Aortic Dissection

Aortic dissection is a life-threatening condition in which there is a tear in the inner layer of the body's major artery (aorta) carrying blood out of the heart . The aorta carries oxygen-rich blood from the heart to the rest of the body. It has three tissue layers: an inner layer, a middle layer, and an exterior layer. Aortic dissection happens when a tear develops in the inner layer of a weaker part of the aorta. Normal blood flow to different parts of the body may be reduced or interrupted when diverted blood travels between tissue layers, or the aorta may rupture altogether.

Aortic dissections are separated into two groups, depending on which part of the aorta is affected:

  • Type A : A typical and dangerous type involving a tear in the aorta section where it exits the heart. There can also be a tear in the upper aorta (ascending aorta), which may advance into the abdomen.
  • Type B : It involves a tear in the lower aorta (descending aorta), which may advance into the abdomen.

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Symptoms

Aortic dissection symptoms might be similar to those of other disorders. One might also have symptoms of a heart attack. Few people are not in pain. The most common symptoms are as follows:

  • Loss of vision
  • Loss of consciousness
  • Shortness of breath
  • Fever
  • A weaker pulse in one arm than the other
  • Pale skin
  • Fainting or dizziness
  • Nausea
  • Profuse sweating
  • Sudden, severe upper back or chest pain
  • Leg pain
  • Mild neck, jaw, or chest pain
  • Sudden trouble speaking
  • Paralysis or weakness on one side of the body,
  • Tingling, numbness, or pain in the toes or fingers
  • Trouble walking

When to see a doctor?

If you have severe chest discomfort, fainting, abrupt shortness of breath, or stroke symptoms, call the doctor right away. These signs and symptoms aren't necessarily indicative of a major condition, but it's essential to consult a doctor as soon as possible. Aortic dissection can have serious effects, including organ failure or serious health problems if it is not treated immediately. Early detection and treatment may help you live longer.


Causes

  • Aortic dissection is a tear or damage in the inner aortic wall.
  • Aortic dissection often develops when the blood pressure is high, the aortic tissue weakens allowing the aorta layers to break easily.
  • Aortic dissection might be caused by a condition that a person has had since birth.
  • Rarely, aortic dissection can happen as a result of a vehicle accident. This occurs when the chest, or any region of the chest, is severely harmed in an accident.

Risk factors

Aortic dissection is rare. The following are risk factors for the condition:

  • Age : The majority of abdominal aortic aneurysms occur in adults over the age of 65.
  • Aortic valve issues : People who are born with a bicuspid aortic valve are more likely to develop aortic aneurysms. Gender: Men are more likely than women to have abdominal aortic aneurysms
  • Connective tissue disease : Aortic aneurysms can be caused by connective tissue disorders, such as Marfan syndrome.
  • High blood pressure : High blood pressure : Long-term hypertension puts extra strain on the arterial walls, increasing their susceptibility to rupture.
  • An infectious or inflammatory condition : Syphilis or artery inflammation caused by giant cell arteritis or Takayasu's arteritis can raise the risk of aortic dissection.
  • Trauma to the chest : A severe chest injury may, in rare cases, lead to an aortic tear.
  • Pregnancy : Aortic dissections can occur in rare circumstances during pregnancy.
  • High-intensity weightlifting : This type of resistance training increases blood pressure which might cause an aortic tear.

Complications

Diagnosis of aortic dissection can be challenging. The condition and symptoms might be confused with those of different conditions. Because an aortic dissection can cause serious damage in a short period of time, it must be diagnosed and treated as soon as possible. Without proper medical care, this condition can lead to catastrophic consequences, such as

  • Aortic regurgitation
  • Heart attack
  • Cardiac tamponade
  • Organ failure
  • Aortic rupture
  • Heart failure

Prevention

People at risk of aortic dissection, especially those with a family history, can minimise their risk by adopting healthy lifestyle changes. The following are some methods for preventing Aortic Dissection.

  • Getting regular heart examinations.
  • Monitoring blood pressure regularly and receiving treatment for hypertension.
  • Consuming a balanced diet rich in whole grains, fruits, and vegetables while limiting salt intake.
  • Exercising regularly
  • Maintaining a healthy body weight
  • Avoiding smoking
  • Following a treatment plan for any existing medical conditions that increase the risk of aortic dissection.
  • Wearing a seat belt when driving to reduce the likelihood of chest injuries.

Diagnosis

A doctor will inquire about the medical history and do a physical examination to identify aortic dissection. The following signs and symptoms can help in diagnosing the condition:

  • An abnormal heartbeat
  • Blood pressure differences between the left and right arms.
  • Sudden and acute pain in the chest, back, or abdomen.
  • Chest X-ray : Chest X-ray: A widening of the aorta can be seen on a chest X-ray. However, because the pictures may seem normal in 10 to 20% of persons with aortic dissection, additional tests may be needed.
  • Transesophageal echocardiogram (TEE) : A TEE involves inserting a probe into the food pipe near the aorta. Sound waves provide a picture of the heart that the doctor may examine for anomalies.
  • Aortic angiogram : Aortic angiogram: During this treatment, the doctor will inject a contrast liquid into the arteries. They will next take X-rays to look for any aortic anomalies.
  • Magnetic resonance angiogram (MRA) : Angiogram using magnetic resonance imaging (MRA). A magnetic field and radio waves are used in this test to examine the blood arteries.
    Additional tests, such as blood tests, may help the doctor in ruling out other conditions and situations with similar symptoms.

