Have you heard of the dangerous condition called Aortic Dissection? Let's talk about it in detail!

Have you ever wondered what kind of damage can happen to the main blood vessel in our body, the largest pipe that carries blood from the heart to the entire body? Aortic dissection is a dangerous condition that can suddenly become life-threatening. Although this is a bit scary, it is very important to be aware of this. Because if recognized early, it can be treated.

What is Aortic Dissection? Let's understand it simply.

Simply put, an aortic dissection is a tear (a tear) in the wall of your aorta , the main blood vessel that carries oxygenated blood from your heart to your entire body. Think of the aorta as the main water pipe in your home. It runs through your chest, through your abdomen, and down to your legs.

This is a very rare condition. It happens like this: The wall of the aorta is made up of three layers. For some reason, the innermost layer of this wall becomes weak, causing a small tear in it. Then, high-pressure blood rushes through the tear, separating the inner layer and the middle layer. It's like a wall being torn in two. This is called a dissection .

When blood starts to flow in the wrong direction like this, the normal blood flow to other parts of the body can be blocked or reduced. Sometimes, the entire aorta can burst.

This is a very serious, life-threatening condition. If not diagnosed and treated promptly, death can occur. Therefore, if you experience these symptoms, do not panic and go to an emergency room immediately.

It is reported that this condition occurs in between 5 and 30 per million people each year.

What are the main types of aortic dissection?

There are two main types of aortic dissection:

1. Stanford Type A Aortic Dissection: This starts at the very beginning of your aorta, the part closest to your heart. It can be life-threatening . It usually requires emergency open-chest surgery. This involves either repairing the beginning of the torn aorta or removing it and replacing it with a prosthetic part. Most of the time, the dissection continues all the way down the aorta. Type A is more common than type B.

2. Stanford Type B Aortic Dissection: This starts in the lower part of the aorta, a little further from the heart, just after the aortic arch, in the descending aorta. Like Type A, this can usually extend from the descending aorta to the abdominal aorta. However, this type does not involve the first part of the aorta. This may or may not require immediate surgery. This depends on where the dissection is and whether it is blocking blood flow to your other organs.

Doctors use another classification system, called the DeBakey classification system . It has three types. The first type (Type 1) starts in the ascending aorta and extends all the way to the descending aorta. The second type (Type 2) starts in the ascending aorta and is limited to the ascending aorta (both are similar to Stanford type A). The third type (Type 3) starts in the descending aorta and extends downward (this is similar to type B).

What are the symptoms of an aortic dissection? How do you recognize it?

The main characteristic of an aortic dissection is that it occurs suddenly . It can happen at any time. It often occurs during exertion, with a sudden increase in blood pressure. However, it can also happen while you are sleeping or just standing. There are no warning signs that come before it.

These are the common symptoms you may experience:

• A sudden, severe, sharp pain in the chest or upper back. It can feel like it's being torn from the inside, stabbed with a knife, or like skin being ripped off.
• Severe stomach pain.
• Difficulty breathing (dyspnea).
• Fainting or dizziness.
• Low blood pressure.
• Abnormal heart sounds (diastolic heart murmur or muffled heart sounds).
• A rapid, weak pulse.
• Excessive sweating.
• Confusion (inability to concentrate).
• Loss of vision.
• Stroke symptoms include things like weakness on one side of the body and difficulty speaking.

If you have symptoms of an aortic dissection like this, especially severe chest pain or signs of a stroke, call 911 immediately or go to the nearest emergency room. Don't take this for granted, every second counts.

What are the causes of aortic dissection?

An aortic dissection occurs when the cells in the walls of the aorta gradually weaken. This weakening may have been going on for years, until the weakest point in the aortic wall can no longer withstand it. That's when a tear occurs, causing an aortic dissection.

Doctors believe that most cases of aortic dissection are caused by a basic weakness in the aortic wall (perhaps inherited). In other cases, the pressure from persistent high blood pressure can weaken the aortic wall, leading to a tear and dissection.

Aortic dissection usually occurs in areas where the aortic wall is under the greatest pressure. For example, your ascending aorta. Dissections in the upper aorta are about twice as common as those in the lower aorta.

Who is most at risk for this? What are the risk factors?

