AORTIC DISSECTION Etiology and Clinical manifestations with Treatment

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

AORTIC DISSECTION Etiology Clinical manifestations Treatment

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.
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