Aortic Dissection, Causes, Diagnosis, Treatment, Prevention, Complications

Aortic dissection is a condition when the inner lining of the aortic blood vessels tears and separates from the middle layer of the aortic wall. Sometimes, the symptoms of an aortic dissection are similar to those of other diseases, such as heart disease and stroke. If not treated immediately, this condition can be fatal.

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The aorta is the largest artery in the body that functions to receive oxygen-rich blood from the heart. This oxygen-rich blood will flow throughout the body through the branches of the arteries.

If the aorta is torn, blood will leak and flow through the gaps between the tears, forming false blood vessels in the aortic wall that keep the inner and middle layers of the aorta separated.

Aortic dissection is divided into type A and type B. In type A, the tear occurs in the upper aorta (ascending aorta). Whereas in type B, the tear occurs in the lower aorta (descending aorta). Both types of aortic dissection can extend into the abdomen, but type A aortic dissection is generally more dangerous than type B aortic dissection.

Causes and Risk Factors of Aortic Dissection

Aortic dissection occurs where the aortic wall is weak and damaged. It is not known exactly what caused this damage. However, there are several factors that can increase the risk of damage to the aortic wall, namely:

Age over 60 years
Pregnant or high blood pressure during delivery
Family history of aortic dissection
Hardening of the arteries (atherosclerosis)
Weakness and swelling in the arteries (aortic aneurysm)
Congenital abnormalities of the heart and blood vessels, such as aortic stricture, patent ductus arteriosus, bicuspid aortic valve, and coarctation of the aorta
Genetic diseases, such as Turner syndrome, Marfan syndrome, Loeys-Diets syndrome, and Ehlers-Danlos syndrome
Swelling in the blood vessels, for example due to arteritis
Sexually transmitted diseases, such as syphilis
Injury to the chest, for example from a car accident or fall
Habit of smoking or using cocaine
Habit of lifting weights excessively

Symptoms of Aortic Dissection

The symptoms of aortic dissection are similar to those of other diseases, especially heart disease. Generally, the symptoms of aortic dissection occur suddenly and can occur at any time. Some of the symptoms are:

Pain in the chest and upper back that appears suddenly and is unbearable, like a stabbing sensation that travels to the neck and lower back
Sudden severe abdominal pain due to a blockage in the vessels that carry blood to the intestines (mesenteric arteries)
Stroke-like symptoms, such as difficulty speaking, visual disturbances, and paralysis on one side of the body
Weak pulse on one side of the arm or thigh compared to the other
Pain in the legs which may be accompanied by difficulty walking or paralysis
Tingling or numbness in the fingers or toes
Excessive sweating
dazed
Hard to breathe
Dizzy
Nauseous
Faint

When to see a doctor

Immediately see a doctor if you experience symptoms of chest pain, shortness of breath, or symptoms of a stroke. Left aortic dissection can cause internal bleeding and heart damage.

Please note, some of the symptoms above do not always indicate a serious condition. However, you are still advised to see a doctor. By undergoing early examination and treatment, you will avoid complications that can be fatal.

Diagnosis of Aortic Dissection

Aortic dissection is not easy to detect, because it presents symptoms that are similar to a number of other medical conditions.

To diagnose aortic dissection, the doctor will ask about the patient's symptoms, as well as the patient's and family history. Next, the doctor will check the patient's heartbeat using a stethoscope and measure the blood pressure in both the patient's arms.

The doctor can suspect the patient has an aortic dissection if the blood pressure in the two arms of the patient is different. However, to further confirm the diagnosis, the doctor will carry out supporting examinations, such as:

Chest X-ray, to see if there is aortic dilation
Transesophageal echocardiography (transesophageal echocardiogram), to see a picture of the heart
CT scan, to see the condition of the heart, aorta, and other blood vessels more clearly by using a contrast agent
Magnetic resonance angiogram (MRA), to see blood flow in the aorta

Treatment of Aortic Dissection

Aortic dissection can cause death several hours after the attack occurs. Therefore, the patient must get treatment immediately. Some of the handling methods are:

Drugs

Medicines that doctors can give are beta blockers and sodium nitroprusside. Administration of these drugs aims to lower heart rate and blood pressure so that the aortic dissection does not get worse.

Operation

Surgery is performed to remove the damaged portion of the aorta and replace it with a synthetic material. If there is a leak in the heart valve, the doctor will also perform heart valve replacement surgery.

After conditions return to normal, all patients with aortic dissection must take drugs for the rest of their lives to reduce pressure in the aorta and maintain blood pressure stability.

The drugs in question include antihypertensive drugs such as beta blockers or calcium antagonists, angiotensin-converting enzyme (ACE) inhibitor drugs, and cholesterol-lowering drugs.

Complications of Aortic Dissection

Aortic dissection can extend along the length of the aorta and can occlude one of the arterial branches so that blood flow is blocked. This blockage of blood flow can cause various complications, depending on the location of the blockage.

Complications that can occur due to aortic dissection are:

Heart valve damage
Cardiac tamponade, which is the accumulation of blood or fluid in the space between the heart and the heart muscle
Stroke, resulting from a blockage in an artery that supplies blood to the brain
Heart attack, if a blockage occurs in the arteries that supply blood to the heart muscle
Kidney failure, resulting from blockages in the arteries that supply blood to the kidneys
Damage to the spinal cord causing paralysis in the limbs if the arteries in the spinal cord are blocked
Death, due to internal bleeding

Prevention of Aortic Dissection

Aortic dissection cannot be completely prevented, but you can lower your risk of developing this disease by:

Control blood pressure regularly
Maintain ideal body weight
Do not smoke
Maintain diet and avoid foods high in cholesterol
Wear a seat belt when driving a car, to avoid impact to the chest
Consult with your doctor about the health conditions of you and your family, especially if there is a history of disease or abnormalities of the aortic blood vessels

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