About Aortic Dissection
Aortic dissection occurs when a weak section of the aorta wall rips or tears. The exact disease mechanism is not yet fully understood, but several factors can contribute to the development of aortic dissection.
Possible disease mechanisms include:
- Mechanical wall stress: Increased pressure on the artery walls, often due to long-term hypertension, can weaken the aortic wall and make it more prone to tearing.
- Susceptible intimal layer: The innermost layer of the aorta, called the intima, may be more vulnerable in individuals with certain genetic conditions like Marfan syndrome or Turner syndrome.
- Medial degeneration: The middle layer of the aorta, called the media, can undergo structural changes that weaken its integrity and increase the risk of dissection.
Non-modifiable risk factors are factors that cannot be changed. These include:
- Age and sex: Aortic dissections are more common in men between the ages of 50 and 65. However, both men and women can develop this condition.
- Certain genetic disorders: Conditions like Marfan syndrome and Ehlers-Danlos syndrome affect connective tissue integrity and increase the risk of aortic dissection.
Modifiable risk factors are factors that can be influenced or changed. These include:
- High blood pressure: Long-term uncontrolled hypertension puts greater stress on the artery walls, increasing the likelihood of tearing.
- Smoking: Tobacco use damages blood vessels and contributes to arterial stiffness, which can raise the risk of aortic dissection.
- Inflammatory conditions: Infections like syphilis or inflammation of the arteries (giant cell arteritis or Takayasus arteritis) can also raise the risk of aortic dissection.
It's important to note that these risk factors may vary from person to person. Lifestyle modifications and regular medical check-ups are crucial for managing modifiable risk factors.
The most common early symptoms of an aortic dissection include:
- Sharp, stabbing chest pain that starts suddenly and may resemble a heart attack
- Pain that starts under the chest bone and can radiate to the back or under the shoulder blades
- Pain that can move to various areas of the body such as the shoulder, arm, neck, jaw, hips, abdomen, arms, or legs
As aortic dissections progress or reach higher severity, other common symptoms may occur, including:
- Fainting
- Dizziness
- Anxiety
- Clammy skin
- Nausea
- Vomiting
- Pale skin
- Shortness of breath
- Rapid, weak pulse
It's important to note that Aortic Dissection is a life-threatening condition with a high mortality rate. If you experience sudden tearing pain in the chest, neck, jaw, belly, or shoulder or any of these symptoms mentioned above, seek emergency medical care immediately by calling 911 or local emergency services.
To diagnose an aortic dissection, doctors commonly perform the following examinations, tests, and procedures:
- Medical history: A doctor will ask about your symptoms, medical history, and any risk factors associated with aortic dissection.
- Physical examination: The doctor will conduct a physical examination to check for signs such as abnormal heartbeat and differences in blood pressure between the arms.
- Chest X-ray: This imaging test can reveal a widening of the aorta, although it may appear normal in some cases.
- Transesophageal echocardiogram (TEE): A probe is placed down the food pipe to produce an image of the heart using sound waves. This helps identify irregularities in the aorta.
- Aortic angiogram: Contrast liquid is injected into the arteries, and X-rays are taken to detect abnormalities in the aorta.
- Magnetic resonance angiogram (MRA): This test uses magnetic fields and radio waves to examine blood vessels.
Additional examinations, tests, and procedures to determine the severity of aortic dissection may include:
- Computed tomography angiography (CTA): This imaging technique provides detailed images of blood vessels to assess the extent of dissection.
- Echocardiography: Different types of echocardiograms can evaluate heart function and identify any complications associated with aortic dissections.
- Blood tests: These tests can help assess organ function and detect any abnormalities that may result from an aortic dissection.
Remember, diagnostic decisions should be made by your healthcare professional based on your individual circumstances.
The goals of treatment for an aortic dissection are to reduce the force of blood flow exerts on the aortic wall, control pain and anxiety, and prevent complications such as aortic rupture and pericardial tamponade. Blood pressure control is important in managing chronic aortic dissection. Recommended values are lower than 130/80 mmHg.
Medications:
- Beta blockers: These medications reduce blood pressure and heart rate, protecting the myocardium against ischemia. They help achieve normal blood pressure and heart rate levels.
- Vasodilators: Calcium channel blockers or nitroglycerin can be used to reduce hypertension in emergency situations.
- Intravenous opiates: These are used to manage severe pain and anxiety associated with aortic dissection.
Therapies:
- Surgical intervention: Surgical treatment is used for certain types of aortic dissections. It aims to replace the diseased ascending aorta, treat or monitor the distal aortic patent false lumen, and relieve aortic regurgitation.
These treatments work together to achieve the goals of reducing force on the aortic wall, controlling pain and anxiety, maintaining normal blood pressure and heart rate, preventing complications, and improving blood flow in affected branches. Remember to consult your healthcare professional for personalized advice.