There are several factors that increase your risk of developing aortic dissection. See if these apply to you:

• Persistent high blood pressure (hypertension): This is the most important and common risk factor . High blood pressure directly damages the tissue layers of the aorta. This causes the elastic fibers to be lost, the structure of the wall to collapse, and the wall to thicken.
• Atherosclerosis (fatty deposits in blood vessels) or high cholesterol.
• Use of tobacco products (cigarettes, beedis, etc.).
• Aortic aneurysm (an abnormal bulge or bulge in the wall of your aorta).
• Aortic valve disease.
• Congenital heart conditions, such as a bicuspid aortic valve (a valve with two leaflets instead of the usual three) or Turner syndrome .
• Connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, are problems that can be inherited from parents to children.
• Other hereditary thoracic aortic conditions, which mainly affect your aorta.
• If someone in your family has had aortic dissection (family history).
• Aortitis (inflammation/swelling of the aorta).
• Severe injuries to the chest. For example, a high-speed vehicle accident, a fall from a height of more than 20 feet.
• Being male (men are at higher risk than women).
• Being between the ages of 40 and 70. As you age, the flexibility of the aortic wall decreases.
• Having high blood pressure during pregnancy, especially during childbirth.
• Activities that can cause high blood pressure over a long period of time, such as using drugs like cocaine or amphetamines.

These conditions can develop quickly in people who engage in powerlifting and are prone to aneurysms or dissection.

If you have these high-risk factors (such as an aneurysm or a connective tissue disorder), find an aortic center of excellence for your treatment. These centers have the latest treatments. They also provide the best care by bringing together a multidisciplinary team of doctors (cardiologists, radiologists, geneticists). Studies have shown that centers that specialize in treating aortic diseases have the best outcomes for these complex cases.

What are the possible complications of aortic dissection?

An aortic dissection can cause serious complications such as:

• Stroke.
• Damage to the aortic valve.
• Heart attack.
• Heart failure.
• Damage to internal organs like the kidneys.
• Cardiac tamponade: The accumulation of fluid between the heart muscle and the sac around the heart (pericardium).
• Death.

How do doctors diagnose aortic dissection? What are the diagnostic methods?

A doctor may suspect aortic dissection based on your symptoms. However, they will need to determine whether you have aortic dissection or another health problem that has similar symptoms, such as a heart attack or stroke. With aortic dissection, it may be difficult to feel the pulses in your arms and legs. A doctor may also find that the blood pressure in one arm is higher than the other.

Doctors need to diagnose aortic dissection quickly because you may need emergency surgery. Once your medical team has diagnosed aortic dissection, a specialized transport team may transfer you to a center that manages these complex conditions.

What are the diagnostic tests?

A doctor may order tests like these:

• Chest X-ray: This is a quick test that uses a small amount of radiation to take pictures of your heart, lungs, blood vessels (such as the aorta), and bones in your chest.
• CT scan: This test helps get the best possible view of the aorta quickly in an emergency. It can help a doctor see if there is an aneurysm or dissection. You may also have a special fluid (IV contrast) injected into your vein as part of this test.
• Transthoracic echocardiogram (TTE): This uses ultrasound technology to produce moving images of your heart valves, heart chambers, and the beginning of your aorta (aortic root).
• Transesophageal echocardiogram (TEE): This can produce clearer, more detailed images of the heart valves and chambers than a regular transthoracic echocardiogram. It also provides a better view of the thoracic aorta in the chest. In this test, a doctor inserts an ultrasound device through your mouth into your esophagus. The esophagus is located directly behind the heart and in front of the descending aorta.
• MRI scan: This uses a large magnet and radio waves to make detailed pictures of the organs and structures inside your body, including your aorta. It can show moving images of the heart valves, chambers, and how blood flows through the aorta. However, this test takes longer than a regular CT scan, so it is used less often in emergencies.

How is an aortic dissection treated?

The treatment for an aortic dissection depends on the location of the tear and dissection.

• For a type A aortic dissection (if the first part of the aorta, closest to the heart, is affected), you will need surgery immediately.
• In a type B aortic dissection, if the dissection cuts off blood flow to vital organs and body parts, such as your kidneys, intestines, legs, or spinal cord, you will need emergency surgery. If your CT scan shows any high-risk features, you will need surgery soon.
• In less severe cases, treatment for aortic dissection may begin with medications to slow your heart rate or lower your blood pressure. Surgery may be performed later if complications develop.

Surgery and Endovascular Treatment

Surgical options include:

• Graft replacement: A surgeon removes the damaged part of your aorta and replaces it with a tube made of artificial tissue (a graft). Depending on the extent of the dissection, they may also need to repair your aortic valve, aortic root, or your aortic arch and the veins that carry blood to your head and arms. This is open-heart surgery and is the best treatment for an emergency type A aortic dissection.
• Endovascular stent-graft repair: In this procedure, a doctor repairs your aorta from the inside. This procedure uses a stent graft. This is a synthetic tube made of metal wires with a support (like a scaffold) attached to it. The stent strengthens the weakened part of the aorta. Endovascular repair is the best option for a complicated (blood flow to vital organs is blocked, or there are high-risk features on a CT scan) type B dissection. A doctor does this by making a small incision in your femoral artery in your groin and using wires and catheters.
• Hybrid approach: In this procedure, a doctor uses both open surgery and endovascular stent-graft techniques to repair the aorta. This technique is used when the repair needs to extend all the way to the aortic arch, which supplies blood to the brain and arms. This can be done as an emergency procedure for a type A dissection. It can also be done as part of a two-stage repair, using a bypass from a blood vessel in your neck to help prepare for an endovascular repair for a type B dissection.