  • Treatment

    Aortic dissection requires immediate medical attention to avoid complications. Medication, surgery, or both are commonly used in this treatment.

    • Medications : People with type B aortic dissection may be given beta-blockers and nitroprusside to lower their heart rate and blood pressure and prevent the tear from worsening. People with type A aortic dissection may also take these drugs to help stabilise their condition, although surgery to repair the tear is usually required. Most patients with aortic dissection must take blood pressure drugs for the rest of their lives.
    • Surgery : Surgery is usually performed on people who have type A aortic dissection to remove the damaged segment of the aorta and replace it with a tube. This technique stops blood from entering the aortic wall. If the aortic valve is leaking, the surgeon will replace it as well. People suffering from type B aortic dissection may go through a similar process, but their operation may also include the insertion of stents, which are thin mesh tubes used to reconstruct the aorta.
    • Follow-up treatment : Patients may require frequent imaging scans to monitor their condition.

    Do’s and Don’ts

    It may take some time to restore energy after an aortic dissection. However, patients should maintain a healthy lifestyle and take preventative measures while the aorta is being monitored. These dos and don'ts also apply to individuals who have had aortic dissection surgery.

    Do’sDon’ts
    Maintain a healthy blood pressure Push, pull, bear down or lift anything heavy
    Maintain healthy body weight. Smoke or use any other tobacco products
    Do mild to moderate physical activity regularly. Participate in rigorous, competitive, or contact sports.
    Follow up with the doctor regularly to monitor overall health. Eat high-salt diet
    Wear a seatbelt in the vehicleEat saturated fats and junk foods

    By following the dos and don’ts for aortic dissection manage the symptoms and lead a healthy life. Seek timely treatment and follow up with your doctor to better monitor your condition.

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    Aortic Dissection Care at Medicover

    Aortic Dissection treatment is performed at Medicover hospital by the best team of cardiologists and medical professionals. Our highly qualified staff treats a variety of heart illnesses and ailments using the most up-to-date diagnostic tools, medical equipment, and technologies. We use a multidisciplinary approach to treat aortic dissection to give patients complete satisfactory health outcomes and respond to their medical requirements for a faster and more sustainable recovery.

    Citations

    https://www.ncbi.nlm.nih.gov/books/NBK441963/
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    Frequently Asked Questions

    1. What is an aortic dissection?

    An aortic dissection is a critical health issue characterized by the occurrence of a rupture in the inner lining of the aorta, the expansive blood vessel responsible for transporting blood outward from the heart. This rupture has the potential to induce the movement of blood amidst the various layers of the aortic wall, a situation that can give rise to extremely severe and life-endangering complications.

    2. What are the different types of aortic dissections?

    Aortic dissections are classified into two main types: Type A and Type B. Type A involves a tear in the ascending aorta, while Type B involves a tear in the descending aorta. Type A dissections are typically more critical and require immediate medical attention.

    3. What are the symptoms of aortic dissection?

    Symptoms of aortic dissection might encompass abrupt and intense discomfort in the chest or back, frequently characterized as sensations of "tearing" or "ripping." Additional signs encompass difficulty in breathing, feelings of lightheadedness, diminished strength, and manifestations associated with insufficient blood supply to bodily organs.

    4. How is aortic dissection treated?

    Treatment for aortic dissection involves managing blood pressure and heart rate, and in some cases, surgery may be necessary to repair the tear. The specific treatment approach depends on the type and severity of the dissection.

    5. What causes aortic dissections?

    Aortic dissections can be caused by a variety of factors, including high blood pressure, atherosclerosis (build-up of plaque in arteries), genetic conditions that affect connective tissue, trauma, and certain medical procedures.

    6. How is aortic dissection diagnosed?

    Typically, the process of diagnosing aortic dissection entails a fusion of the patient's medical background, a thorough physical assessment, utilization of imaging procedures like CT scans and MRIs, and occasionally echocardiography. This collective approach facilitates the visualization of the aorta and permits an evaluation of the scope and magnitude of the tear.

    7. What is Stanford Type B aortic dissection?

    Stanford Type B aortic dissection refers to a tear in the descending aorta, occurring after the left subclavian artery. It is managed differently from Type A dissections and may require medical management or surgery depending on its severity.

    8. What is thoracic aortic dissection repair?

    The repair of a thoracic aortic dissection involves a surgical intervention aimed at mending a rupture in the aorta. The method of surgery employed is contingent upon the specific type and whereabouts of the dissection, and it may encompass the substitution of the impaired portion of the aorta with a graft material.

    9. What are the warning signs of an ascending aortic dissection?

    Warning signs indicating an ascending aortic dissection encompass the abrupt onset of intense chest discomfort, which could potentially extend towards the back, neck, or arms. Alongside this, symptoms might encompass difficulty in breathing, perspiration, and an overwhelming sense of impending calamity.

    10. How is the management of aortic dissection approached?

    Management includes stabilizing the patient's condition, often with medications to control blood pressure and heart rate. Type A dissections usually require emergency surgery, while Type B dissections might be managed with medications and close monitoring.

    11. Is aortic dissection surgery risky?

    Aortic dissection surgery carries risks like any major surgery, including bleeding, infection, and complications related to anesthesia. However, the surgery is often necessary to prevent life-threatening complications associated with aortic dissection.

    12. What does "Type A" and "Type B" dissection mean?

    "Type A" refers to an aortic dissection involving the ascending aorta, while "Type B" refers to a tear in the descending aorta. These distinctions are crucial for determining treatment approaches and management strategies.


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