Aortic dissection, Chest Pain

Aortic dissection

Aortic dissection

Aorta is the main artery that supplies oxygen and nutrient-rich blood from the heart to other body parts. It is a severe condition that begins abruptly in which the inner lining of the body’s main artery tears. Blood rushes out from the torn artery, causing the inner and middle layers of the aorta to split. Aorta dissection is deadly when the blood rushes outside the aortic wall. It is a rare condition and usually occurs in men in their 60s or 70s. It is a life-threatening condition that needs immediate medical attention. 

Types of aortic dissection:

An aortic dissection is mainly caused by a weakened area of the aorta’s wall. It is divided into two subgroups, depending on the part of the affected aorta;

  • Type A aortic dissection:

It is a prevalent and dangerous type of aortic dissection. Tears occur in the part of the aorta closer to the heart. Tears happen in the upper aorta and extend or lead towards the abdomen. It usually requires immediate open chest surgery to treat or repair the aorta dissection from the start. 

  • Type B aortic dissection:

Tears in the lower aorta also extend or lead towards the abdomen. Depending on the aorta dissection location, surgery may or may not be required for immediate treatment.

Causes of aortic dissection:

The causes are underlying, but some are;

  • Weakness in the aortic wall
  • Slowly breakdown of the aortic cells
  • Genetics 
  • High blood pressure
  • Stress on the wall of the aorta 
  • Atherosclerosis 
  • Aortic aneurysm 
  • Aortic coarctation 
  • Bicuspid aortic valve 

Symptoms of the aortic dissection:

Symptoms are similar to other heart problems like a heart attack. The main signs and symptoms are;

  • Sudden and severe chest and upper back pain 
  • Loss of consciousness 
  • Dizziness 
  • Low blood pressure 
  • Sudden and frequent stomach pain 
  • Tearing pain sensation which radiates from the neck to down back
  • Difficulty in breathing 
  • Weakened muscles of arm and thigh
  • Vision problem 
  • Heavy sweating 
  • Difficulty in speaking 
  • Loss of movements 
  • Leg pain 
  • Difficulty in walking 

When to see a doctor:

Early recognition and treatment can save your life. It can be life-threatening and needs immediate medical attention. 40% of patients die immediately due to completely rupturing the aorta and bleeding out. Seek close medical attention when you have the following symptoms;

Risk factors of aortic dissection:

Risk factor are;

  • Hypertension (uncontrolled high blood pressure)
  • Atherosclerosis (hardening of the arteries)
  • Aortic coarctation (congenital disability. Narrowing of the aorta from birth)
  • Aortic valve disease 
  • Vasculitis, especially aortitis 
  • Bicuspid aortic valve (defect in aortic valve)
  • Aortic aneurysm (bulged and weakened artery) 

Certain diseases also increase the risk factor, which are;

  • Turner syndrome:

Heart attacks and other heart problems result from this syndrome. 

  • Marfan syndrome:

In this syndrome, the body’s connective tissue that supports many structures becomes weak. People with this disorder or syndrome have a family history of aortic aneurysms. 

  • Other connective tissue disorders:

Ehlers-Danlos syndrome is a class of connective tissue disorders that leads to loose joints and fragile blood vessels. Loeys-Dietz syndrome cause twisted arteries, especially in the neck region. 

  • Inflammation:

Inflammation of the arteries also leads. 

Other potential risk factor are;

  • Age (it is common in age 60 and older people)
  • Sex (men are more likely affected than women)
  • Cocaine use (drugs temporarily increase blood pressure)
  • Pregnancy
  • High-intensity weightlifting (strenuous resistance training may increase the risk of aortic dissection by raising blood pressure during activity)

Complications of aortic dissection:

Complications are;

  • Severe internal bleeding cause death
  • Stroke
  • Kidney failure causes organ damage
  • Aortic regurgitation (aortic valve damage)
  • Cardiac tamponade (ruptured heart lining)
  • Severe bleeding can lead to death
  • Organ damage 

Diagnosis of aortic dissection:

Detection or diagnosis is very challenging because symptoms are similar to other heart problems. Symptoms are;

  • Frequent or sudden tearing 
  • The difference in blood pressure of left and right arm
  • The widened aorta is shown in the chest X-ray

The following tests are used for aortic dissection diagnosis;

  • Transesophageal echocardiogram:

It is a special echocardiogram to check the clot in the heart. Sound waves are produced and depict a heart in motion. A transducer is inserted through the esophagus to provide a clear image of the aorta. 

  • CT scan of the chest (computerized tomography):

CT scans produce cross-sectional pictures of the body. It confirms the diagnosis of aortic dissection and provides detailed images of the body parts such as bones, fat, muscles, blood vessels, and organs. 

  • MRA (magnetic resonance angiogram):

An MRA uses magnetic field and radio waves energy in this test to produce a clear image of blood vessels and help identify abnormalities or problems. 

Treatment of aortic dissection:

Aortic dissection requires immediate medical treatment. Treatment depends on the area of the aorta and may include medications or surgery. 

Type A aorta dissection:

Treatment of type 1 aorta dissection includes;

  • Medications:

Medications help reduce heart rate and lower blood pressure, preventing aortic dissection. Medicines are given to the patient before surgery. 

  • Surgery:

Surgeons remove the aortic dissection and stop the bleeding in the aortic wall. A synthetic tube is used to rebuild or reconstruct the aorta. If the aortic valve leaks, it may be replaced at that time. New valves were placed in the synthetic tube.

Type B aorta dissection:

Treatment of type 2 aorta dissection includes;

  • Medications:

The same medications used to treat type A are also used to treat type B without surgery. Some vasodilators are used in type 2 aortic dissection;

  • Nitroprusside 
  • Hydralazine 
  • Beta-blockers 

These medications are used to improve or lower blood pressure. 

  • Surgery:

The procedure of surgery is also similar to type A. In type B, some wire mesh tubes are placed in the aorta to repair complex aorta dissection. 

Prevention of aortic dissection:

By doing the following steps, you can reduce or prevent the risk;

  • Control blood pressure: if you are a patient with high blood pressure, take a blood pressure measuring device to monitor daily blood pressure. 
  •  Avoid smoking: take some steps to stop smoking. 
  • Main a healthy weight: do regular exercise. Follow the low salt or fat diet with plenty of fruits, vegetables, and whole grains.
  • Wear a seat belt: wear a seat belt when driving in the car to reduce the risk of chest injury.
  • Work with doctor or healthcare provider: if you have a family history of aortic dissection, remain in contact with your doctor or healthcare provider. 


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