An aortic dissection is a serious tear in the inner layer of the aortic wall. This tear is seen somewhere between your chest and your abdomen. To be clearer, an aortic dissection is a serious condition in which a tear is seen in the inner layer of the aorta (the large blood vessel branching off the heart). Blood rushes through the tear, hence causing the inner and middle later of the aorta to separate. This separation of the aorta is simply known as aortic dissection. Aortic dissection is often considered fatal, if the blood-filled path ruptures through the outside aortic wall. This is why it is very important to obtain emergency medical attention if something wrong is suspected.
Causes of Aortic Dissection:
Aortic dissection is most common in men of age between 60 and 70, making it relatively uncommon. The exact cause of aortic dissection is still unknown but most dissections are due to the deterioration of the aortic wall.
The aortic tissue is stressed by chronic high blood pressure, making it more likely to tearing.
Hypertension also causes aortic dissection. It is found that most patients who suffer aortic dissection have a history of hypertension. Thus overtime, hypertension weakens the wall of the aorta, and it becomes more vulnerable to dissection.
Aortic dissection is associated with certain genetic tissue disorders as well, such as Marfan. This is a condition associated with a weakened and enlarged aorta, and unfortunately some people are born with this condition.
In women aortic dissection is mostly seen under the age of 40 during pregnancy. The increased production of hormones that work on smooth muscle for the uterine growth causes a dissection during pregnancy.
It is very rare that aortic dissections are caused by some injury to the chest area, such as during various accidents or falls.
Depending on which part of the aorta is affected, Aortic dissections are divided into two groups:
- Type A: This type involves a tear in the part of the aorta where it exits the heart. A tear in the upper aorta also comes under this same type. This is more common and dangerous type and may extend to the abdomen.
- Type B: The second type involves a tear in the lower aorta only. This may also extend into the abdomen.
Symptoms of Aortic Dissection:
The symptoms of aortic dissection may resemble to or be similar to heart attack. Some signs and symptoms may include:
- Sudden excruciating pain, tearing or ripping sensation as described more often. Only 10% of patients get painless aortic dissection.
- The patient’s blood pressure may elevate in the early stages of dissection.
- Shortness of breath and sometimes loss of consciousness.
- Weak pulse may be experienced in one are compared to the other one.
- Difficulty speaking.
- Loss of vision, weakness in one side of your body.
Consulting the doctor as soon as possible is recommended as soon as you see the above symptoms.
- Men have three times more chances of having aortic dissection than women.
- Aortic dissection is most common on people of ages 60 to 80 are most common.
- Cocaine users are at risk of many things including aortic dissection. Cocaine temporarily elevates blood pressure.
- Pregnant women are at risk of aortic dissection as well.
- Different physical trainings and weight lifting increases blood pressure thus increasing the risk of aortic dissection.
- People with connective tissue disorders have higher risk of aortic dissection.
An aortic dissection should never be taken lightly as it can lead to many life-threatening complications. Aortic dissection causes death due to sever internal bleeding. Aortic dissection leads to stroke and different organ damage including kidney failure or fatal intestinal damage and aortic valve damage.
Aortic dissections cause many life- threatening emergencies that require prompt diagnosis and treatment. Early diagnosis leads to successful treatment.
Since the symptoms are similar to many other health problems, detecting an aortic dissection can be quite problematic. Doctors suspect an aortic dissection if the signs and symptoms are seen like sudden chest pain, widening of the aorta on chest X-ray, difference in blood pressure in the right and left arms. Although all these symptoms give the idea of aortic dissection, it is not enough to declare it. Obviously the chest X-ray is the first step in detection, which revels a widened aorta in most of the patients with symptoms. But more imaging techniques are needed for the doctor to declare aortic dissection on any patient.
- Transthoracic echocardiogram (TTE) or transesophageal echocardiogram (TEE): This test provides high accuracy for quick decision-making. High-pitched sound waves are used to produce an image of the heart. An ultrasound probe is inserted through the esophagus, which is placed close to the heart and the aorta. This test provides a clearer picture of the heart than a regular echocardiogram.
- CT scan: CT scan has a sensitivity more than 90% and high contract that makes the heart, aorta and other blood vessels more visible.
- MRI: MRI is the most accurate test to detect different forms of dissection. An MRI uses radio wave energy pulses and magnetic field to make pictures of body. This same technique is used to look at the blood vessels. Because of different time and transport considerations an MRI is not practical for acute situations.
- The patients are suggested to have an ECG as well.
Treatment of Aortic Dissection
Depending upon the size of the dissection and the time of its occurrence, treatment for an aortic dissection may vary. Treatments may include both medications and surgery. Surgery is suggested only if the patient has life-threatening complications such as aortic rupture, uncontrolled hypertension, ischemia of the limbs and other organ systems and progressive dissection. Treatment depends on the type of dissection as well.
Treatment for type A aortic dissection:
- Surgery: Surgeons remove as much of the dissected aorta as possible. The entry of blood into the aortic wall is blocked and the aorta is reconstructed with a synthetic tube called a graft. As a result of the damaged aorta, the aortic valve may leak. If leaked it may be replaced at the same time.
- Medications: Beta-blockers and nitroprusside (Nitro press) are some medications that reduce heart rate and lower the blood pressure. These medications can prevent the aortic dissection from getting worse. They may be given to stabilize blood pressure before surgery.
Treatment of type B aortic dissection:
- Surgery: The procedure of surgery is similar to that used to treat a type A aortic dissection. Sometimes small wires mesh tubes that act as a sort of support may be placed in the aorta. This is done to repair complicated type B aortic dissections.
- Medications: The medications that are used to treat type A aortic type B aortic dissections are same.
There are various follow-ups required after treatment. You may need CTs or MRIs follow-ups to analyse your condition. Also, you may need to take blood pressure lowering medication for life. In addition, you may need follow-up CTs or MRIs periodically to monitor your condition.
Prevention of Aortic Dissection:
Prevention is better than cure. So here are some prevention tips to reduce the risk of aortic dissection.
- Blood pressure control.
- Avoid smoking.
- Maintain your diet with fruits and vegetables.
- Exercise in a regular basis.
- Avoid injuries as much as possible.