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Aortic Dissection

I S   I T   A   F A T A L   C O N D I T I O N   ?

Firstly, let’s learn more about the Aorta:

The aorta is the biggest and one of the most important arteries in the body as it transports blood to all parts of the body. The wall of the artery is made up of three layers, the intima, media and adventitia; containing mainly elastic fibres, collagen fibres and many more. The aorta can be divided into three sections, including the ascending, descending and abdominal aorta.

What is Aortic dissection:

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 A dissection occurs when the inner lining of the aorta is torn apart as the blood flows into the lining. This then creates a ‘false lumen’, which is when the tear in the wall of the aorta allows blood to enter and therefore providing an alternative passage of blood to flow. This can lead to complications such as a decrease in blood supply to the rest of the body, dissection affecting other arteries and also blocking of blood flow in the ‘true lumen’, which is the original lumen of the aorta. Inevitably, these can cause failure of vital organs or expansion of the aorta, aneurysm. The rupture may spread to the outer wall of the aorta, weakening the aortic wall and this is when the condition can become very fatal within the next 24-48 hours.

Aortic dissection can be separated into two types of conditions:

Type A: This started off with a tear in the ascending aorta and may extend to the abdominal aorta (the most common and dangerous type).
                Type 1: affects both the ascending and descending aorta.
                Type 2: affects only the ascending aorta.
Type B: This occurred at the descending aorta which may extend to the abdomen.

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Risk factors associated with aortic dissection:

  • Hypertension (high blood pressure)

  • Atherosclerosis (buildup of plaque in the artery)

  • Weakened and swelling artery

  • Aortic valve stenosis (narrowing the opening of the aortic valve)

  • Aortic coarctation (narrowing of the aorta)

  • Genetic disorders relating to the aorta and aortic valve

  • Average age of aortic dissection occurring is in the 60s.

Diagnosis

                 DANGER → They may mimic certain symptoms of other diseases, leading to the delay of their diagnosis.

  • Measuring blood pressure

  • Evaluating the heart and pulse rate

  • Suspicions of a heart murmur

  • ECG (electrocardiogram) 

  • displays dissectionChest x-ray 

  • Indicating enlargement of the aorta

  • Computed tomography (CT) scan

  • True and false lumen

  •  Transesophageal echocardiogram

  • Image the heart and the aorta, 

  • Magnetic resonance imaging (MRI) 

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Symptoms:

  • Sudden severe chest or upper back pain (known as a ‘tearing sensation’)

  • Severe abdominal pain

  • Loss of consciousness

  • Shortness of  breath

  • Heart attack

  • Stroke

  • Sudden difficulty in speaking, loss of vision or weakness of one side of the boy.

Treatment

             Control blood pressure

  • Morphine is used to reduce any painful sensations (pain can cause an increase in blood pressure).

  • Intake of beta blockers is also recommended as it can lower the heart rate and blood pressure as well.

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         Surgical treatment 

Acute aortic dissection involves the ascending aorta, immediate surgery is indicated (this can be difficult). A Dracon graft is required to replace part of the aorta to prevent blood flow into the false lumen’ and damaged valves will also be replaced. The catheter-based procedure improves vital organ arterial perfusion, the catheter is inserted through a blood vessel. Once the catheter has been removed the surgeon will then close the incision and wrap a small bandage around the wound. 
 
However, patients with chronic aortic dissection (patient who has suffered from this condition for a long period of time) can be treated with the reliance on medical therapies.

Preventions

  • Control blood pressure -using blood pressure measuring device to help monitor blood pressure

  • Don't smoke

  • Maintain an ideal weight- consuming low-salt diet and taking regular exercise

  • Work closely with doctors if there is a genetic predisposition of having aortic dissection.

REFERENCES: 
James H Black, III, MDWarren J Manning, MD. (2019) Management of acute aortic dissection. [online] available at: https://www.uptodate.com/contents/management-of-acute-aortic-dissection
 
James H Black, III, MDWarren J Manning, MD. (2019) Clinical features and diagnosis of acute aortic dissection. [online] available at: https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-acute-aortic-dissection
 
Derek Juang, MD Alan C. Braverman, and MD Kim EagleMDFrom the Cardiovascular Division, Department of Medicine, University of Michigan School of Medicine, Ann Arbor (D.J., K.E.); and the Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Mo (A.C.B.). (2008) . Aortic Dissection.  [online] available at: https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.108.799908
 
Mark Graber, MD. (2003) Crushing Chest Pain: A Missed Opportunity  [online] available at:  https://psnet.ahrq.gov/web-mm/crushing-chest-pain-missed-opportunity

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