Aortic dissection

What is aortic dissection?

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 most often occurs in the chest portion of the aorta but can also occur in the abdominal portion. The exact cause is unknown, but risks include atherosclerosis and hypertension. Traumatic injury is a major cause of aortic dissection, especially blunt trauma to the chest as with the steering wheel of a car during an accident. It may also be associated with other injury, infection, congenital weakness of the aorta, collagen disorders such as Marfan's syndrome, pseudoxanthoma, elastoma, Ehlers-Danlos syndrome, relapsing polychondritis, or abdominal aortic aneurysm. Pregnancy, valve disorders (including aortic insufficiency) may also be associated with aortic dissection.

Aortic dissection occurs in approximately 2 out of 10,000 people. It can affect anybody, but it is most common in men over 40 years of age.

Prevention:

Adequate treatment and control of atherosclerosis and hypertension may reduce risk although many cases are not preventable. Use safety precautions to reduce the risk of injury.

Symptoms (some may begin suddenly):

a.) Chest pain

I.) Sudden, severe, sharp, stabbing, tearing, or ripping

II.) Located below the sternum, under the shoulder blades, or in the back

III.) Pain may radiate to shoulder, neck, arm, jaw, abdomen, hips

IV.) Location of pain may change

b.) Difficulty concentrating, feeling confused or disorientated

c.) Decreased movement or sensation, any location

d.) Feelings of anxiety

e.) Rapid pulse, heart rate

f.) Excessive sweating

g.) Dry skin/mouth, increased thirst

h.) Nausea, vomiting

i.) Dizziness, fainting

j.) Shortness of breath

I.) Difficulty breathing when flat and at night

k.) Excessive yawning

l.) Clammy skin

m.) Weak or absent pulse

n.) Excessive cough

o.) High blood pressure

Signs and Tests:

Listening with a stethoscope at the chest and abdomen may reveal a "blowing" murmur over the aorta, a heart murmur, or other abnormality. There may be decreased pulses in the upper extremities. There may be signs of hypovolemia (a decrease in the volume of circulating blood) or signs resembling acute MI. There may also be signs of shock but with normal blood pressure.

Aortic dissection or aortic aneurysm may be revealed on:

a.) an aortic angiography

b.) a chest MRI or CT scan of chest

c.) an echocardiography

d.) a chest X-ray (may show mediastinal widening)

e.) a Doppler ultrasonography (occasionally performed)

f.) ECG may show signs of cardiac tamponade

g.) CBC is performed to evaluate blood loss

Treatment:

The goal of treatment is prevention of complications. Hospitalization is usually required. Antihypertensives may be prescribed to reduce blood pressure.  These may be given through a vein. Analgesics may be needed for pain. Cardiac medications such as beta-blockers may reduce some of the symptoms. Surgical repair or replacement of the section of aorta is curative.

Prognosis:

Aortic dissection may be life threatening. The disorder is curable with surgical repair if it is performed before aortic rupture. Less than half of the patients with ruptured aorta survive.

 Complications:

a.) Bleeding from the aorta

b.) Aortic rupture causing rapid blood loss, shock, death

c.) Clot formation

d.) Insufficient circulation past the area of the dissection

e.) Irreversible kidney failure

f.) Stroke

g.) Myocardial infarction (tissue death)

h.) Cardiac tamponade  

It is imperative that you seek medical attention immediately if you develop severe abdominal pain or other symptoms that are suggestive of an abdominal aortic aneurysm Aortic dissection.

Nagender A. Reddy, M.D.