AORTIC DISSECTION & TREATMENT
Definition: What is "aortic dissection"?
Aortic dissection is a condition wherein the wall of the aorta tears, causing blood to flow between the layers of the aorta wall & forcing the layers apart. Aortic dissection is a life threatening condition & is considered as a medical emergency because it could lead to a quick death even with appropriate treatments. If the dissection tears the aorta through all its three layers, rapid & massive blood loss would occur. Aortic dissection that result in rupture have 80% mortality rate. Almost 50% of patients with aortic dissention die before they reach the hospital.
Symptoms & Signs
More than 95% of patients with Aortic dissection experience severe pain at sudden onset. Patients describe the condition as "stabbing, sharp & tearing in nature". Anterior chest pain is the most common complain associated with ascending aorta, while intrascapular pain (or back pain) is experienced with descending aortic dissections. Less common symptoms of Aortic dissection include cerebrovascular assident, cardiac arrest, paraplegia, congestive heart failure, syncope, peripheral neuropathy & sudden death. Blood pressure changes, myocardial infarction, pleural effusion & aortic insufficiency also occurs in most patients.
Treatment: How to Treat "aortic dissection"?
The risk of death caused by Aortic dissection is highest during the first several hours after dissection starts & decreases afterwards. As such, therapeutic methods vary for acute dissection & chronic dissection. If high blood pressure is present, patients would be medicated to control blood pressure. Medical management of Aortic dissection is usually focused in lowering blood pressure & reducing shear-force dP/dt. For this reason, vasodilators combined with a beta blocker is used to reduce shear stress. Calcium channel blockers are also effective in treating Aortic dissection. Severe Aortic dissection calls for surgical treatment.
Aortic dissection is associated with various connective tissue disorders. Inflammation of the artery (vasculitis) is rarely associated with this condition. However, Aortic dissection can be a result of chest trauma. Aortic dissection is associated with high blood pressure, accounting to 75% to 80% patients with a previous history of hypertension. Aortic dissection occurs in patients who are 50 to 70 years old. The incidence of Aortic dissection is twice as high in males than in females with a ratio of 2:1 respectively. 50% of women who develops Aortic dissection on or before age 40 occur during pregnancy. Bicuspid aortic valve, marfan syndrome & turner syndrome all increase the risk of aortic dissection. This condition could also be a late effect of cardiac surgery.