Aortic Dissection
A Critical Overview
Aortic dissection is an emergency condition characterised by a tear in the inner layer of the aorta, the major artery branching from the heart. This tear allows blood to surge through the tear into the middle layers of the aorta, causing the inner and middle layers to separate (dissect). If not promptly treated, an aortic dissection can lead to fatal complications.
Causes
Several factors can contribute to the risk of an aortic dissection, including:
- High Blood Pressure: The most common risk factor, putting continual stress on the arterial walls.
- Atherosclerosis: The buildup of plaques in the artery walls that can weaken them.
- Smoking: Contributes to the weakening of arterial walls and atherosclerosis.
- Genetic Conditions: Disorders like Marfan syndrome can predispose individuals to an aortic dissection.
- Aortic Valve Defects: Issues with the aortic valve can increase stress on the artery.
- Physical Injury: Trauma to the chest area can initiate a dissection.
- Idiopathic Causes: In some cases, the cause remains unknown.
Symptoms
The symptoms of an aortic dissection can mirror those of other cardiac emergencies, leading to delays in diagnosis:
- Sudden, severe chest or upper back pain, often described as tearing or ripping, radiating to the neck or back.
- Sudden severe abdominal pain.
- Loss of consciousness, shortness of breath.
- Symptoms mimicking a stroke: difficulty speaking, loss of vision, weakness, or paralysis on one side of the body.
- Discrepancy in pulse strength between limbs.
- Leg pain, difficulty walking, or paralysis.
Diagnosis
An Aortic Dissection is often detected inadvertently through an ECHO or ultrasound scan aimed at diagnosing other conditions. A CT angiogram is a more definitive test that confirms the diagnosis and helps determine the treatment approach based on the dissection’s extent.
Treatment for Aortic Dissection
Medications
The initial treatment focuses on stabilising the patient by reducing heart rate and lowering blood pressure to prevent the dissection from worsening. Many patients manage well with medication alone.
Surgery
For more severe cases, surgical intervention might be necessary. This involves removing as much of the dissected aorta as possible, sealing off blood entry into the aortic wall, and reconstructing it with a synthetic graft.
Thoracic Endovascular Aortic Repair (TEVAR)
TEVAR is a minimally invasive option that involves inserting a stent-graft through a small incision in the groin to repair the aorta. This stent-graft helps to realign the aorta, allowing blood to flow correctly while preventing blood from entering the dissected area.
Prevention
Preventative measures include controlling blood pressure, avoiding smoking, maintaining a healthy weight, and wearing seat belts to reduce the risk of traumatic injury. Genetic counseling is recommended for individuals with a family history of aortic dissection or related genetic conditions.
Aortic dissection requires immediate medical attention to prevent life-threatening complications. Through a combination of rapid diagnosis, effective treatment, and preventive lifestyle adjustments, individuals can significantly reduce the risks associated with this serious condition.