AORTIC DISSECTION Etiology Clinical manifestations Treatment

• Aortic dissection is a tear of the intima transversely or circumferentially .
• relatively uncommon, though catastrophic illness often presenting with severe chest pain and acute hemodynamic compromise
• It is commonly seen along the right lateral wall of ascending aorta.
• primary event in aortic dissection is a tear in the aortic intima
• Blood passes into the aortic media through the tear, separating the intima from the surrounding media and/or adventitia, and creating a false lumen
• Propagation of the dissection can occur both distal and proximal to the initial tear

Aortic dissection may be : (Stanford classification)

1. Type A  involving ascending aorta.
2. Type B – Jnvolving descending aorta.

AORTIC DISSECTION Etiology  : –

• Atherosclerosis
• Hypertension
• Cystic medial necrosis
• – Marfan syndrome
• -Jo Ehlers-Danlos syndrome
• – Takayasu arteritis
• – Congenital
• Coarctation of aorta
• Vasculitis.
• Common in elderly males.

AORTIC DISSECTION Clinical manifestations

• Hematuria Myocardial ischemia
• Pain is felt in front or back of chest Syncope
• Dyspnoea
• Hypertension
• Hypotension
• Absent pulses
• AR
• Pulmonary edema
• Carotid artery obstruction – resulting in hemiple­gia, paraplegia
• Sudden onset of severe pain with sweating.

Investigations

• X-ray chest – widened mediastinum
• ECG – may show MI or LVH strain pattern
• 2D echocardiography Aortography Coronary angiography
• TEE – transesophageal cardiography CT, MRI.

AORTIC DISSECTION Treatment

• For hypertension-antihypertensives like IV beta blockers, Verapamil, Diltiazem
• For hypotension – IV fluids
• Surgical correction
• Aortic grafts.

AORTIC OCCLUSION Atherosclerotic occlusive disease

• Claudication of back, hips, thighs-as in Leriche syndrome, in which there is occlusion of the aorta at ~he .origin of the .l!.@c arteries or the bifurcate
• Absence of pulses
• Cold lower limbs
• Occlusion can occur at other sites also.

Treatment

• Thrombectomy Balloon angioplasty.

AORTITIS Causes:

• Syphilitic aortitis
• Rheumatic aortitis
• Ankylosing spondylitis
• Psoriatic
• Reiter’s syndrome
• Takayasu arteritis
• Giant cell arteritis.