Medicines

A doctor may prescribe medications, such as beta-blockers, to lower your heart rate and blood pressure. In some cases of type B aortic dissection, medications alone may be used to treat the dissection initially. Depending on the severity of the tear and the size of the dissection, surgery may be performed months or years later.

Can aortic dissection be prevented?

There are many factors that you cannot change that increase your risk of developing aortic dissection. For example, certain congenital heart conditions, connective tissue disorders, or genetic factors associated with a family history of aortic dissection.

However, you can reduce some of your risks:

• Control your blood pressure.
• Avoid tobacco products completely.
• Maintain a healthy weight for you.
• Always wear a seat belt when riding in a vehicle to prevent chest injuries in the event of an accident.
• Go for regular medical checkups, and see a doctor if you notice any changes in your health.
• If a first-degree relative (parent, child, or sibling) has had aortic dissection, ask your doctor to assess your risk for aortic disease. Your doctor can then monitor you and provide you with necessary treatment before an aortic event occurs.

If you are diagnosed with an aortic aneurysm, see a doctor who specializes in aortic diseases (a cardiologist or cardiac surgeon). They can assess your risk and, if necessary, monitor you for surgery to repair your aorta.

What to expect if you have an aortic dissection?

Aortic dissection is a potentially life-threatening event. People with sudden aortic dissection (type A) have a higher mortality rate. About 40% of people with type A aortic dissection die immediately, due to the aorta completely rupturing and bleeding.

People who survive the emergency are usually left with a chronic dissection in the untreated parts of their aorta. This may require treatment at a later time.

With the advancement of modern treatments, the prognosis in the chronic phase is improving. However, life expectancy after aortic dissection is short compared to the general population. However, with prompt treatment and management by a trained aortic team, it is possible to live a normal life for many years after aortic dissection.

How do I take care of myself?

A doctor will usually prescribe blood pressure medications, such as beta-blockers, to manage your blood pressure and heart rate. You will need to take these for the rest of your life . You may need more than one blood pressure medication.

It is also very important to avoid tobacco products after an aortic dissection.

Aerobic activities such as walking, cycling, and swimming are good. However, some activities, such as heavy lifting (more than half your body weight), should be avoided. They can increase your blood pressure and put extra pressure on the aorta.

When should I see my doctor?

After you survive an aortic dissection – even if you don’t have surgery – you’ll need to see a doctor regularly (usually every 3 to 12 months) for a CT or MRI scan. This allows doctors to catch any changes early and act accordingly.

What questions should I ask my doctor?

Here are some questions you can ask your doctor:

• What type of aortic dissection do I have?
• Will I need surgery?
• Can you refer me to a support group for people who have had an aortic dissection?

What is the difference between aneurysm, rupture, and dissection?

These words can be a bit confusing, so let's clarify:

• Aortic aneurysm: This is a balloon-like, balloon-like bulge in a weak spot in the wall of your aorta. Or an entire section of the aorta is bulging. An aortic aneurysm can cause aortic rupture or aortic dissection.
• Aortic rupture: This is a complete tear, or hole, in the wall of the aorta, causing blood to leak through the hole into the surrounding area.
• Aortic dissection: This is a tear in the innermost layer of the aorta. This allows blood to leak through, further separating the inner and middle layers of the aortic wall. This can usually extend for a long distance in both directions along your aorta, and can also spread to the blood vessels that branch off from the aorta.

An aortic dissection is a really scary, confusing experience. Surviving it can be a mixed bag of emotions. Your feelings are valid, and there are others who understand what you're going through. Be your own voice, ask questions about anything that's unclear. Keep taking your medications, follow all of your doctor's instructions, and attend all of your doctor's appointments.

It is very important to go to an aortic center of excellence, which has extensive experience in treating these types of diseases and has the support of various specialists. The results obtained from such centers are much better than those that treat a very small number of patients.

The most important message to take home

So, you probably understand by now that Aortic Dissection is a sudden, very dangerous, life-threatening condition. If you experience sudden, severe chest pain, back pain, or symptoms of a stroke, don't ignore it. Seek medical attention immediately.

• Time is life: Early diagnosis and treatment can save a life.
• Be aware of risk factors: Be aware of things like high blood pressure, smoking, and family history. Try to control them.
• Proper treatment and follow-up: Use the medications prescribed by your doctor exactly as prescribed. Go for medical check-ups on time.
• Expert help: If possible, seek treatment from a specialist center that treats these types of illnesses.

We hope this information is useful to you. Stay healthy!

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