Aortic Dissection

Aortic dissection is a disorder in which the inner wall of aorta, the largest blood vessel in the body, tears and separates from the middle layer. The dissection or separation happens as blood surges through the wall when the inner lining tears. Dissection can lead to blood vessel rupture or reduced blood flow through the vessel. Symptoms of dissection are not specific and resemble that of many other conditions. This makes diagnosis hard. It is diagnosed by X-ray and CT scan. The tear can be repaired by surgery or stent. Medications are recommended to regulate blood pressure.

Symptoms of aortic dissection resemble that of many other common heart ailments. The most common symptoms of the condition are:

• Sudden, excruciating pain in the chest or upper back. The pain feels like ripping or tearing, and the pain may extend to abdomen or lower back, if the arteries in these regions are blocked 
• Fainting as a result of pain
• Difficulty in breathing
• Difficulty in speaking
• Weakness of one side of the body
• Weak pulse in one arm

The main cause of Aortic dissection is the weak regions of the wall of the blood vessel. High blood pressure is one of the contributing factors for weakening of arterial walls. Certain genetic conditions like Marfan syndrome, characterized by weak and enlarged aorta, increases the risk of blood vessel tear. It is also associated with bicuspid aortic valve and other rare conditions. In some people aortic dissection is congenital.

Aortic dissections are of two types, depending on the location of dissection in the blood vessel:

• Type A – the tear is located at the region of aorta where it exits heart or in the upper part of the blood vessel. This is more common and dangerous type of aortic dissection.
• Type B – This involves a dissection in the lower part of aorta. This may also extend to the abdomen.

Major risk factors for aortic dissection are:

• Hypertension
• Atherosclerosis
• Aortic aneurysms
• Defect in aortic valve, like bicuspid valve
• Narrowing of aorta
• Genetic diseases like Turner’s syndrome, Marfan syndrome, connective tissue disorders, and inflammatory diseases are also known to increase the risk of aortic dissection. It is more commonly seen among men in the age group of 60-80 years. Cocaine increases blood pressure temporarily and is a risk factor in the development of aortic dissection. Strenuous physical strain like heavy weight lifting increase blood pressure, and thus enhance the chances of aortic wall separation.

Making a diagnosis of aortic dissection is done by several tests.

Symptoms of aortic dissection are not specific and resemble that of many other conditions. The most characteristic symptoms that indicate aortic dissection are:

• Sudden, excruciating pain in the chest or upper back
• Enlarged aorta as seen in chest X-ray
• Difference in blood pressure between arms and legs

Sensitive imaging techniques are used to visualize the structure of blood vessels. Transesophageal echocardiogram provides a clear picture of heart and blood vessel. CT scan provides a clear image, particularly when used with a contrast dye. Magnetic resonance angiogram also is sensitive technique for obtaining clear image of the heart and blood vessels.

Treatment of aortic dissection depends on the part of aorta involved. Surgery and medications are the usual recommendations for treating aortic dissections.

Type A aortic dissection – In surgical repair of the dissection, surgeons remove the torn part of the wall and block the entry of blood into the region. The wall of the blood vessel is then reconstructed with a synthetic graft. Blood pressure lowering medications are used to reduce heart rate and blood pressure, thus preventing the worsening of symptoms.

Type B aortic dissection—the wall separation can be corrected by removing the tear and placing a stents. Beta blockers and nitroprussides are used to lower blood pressure.

Surgical repair requires regular follow up and blood pressure lowering medications for a life time.

Reducing the risk factors are the best preventive measures for aortic dissection. Controlling blood pressure and maintaining a healthy body weight are the most important among them. Conditions like aortic aneurysms or a family history of dissection require periodic monitoring.

A few alternative and homeopathic remedies exist for aortic dissection.

Belladonna, nux vomica, natrum muriaticum, glonoine, and rauwolfia are used to reduce blood pressure, one of the common causes of aortic dissection. Relaxation techniques help to control breathing and blood pressure.

Lifestyle modifications are necessary in order to cope with aortic dissection.

Keeping the blood vessels healthy is a good self-management principle for controlling aortic dissections.

Avoiding substance abuse, keeping blood pressure normal, regular exercise, and having a healthy diet keep the blood vessels healthy and strong. Learn relaxation techniques to avoid stressful situations.

Talk to doctor or other healthcare professionals about the fear and experiences for coping with the condition.

Joining a support group may be helpful.

Aortic dissection may lead to bleeding, a fatal complication. It may also lead to organ damage, stroke, and aortic valve damage.