Aortic Dissection

Symptoms

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Aortic dissection symptoms are often similar to symptoms of other conditions and may include:

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• Sudden chest or back pain which extends to the neck

• Sudden abdominal pain

• Loss of consciousness

• Shortness of breath

• Stroke symptoms such as sudden difficulty speaking, loss of vision, weakness or paralysis of one side of the body

• Blood pressure difference between arms

• Leg pain

• Difficult walking

• Leg paralysis

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Causes

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The aortic dissection may happen anywhere along the aortic wall. Chronic hypertension stresses the inner aortic layer, making it vulnerable to tearing. Some people are born with Marfan syndrome, bicuspid aortic valve or other disorders associated with weakening of the blood vessels walls, so they are in higher risk for dissection. Sometimes, aortic dissections are caused by traumatic injury to the chest area. Aortic dissections are divided into two groups, depending on which part of the aorta is dissected:

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• Type A. The more common and dangerous type that involves the ascending aorta, which may extend into the abdomen.

• Type B. This involves the descending aorta, which may also extend into the abdomen

 

Risk factors

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Risk factors include:

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• Uncontrolled hypertension

• Atherosclerosis

• Pre-existing aortic aneurysm

• Bicuspid aortic valve

• Aortic coarctation

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Some genetic risk factors, include:

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Turner's syndrome. Hypertension, heart problems and other health problems may result from this disorder.

Marfan syndrome. This is a condition in which connective tissue is weak so, the wall of aorta becomes weak and vulnerable for dissections. Patient with such a disorder usually have a family history of aneurysms.

Other connective tissue disorders. This includes Ehlers-Danlos syndrome, a group of connective tissue disorders characterized by skin that bruises or tears easily, loose joints and fragile blood vessels and Loeys-Dietz syndrome, with twisted arteries, especially in the neck.

Inflammatory or infectious conditions. These may include giant cell arteritis and syphilis.

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Other potential risk factors include:

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Sex. Men have about double the incidence of aortic dissection.

Age. The incidence of aortic dissection peaks in the 60s and 70s.

Cocaine use. This drug may be a risk factor for aortic dissection because it temporarily increases blood pressure.

Pregnancy. Infrequently, aortic dissections occur in otherwise healthy women during pregnancy.

High-intensity weightlifting. This and other strenuous resistance training may increase the risk of aortic dissection by increasing blood pressure during the activity.

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Complications

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An aortic dissection can lead to:

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• Deadly severe bleeding

• Renal failure

• Life-threatening intestinal necrosis

• Stroke

• Aortic valve regurgitation

• Cardiac tamponade

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Prevention

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This includes:

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• Control of hypertension.

• Quit smoking.

• Maintain an ideal weight.

• Wearing a seat belt. This reduces the risk of traumatic injury to the chest area.

• Work with doctors. If there is an increased risk for aortic dissection, than is necessary to be in touch with a doctor and find out, how often there is a need for monitoring and if surgery is necessary to repair the aneurysm.

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Diagnosis

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Detecting an aortic dissection is not always easy, because the signs can be similar to other diseases. Doctors may suspect an aortic dissection, if the following signs are present:

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• Sudden tearing or ripping chest pain

• Widening of the aorta on chest X-ray

• Significant blood pressure difference between right and left arms

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Diagnostic procedures include:

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Transesophageal echocardiogram. A TEE is a special type of echocardiogram in which an ultrasound probe is inserted through the esophagus. The ultrasound probe is placed close to the heart and the aorta, providing a clearer picture of your heart than a regular echocardiogram.

Computerized tomography (CT) scan. This is the gold standard exam used to diagnose an aortic dissection, with an injected contrast solution. Contrast makes the heart, aorta and other blood vessels more visible on the CT.

Magnetic resonance angiogram (MRA). This is another procedure for the diagnosis of aortic dissection that can be helpful.

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Treatment

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The aortic dissection is an emergency condition, which needs immediate treatment. Regarding the type of dissection, the patients should be treated with surgery or medications.

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Type A aortic dissection

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Treatment for type A aortic dissection may include:

• Surgery. The surgeons replace as much of the dissected aorta as possible with a synthetic tube graft. If the aortic valve leaks as a result of the damaged aorta, it may be replaced at the same time.

• Medications. Some medications, such as beta blockers and nitroprusside, reduce heart rate and lower blood pressure preventing the aortic dissection from worsening. They may be given to people with type A aortic dissection for stabilizing and preparing them for surgery.

 

Type B aortic dissection

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Treatment of type B aortic dissection may include:

• Medications. The same medications that are used to treat type A aortic dissection may be used without surgery to treat type B aortic dissections.

• Surgery. The procedure is similar to type A aortic dissection surgery. Often stents may be placed in the aorta to repair complicated type B aortic dissections.

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After treatment, the patients will need to receive medication for blood pressure control all the time. In addition, they will need follow-up with CTs or MRIs.