dissectionThe aorta is a condition when the inner lining of the aortic blood vessel tears and separates from the middle layer of the aortic wall. Sometimes, the symptoms of an aortic dissection are similar to those of heart disease and stroke.
The aorta is the largest artery in the body whose function is to receive oxygen-rich blood from the heart, then circulate it throughout the body through the arteries. If the aorta is torn, blood will leak and flow through the tear, forming a false blood channel in the aortic wall.
Aortic dissection is divided into two, namely:
- Type A aortic dissection, characterized by a tear in the upper aorta (Fig.ascending aorta)
- Type B aortic dissection, characterized by a tear in the lower aorta (Fig.descending aorta)
Both types of aortic dissection can extend into the abdomen. In general, type A aortic dissection is more dangerous than type B aortic dissection.
Causes and Risk Factors of Aortic Dissection
An aortic dissection occurs in a weak, damaged area of the aortic wall. The exact cause of this damage is not known. However, this condition is thought to be influenced by the following factors:
- Uncontrolled high blood pressure
- Hardening of the arteries (atherosclerosis)
- Weakened and swollen arteries (aortic aneurysm)
- Congenital disorders of the heart and blood vessels, such as narrowing of the aorta, 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 of blood vessels, for example due to arteritis
- Sexually transmitted diseases, such as syphilis
- Injury to the chest, for example from a car accident or a fall
- Smoking and cocaine use
- Excessive weight lifting habits
Symptoms of Aortic Dissection
Symptoms of aortic dissection are similar to those of other diseases, especially heart disease. Some of these symptoms are:
- Chest pain and upper back pain that comes on suddenly and becomes unbearable, such as a stabbing sensation that radiates to the neck and lower back
- Abdominal pain that feels severe and sudden if there is a blockage in the mesenteric artery (the vessel that carries blood to the intestines)
- Symptoms are similar to those of a stroke, including sudden difficulty speaking, loss of vision, 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 that may be accompanied by difficulty walking or paralysis
- Tingling or numbness in the fingers or toes
- Excessive sweating
- Hard to breathe
- Dizzy
- Nauseous
- Faint
When to go to the doctor
Immediately consult a doctor if you experience symptoms of chest pain, shortness of breath, or symptoms of a stroke. Left unchecked aortic dissection can cause internal organ bleeding and heart damage.
Please note, some of the symptoms above do not always indicate a serious condition. However, you are still advised to consult a doctor. With early detection and treatment, you will avoid dangerous complications.
Aortic Dissection Diagnosis
Aortic dissection is not easy to detect, as it exhibits symptoms similar to a number of other health problems.
To diagnose it, the doctor will ask about the patient's symptoms, then check the patient's heart rate using a stethoscope and measure the blood pressure in both the patient's arms.
Doctors can suspect a patient has an aortic dissection if the blood pressures in the patient's two arms are different. However, to further confirm the diagnosis, the doctor will perform additional examinations, such as:
- Chest X-ray, to see if there is dilation of the aorta
- Transesophageal echocardiography (transoesophageal echocardiogram), to see a picture of the heart
- CT scan with contrast agent, to see the condition of the heart, aorta, and other blood vessels more clearly
- Magnetic resonance angiogram (MRA), to see blood flow in the aorta
Aortic Dissection Treatment
Aortic dissection can cause death several hours after the attack occurs. Therefore, the patient must be treated quickly. Treatment methods that can be done include:
- Drug administration
Drugs that can be given by doctors are beta blockers and sodium nitroprusside. These medications aim to lower your heart rate and blood pressure, so the aortic dissection doesn't get worse.
- Operation
Surgery is performed to remove the damaged part 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.
Once conditions return to normal, all aortic dissection sufferers must take medication for the rest of their lives to lower pressure in the aorta and keep blood pressure from becoming high.
The drugs in question include antihypertensive drugs such as beta blockers or calcium antagonists, angiotensin converting enzyme (ACE) inhibitors, and cholesterol-lowering drugs.
Complications of Aortic Dissection
An aortic dissection can extend along the length of the aorta and may close one of the branches of the artery, thereby obstructing blood flow. This blockage of blood flow can cause various complications, depending on the location of the blockage.
Complications that can occur as a result of aortic dissection include:
- Heart valve damage (aortic regurgitation)
- Cardiac tamponade, which is the accumulation of blood or fluid in the space between the heart and the heart muscle
- Stroke, due to blockage in the arteries that supply blood to the brain
- Heart attack, if a blockage occurs in the arteries that supply blood to the heart muscle
- Kidney failure, due to blockages in the arteries that supply blood to the kidneys
- Damage to the spinal cord causing paralysis of the legs, if the blockage occurs in the arteries in the spinal cord
- Death due to internal bleeding
Prevention of Aortic Dissection
Aortic dissection cannot be completely prevented, but you can lower your risk of developing the disease by:
- Control blood pressure regularly
- Maintain ideal body weight
- Stop smoking habit
- Wearing a seat belt when driving a car, to avoid hitting the chest
- Consult a doctor about your health condition and that of your family, especially if there is a history of disease or abnormalities in the aortic blood vessels
