AORTIC DISSECTION

An aortic dissection is a tear in the aorta. This is the primary artery that transports oxygen-rich blood from your heart to the rest of your body. It travels through your chest, belly, and legs. An aortic dissection is an uncommon condition that occurs abruptly when a rip forms in the inner layer of a weaker part of your aorta. Blood rushes through the tear, causing the inner and middle layers (there are three on your aorta wall) to split. As misdirected blood moves between tissue layers, normal blood flow to other regions of your body may slow or halt, and your aorta may rupture altogether.

Types of aortic dissection

There are two main aortic dissection types:

• Stanford Type A Aortic Dissection: This type begins in the first (upper) section of your aorta, near your heart. It may be fatal right away. The first segment of the aorta where the rip began is often repaired or replaced during emergency open-chest surgery. The dissection typically extends the full length of the aorta. This is a more prevalent type than Type B.

• Stanford Type B Aortic Dissection: This type occurs further down your aorta (the descending aorta beyond the arch) and away from your heart. This, like Type A dissection, usually goes from the descending aorta to the abdominal aorta. However, it excludes the initial segment of the aorta. Depending on the site of the dissection and if it is blocking blood flow to your organs, you may or may not need emergency surgery.

Symptoms

Common aortic dissection symptoms you may experience include:

• Sudden, severe, sharp pain in your chest or upper back.

• Severe pain in your belly.

• Shortness of breath (dyspnea).

• Fainting or dizziness.

• Low blood pressure.

• Diastolic heart murmur or muffled heart sounds.

• Rapid, weak pulse.

• Heavy sweating.

• Confusion.

• Loss of vision.

• Stroke symptoms include weakness or paralysis on one side of your body or trouble talking.

Causes

A weakening segment of the aortic wall produces an aortic dissection. Aortic dissections are classified into two categories based on which part of the aorta is affected:

• Type A. This is the more common and dangerous kind, which involves a tear in the aorta near where it exits the heart. The rip may also occur in the ascending aorta, which might extend into the belly.

• Type B. This form involves a rip in the lower aorta (descending aorta), which may also extend into the belly.

Diagnose

A physician may arrange tests such as a chest X-ray, computed tomography (CT) scan, transthoracic echocardiography (TTE), transesophageal echocardiogram (TEE), and magnetic resonance imaging (MRI).

Treatment

The treatment for aortic dissection is determined by where the tear and dissection occur.

• Type A aortic dissection (which affects the initial section of the aorta near your heart) requires emergency surgery.

• If a Type B aortic dissection cuts off blood flow to crucial organs and body components, you will need emergency surgery. These organs include the kidneys, intestines, legs, and spinal cord. If your CT scan reveals any high-risk characteristics, you should seek emergency surgery. In less severe situations, aortic dissection treatments may include medicine to reduce the heart rate or lower blood pressure. If difficulties emerge, you may need to have surgery.

• Surgical options include graft replacement, endovascular stent-graft repair, and hybrid approaches.

Medications

A doctor may prescribe beta-blockers to reduce your heart rate and blood pressure. In some cases of Type B aortic dissection, the dissection may be treated initially with medicine alone. Depending on the severity of the tear and the depth of the dissection, a provider may delay surgery for months or years.

Prevention

Many of the risk factors for aortic dissection are beyond your control. These include being born with specific heart diseases, connective tissue disorders, or genetic risk factors associated with a family history of aortic dissection. However, you can mitigate some of your risks by:

• Managing your blood pressure.

• Avoiding tobacco products.

• Maintaining a weight that’s healthy for you.

• Wear your seat belt to protect your chest from injury in the event of an accident.

• See your provider on a regular basis whenever your health changes.

• If a first-degree relative (parent, child, or sibling) has had an aortic dissection, you should consult a doctor about your risk of developing the condition. A healthcare professional can monitor and treat you before an aortic incident happens.

Conclusion

Aortic dissection is a life-threatening condition that requires immediate medical intervention. Because of the high risk of fatal outcomes, type A ascending aortic dissections frequently require emergency surgery. Initially, medication is often used to treat type B descending aortic dissection; however, if complications arise, surgery may be necessary.

This includes monitoring, lifestyle changes, and blood pressure management. With immediate care and observation, many patients can recover rapidly and reduce their risk of complications.