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AORTIC DISSECTION

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AORTIC DISSECTION

An aortic dissection is a serious condition in which there is a tear in the wall of the inner layer of the aorta, which is the largest blood vessel in the blood and the major artery carrying blood out of the heart to the rest of the body.

  • The aorta is made up of a thick wall with three layers of tissue namely: the tunica intima, the tunica media, and the tunica adventitia
  • These three layers allow the blood vessel to withstand the pressure that is generated when the heart pumps blood to the body
  • The inside layer of the aortic wall that is in direct contact with the blood inside the vessel is the intima, the media is the middle layer, and the adventitia is the outer layer
  • In an aortic dissection, a small tear occurs in the intima. Blood surges through this tear, causing the intima layer to separate or strip away from the media layer (the middle layer)
  • Aortic dissection is often fatal if the blood breaks through the outside aortic wall
  • Aortic dissection is relatively uncommon and it is prevalent in men in their 60s and 70s
  • An aortic dissection can lead to stroke, organ damage such as kidney failure, and death due to severe internal bleeding

There are two types of aortic dissection: Type A and Type B

  • Type A is the most common and dangerous form. It involves a tear in the part of the aorta where it exits the heart or a tear in the upper aorta, called the ascending aorta. It can extend into the abdomen
  • Type B involves a tear in the lower aorta, called the descending aorta. This type can also extend into the abdomen

Without treatment, about 50% of people with type A dissections die within three days and about 10% of people with type B dissections die within a month.

CAUSES

Aortic dissection happens in weakened areas of the aortic wall. Chronic high blood pressure can weaken the aortic tissue, making it more susceptible to tearing.

Sometimes, it may result from congenital abnormalities of the aortic valve, such as Marfan syndrome, bicuspid aortic valve

In rare cases, aortic dissection may be caused by a major trauma to the chest area such as during motor vehicle accidents

Risk factors for the condition include:

  • Hardening of the arteries (atherosclerosis)
  • Uncontrolled high blood pressure
  • Smoking
  • Pregnancy
  • Cocaine use
  • A weak or bulging artery
  • High-intensity weightlifting
  • Aging
  • Heart surgery or procedures
  • Coarctation (narrowing of the aorta)
  • Rare genetic diseases such as Turner’s syndrome and other connective tissue disorders, such as Ehlers-Danlos syndrome, Loeys-Dietz syndrome
  • Inflammatory or infectious conditions, such as giant cell arteritis, syphilis

SYMPTOMS 

  • Sudden severe chest or upper back pain
  • Sudden severe abdominal pain
  • Shortness of breath
  • Loss of consciousness
  • Difficulty walking
  • Sweating
  • Paralysis on one side of the body, loss of vision, sudden difficulty speaking, similar to those of a stroke
  • A weaker pulse in one arm or thigh than the other
  • leg pain
  • Tingling, numbness, or pain in the toes and/or fingers
  • Mild neck or jaw pain

DIAGNOSIS AND TREATMENT

To make a diagnosis, the doctor will review your medical history and carry out a physical examination. Doctors will suspect aortic dissection if the following symptoms are present:

  • Sudden, intense pain or tearing in the chest, abdomen, or back
  • Widening of the aorta on chest X-ray
  • Differences in blood pressure between the left and right arms

More imaging tests are usually needed to confirm a diagnosis, including:

  • Transesophageal echocardiogram to produce an image of your heart
  • CT scan to produce a cross-sectional image of your body
  • Magnetic Resonance Angiogram (MRA) to examine the blood vessel 
TREATMENT

Treatment option usually depends on the area of the aorta affected. To prevent complications or death, immediate treatment may be necessary.

Medications such as beta-blockers and nitroprusside may be recommended if you have type B aortic dissection to help lower heart rate and blood pressure as well as prevent the tear from getting worse.

If you have type A aortic dissection, the doctor may recommend these medications to help stabilize your condition, but ultimately surgery is required as the treatment of choice. During the surgical procedure, the damaged area of the aorta is replaced with an artificial graft. The aortic valve if damaged may also need replacement or repair.

To reduce your risk of aortic dissection:

  • Control your blood pressure
  • Don’t smoke
  • Wear a seat belt to reduce risk of traumatic injury to your chest area
  • Maintain an ideal weight