Aortic dissection

Description

Aortic dissection is a serious condition in which there is a tear in the inner layer of the body's main artery (aorta). The blood runs through the tear, causing the inner and middle layers of the aorta to split (dissect). If the blood passes through the outside aortic wall, aortic dissection is often fatal.

Aortic dissection is relatively uncommon. It usually occurs in men in their 60s and 70s. The symptoms of aortic dissection may mimic those of other diseases, which often leads to delays in diagnosis. However, when an aortic dissection is detected early and treated in time, the probability of survival is greatly improved.

Symptoms

Aortic dissection symptoms can be similar to those of other heart problems, such as a heart attack. The characteristic signs and symptoms include:

  • Sudden severe chest or back pain, often described as a tearing or ripping sensation, which extends up to the neck or down the back
  • Sudden and severe stomach pain
  • Loss of consciousness
  • Shortness of breath
  • Symptoms similar to those of a stroke, including sudden problems with vision, difficulty speaking, weakness or loss of movement (paralysis) on one side of your body
  • Weak pulse in one arm or on the thigh, in comparison with the other
  • The pain in the leg
  • Difficulty walking

When to see a doctor

If you have severe pain in the chest, fainting, sudden shortness of breath or symptoms of a stroke, call 911 or your local emergency number. These signs and symptoms are not always due to a serious problem, but it is better to be seen by a doctor quickly. The early detection and treatment can help save your life.

Causes

Aortic dissection is caused by a weakened area in the wall of the aorta.

Dissections of the aorta is divided into two groups, depending on the part of the aorta affected:

  • Type A. This is the most common and dangerous type involves a tear in the part of the aorta, where it exits the heart. The rupture can also occur in the upper part of the aorta (ascending aorta), that may extend into the abdomen.
  • Type B. This type involves a tear in the lower part of the aorta only (descending aorta), which may also extend into the abdomen.

Risk factors

Some of the things you may increase the risk of aortic dissection include:

  • Uncontrolled high blood pressure (hypertension)
  • The hardening of the arteries (atherosclerosis)
  • Weakened and bulging of the artery (aortic aneurysm)
  • An aortic valve defect (bicuspid aortic valve)
  • A narrowing of the aorta at birth (aortic coarctation)

Certain genetic diseases that increase the risk of having an aortic dissection, including:

  • The Turner syndrome. High blood pressure, heart problems and other health conditions that can result from this disorder.
  • Marfan syndrome. This is a condition in which the connective tissue, which supports the various structures of the body, is weak. People with this disorder often have a family history of aneurysms of the aorta and other blood vessels, or a family history of aortic dissection.
  • Other connective tissue disorders. This includes the Ehlers-Danlos syndrome, a group of connective tissue disorders that involve flexible joints and fragile blood vessels and the Loeys-Dietz syndrome, which causes braid arteries, especially in the neck.

The inflammation of the arteries (giant cell arteritis) can also increase the risk of aortic dissection.

Other potential risk factors for aortic dissection include:

  • Sex. Men are more likely to have an aortic dissection women.
  • Age. Aortic dissection is more likely in people of 60 years and more.
  • The use of cocaine. This drug temporarily increases the blood pressure.
  • Pregnancy. Infrequently, aortic dissections occur in healthy women during pregnancy.
  • High intensity weightlifting. This and other strenuous resistance training can increase the risk of aortic dissection by increasing the blood pressure during activity.

Complications

The possible complications of aortic dissection include:

  • Death due to severe internal hemorrhage
  • The damage in the organs, such as kidney failure or life-threatening intestinal damage
  • Stroke
  • The aortic valve injury (aortic insufficiency) or tear in the lining around the heart (cardiac tamponade)

Prevention

You can reduce your risk of aortic dissection by preventing the injury in the chest, and take measures to keep your heart healthy.

  • Control of blood pressure. If you have high blood pressure, get a home blood pressure measurement device to help control your blood pressure.
  • Do not smoke. If you smoke, take steps to stop.
  • Maintain an ideal weight. Follow a low-salt diet with plenty of fruits, vegetables and whole grains, and exercising regularly.
  • Wear a seat belt. This reduces the risk of chest injury during a car accident.
  • Work with your doctor.If you have a family history of aortic dissection, connective tissue disease or a bicuspid aortic valve, tell your doctor. If you have an aortic aneurysm, find out how often you need to follow and if surgery is needed to repair the aneurysm. If you have a genetic condition that increases the risk of aortic dissection, the doctor may recommend medication, even if your blood pressure is normal.

Work with your doctor. If you have a family history of aortic dissection, connective tissue disease or a bicuspid aortic valve, tell your doctor. If you have an aortic aneurysm, find out how often you need to follow and if surgery is needed to repair the aneurysm.

If you have a genetic condition that increases the risk of aortic dissection, the doctor may recommend medication, even if your blood pressure is normal.

Aortic dissection

Diagnosis

Detecting an aortic dissection can be a challenge because the symptoms are similar to those of many other health problems. Your doctor may think that you have an aortic dissection if you have:

  • Sudden tearing or ripping chest pain
  • Difference of blood pressure between the right and the left arm
  • The widening of the aorta on chest X-ray

The tests used to diagnose an aortic dissection include:

  • Transesophageal echocardiogram (TEE). This test uses sound waves to create images of the heart in motion. A transesophageal echocardiogram (TEE) is a special type of echocardiogram in which an ultrasound probe (transducer) is guided through the esophagus and is placed close to your heart. This test gives your doctor a clearer picture of your heart and of the aorta that a regular echocardiogram.
  • The computed tomography (CT) of the chest. X-rays are used to produce cross-sectional images of the body. A computed tomography (CT) of the chest can confirm a diagnosis of aortic dissection.
  • Magnetic resonance angiography (MRA). A magnetic resonance angiography (MRA) uses a magnetic field and radio wave energy to create images of the blood vessels.

Treatment

Aortic dissection is a medical emergency that requires immediate treatment. Treatment may include medications or surgery, depending on the area of the aorta involved.

Type a aortic dissection

The treatment for type a aortic dissection may include:

  • Surgery. Surgeons remove as much of the aorta dissected as possible and prevent the blood to leak into the wall of the aorta. A synthetic tube (graft) is used to reconstruct the aorta. If the aortic valve leaks as a result of damage of the aorta, it may be replaced at the same time. The new valve is placed in the graft.
  • Drugs. Medications are administered to reduce the heart rate and blood pressure, which can prevent aortic dissection from worsening. It can be given to people with type a aortic dissection for the control of blood pressure before surgery.

Type B aortic dissection

The treatment of type B aortic dissection may include:

  • Drugs. The same medications used to treat type a aortic dissection can be used without the need for surgery to treat type B aortic dissections.
  • Surgery. The procedure is similar to that which is used to correct a type a aortic dissection. Sometimes stents — small wire mesh tubes that act as a sort of scaffold — can be placed on the aorta for repair of complicated type B aortic dissections.

After treatment, you may need to take medications to control your blood pressure for the rest of your life. You may need regular computed tomography or magnetic resonance imaging to monitor your condition.

Symptoms and treatment of Aortic dissection