehicle accident without seat belt protection .

Signs and Symptoms of Acute Aortic Dissection

Acute aortic dissection causes sudden chest pain.  This pain is often described as very severe and tearing; it’s associated with cold sweat.  The pain may be localized to the front or back of the chest.  Typically the pain moves as the dissection gets worse. Other symptoms include paralysis of the lower body or limbs, numbness in limbs, and loss of consciousness. The type of symptoms experienced depends on the location and severity of the dissection. Since the aorta is connected to vessels that lead to the body’s major organs and tissues, an aortic wall separation will curb the flow of blood to the vessels or organs closest to the separation, whether brain, kidney, heart, or stomach. If there’s a dissection in the lower part of the aorta, for example, you might experience a stomachache or lower back pain more severe than any you’ve ever had before.

  • Nausea or vomiting.
  • Cough.
  • Dry skin or mouth.
  • Anxiety.
  • Shortness of breath or difficulty breathing while lying down at night.
  • Dizziness.
  • Fainting.

Treatment for Acute Aortic Dissection

Many cases of aortic dissection are classed as medical emergencies that require rapid stabilization of the patient followed by surgery. Descending aortic aneurysms are often treated medically with good results. However, surgery may be necessary for these patients at some point if their condition worsens.Aortic dissections are generally classified as Type A, referring to those that occur in the ascending aorta (the part closest to the heart), and Type B, all those not involving the ascending aorta. Type B, in other words, refers to dissections in the descending aorta (a portion that extends down through the abdomen). Type A dissections, because they involve the early part of the aorta and have the potential to block blood flow to the brain, require immediate medication to reduce blood pressure, followed by surgery to repair the dissection. Type B, depending on the location and severity of the dissection, may be treatable by medication alone or by a combination of medication and surgery.

  • Patients with Marfan syndrome are administered antibiotics prior to any surgical or invasive procedure to protect their heart valves , which are prone to infection.
  • Medications that slow the heart’s resting rate and reduce the force of the accompanying heart muscle contraction, thus lessening the heart’s workload and reducing the tension on the wall of the aorta. These may be given orally or intravenously.
  • Medications that lower blood pressure , reducing strain on the heart. These may be given orally or intravenously.