Aortic Dissection
content of this page
1- Introduction
2- Physiological Overview
3- Symptoms
4- Treatment
Introduction
Physiological Overview
Aortic dissection occurs when there is a tear in the inner layer of the aorta, the largest artery that carries oxygen-rich blood from the heart to the rest of the body. This tear allows blood to enter between the layers of the aortic wall, creating a false channel known as a dissection. The condition is often associated with underlying weaknesses in the aortic wall, such as high blood pressure or connective tissue disorders.
Physiologically, aortic dissection can lead to several complications. The initial tear can extend along the length of the aorta, potentially disrupting blood flow to vital organs or causing the aorta to rupture, which is life-threatening. Depending on the location and extent of the dissection, symptoms can vary widely and may include sudden, severe chest or back pain, often described as tearing or ripping in nature.
Symptoms
Sudden, severe chest pain: Often described as a tearing or ripping sensation that may radiate to the back or between the shoulder blades.
Back pain: Intense pain in the upper back, often sharp and persistent.
Difficulty breathing: Shortness of breath, particularly if the dissection affects the blood flow to the lungs.
Weakness or paralysis: If the dissection affects blood flow to the arms, legs, or organs, it can lead to weakness or paralysis in these areas.
Loss of consciousness: In severe cases where the dissection causes significant interruption of blood flow to the brain.
Hypotension: Low blood pressure, especially if there is significant internal bleeding or compromised blood flow.
Unequal pulses: The pulses in the arms and legs may feel unequal if the dissection affects blood flow to these areas
Treatment
Medications: Initially, medications are often used to lower blood pressure and heart rate. This helps to reduce the force on the aorta and minimize the risk of further tearing. Commonly used medications include beta-blockers and calcium channel blockers.
Surgical intervention:
- Surgical repair: For Stanford type A dissections (involving the ascending aorta), emergency surgery is usually required. This involves replacing the damaged portion of the aorta with a synthetic tube (graft) through open-heart surgery. The goal is to reestablish normal blood flow and prevent rupture.
- Endovascular repair: For Stanford type B dissections (involving the descending aorta), a less invasive procedure called endovascular repair may be considered. This involves inserting a stent graft through small incisions in the groin and guiding it to the site of the dissection using X-ray imaging. The stent graft reinforces the weakened section of the aorta from the inside.
Monitoring and follow-up: After treatment, ongoing monitoring through imaging tests such as CT scans or MRI is necessary to assess the stability of the repaired aorta and detect any potential complications.
Lifestyle changes: Adopting a healthy lifestyle, including quitting smoking, maintaining a healthy weight, and managing conditions like high blood pressure and high cholesterol, is important to reduce the risk of recurrence and further complications.