To Get More Information On Aortic Dissection! This page will help you learn more about this tragic diease.
What is the aorta: The aorta is the major artery that carries blood from the heart to the rest of the body.
Aortic dissection happens when the inner layer of the aorta’s artery wall splits open (dissects). This most likely occurs where pressure on the artery wall from blood flow is high. One such place is the ascending aorta (the first segment of the aorta), where the aorta originates from the heart’s left ventricle (pumping chamber). This is the part of the aorta closest to the heart (thus the name proximal aorta). When the aortic wall splits, the pulses of blood get inside the artery wall and under the inner layer. This makes the aorta split further. This tear usually continues away from the heart down the descending aorta and into its major branches. Less often the tear may run back toward the heart. Aortic dissection can also start in the descending (distal) segment of the aorta.
-Chest Pain:
-sudden, secere, sharp, stabbing, tearing,or ripping
-Located below the sternum,then radiated under the shoulder blades or the back
-may radiate to shoulder, neck, arm, jaw, abdomen, or hips
-Location may change--pain typically moves distally (to arms and legs) as the aortic dissection progressess in the same direction.
-changes in thought ability, confusion, disorientation
-decreased movement, any location
-decreased sensation, any location
-intense anxiety, anguish
-pallor
-rapid pulse
-profuse sweating
-dry skin/mouth, thirst
-nausea and vomiting
-dissiness, fainting
-shortness of breath-- difficulty breathing when lying flat (orthopnea)
ADDITIONAL SYMPTOMS (can be associated with this disease):
-excessive yawning
-clammy skin
-weak or absent pulse
-cough
-high blood pressure
The symptoms usually begin suddenly.
The Stanford classification divides dissections into 2 types, type A and type B.
Type A involves the ascending aorta (DeBakey types I and II); type B does not (DeBakey type III).This system also helps delineate treatment. Usually, type A dissections require surgery, while type B dissections may be managed medically under most conditions.
The DeBakey classification divides dissections into 3 types.
Type I involves the ascending aorta, aortic arch, and descending aorta.
Type II is confined to the ascending aorta.
Type III is confined to the descending aorta distal to the left subclavian artery. Type III dissections are further divided into IIIa and IIIb. Type IIIa refers to dissections that originate distal to the left subclavian artery but extend both proximally and distally, mostly above the diaphragm. Type IIIb refers to dissections that originate distal to the left subclavian artery, extend only distally and may extend below the diaphragm. Thoracic aortic dissections should be distinguished from aneurysms (ie, localized abnormal dilation of the aorta) and transections, which are caused most commonly by high-energy trauma.
Places where aortic dissection is most commonly found:
The most common site of dissection is the first few centimeters of the ascending aorta, with 90% occurring within 10 centimeters of the aortic valve. The second most common site is just distal to the left subclavian artery. Between 5% and 10% of dissections do not have an obvious intimal tear. These often are attributed to rupture of the aortic vasa vasorum as first described by Krukenberg in 1920.
Aortic dissection involves bleeding into and along the wall of the aorta (the major artery from the heart), most often because of a tear or damage to the inner wall of the artery. This usually occurs in the thoracic (chest) portion of the aorta, but may also occur in the abdominal portion.
The exact cause is unknown, but risks include atherosclerosis (hardening of the arteries) and high blood pressure. Traumatic injury is a major cause of aortic dissection, especially blunt trauma to the chest as can be caused by hitting the steering wheel of a car during an accident.
Aortic dissection may also be associated with other injury, infection, congenital (present from birth) weakness of the aorta, collagen disorders (such as Marfan's syndrome, pseudoxanthoma elasticum, Ehlers-Danlos syndrome, relapsing polychondritis, or abdominal aortic aneurysm). Pregnancy, valve disorders (including aortic insufficiency), and coarctation of the aorta may also be associated with aortic dissection.
Frequency:
In the US: The true incidence of dissection is difficult to estimate. Most estimates are based on autopsy studies. One population-based study estimated the incidence at roughly 6 new aneurysms per 100,000 person-years. Evidence of dissection is found in 1-3% of all autopsies. Aortic dissection occurs in approximately 2 out of every 10,000 people.
Mortality/Morbidity:
From 1-2% of patients with aortic dissection die per hour for the first 24-48 hours. Aortopathy may be present in heritable diseases such as Marfan syndrome, Ehlers-Danlos syndrome, annuloaortic ectasia, familial aortic dissections, adult polycystic kidney disease, Turner syndrome, Noonan syndrome, osteogenesis imperfecta, bicuspid aortic valve, coarctation of the aorta, and connective tissue disorders. It is also seen in heritable metabolic disorders such as homocystinuria and familial hypercholesterolemia. Incidence is increased in pregnancy and syphilis. Thoracic aortic dissection also is associated with crack cocaine use and iatrogenic causes, such as cardiac catheterization.
Race: Aortic dissection is more common in blacks than in whites and less common in Asians than in whites.
Sex: The male-to-female ratio is 3:1.
Age: Approximately 75% of dissections occur in those aged 40-70 years, with a peak in the range of 50-65 years.
The key to diagnosing an aortic dissection is to confirm that it is in fact a dissection and not a heart attack, and which type it is (as the treatment options vary significantly). The gold standard for diagnosing aortic dissection is a computed topography (CT)scan. Other imaging studies may be required to identify the type and location of the dissection. These include: Echocardiogram Magnetic resonance imaging (MRI) Peripheral angiography What are the treatment options for an aortic dissection? Three treatment options exist for an aortic dissection: 1) medical management, 2) interventional catheterization, and 3) cardiovascular surgery. Depending upon the location and severity of the dissection, your physician will decide which option is best for you. A small percent of cases (5 - 10%) are Type B dissections (dissections of the descending aorta). This condition can be treated with surgical repair, but it carries significant risk. Typically, your doctor will monitor the condition periodically and prescribe medications to control the dissection. The techniques used to treat dissections are as follows: Medical Therapy: Blood pressure and cholesterol lowering drugs, and treatment to reverse arteriosclerosis Endovascular Intervention: This minimally invasive procedure requires small incisions in the groin. Small wire-like, catheter devices called endoluminal stent grafts are threaded to the location of the dissection. These devices have a woven synthetic graft tip, which is deployed at the site of dissection and left in place. This provides a channel for blood to flow freely, repairing arterial leakage, and preventing pressure from rupturing the aorta. This procedure is much less invasive than the traditional open surgery, usually with a hospital stay of about 2-3 days and a recuperation period of a couple of weeks. Please note: This procedure can only be performed on specific patients based on clinical criteria, and no long-term data exists regarding its effectiveness compared to open surgery. Open Surgical Repair: The traditional treatment technique involves opening the chest and surgical removing the dissected aorta. A synthetic graft is sewn in its place for blood to flow freely to the rest of the arterial system. This procedure often requires a hospital stay of a week or more, and recuperation can take 6-8 weeks.
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