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)
- Type A involving ascending aorta.
- Type B – Jnvolving descending aorta.
AORTIC DISSECTION Etiology : –
- Cystic medial necrosis
- – Marfan syndrome
- -Jo Ehlers-Danlos syndrome
- – Takayasu arteritis
- – Congenital
- Coarctation of aorta
- Common in elderly males.
AORTIC DISSECTION Clinical manifestations
- Hematuria Myocardial ischemia
- Pain is felt in front or back of chest Syncope
- Absent pulses
- Pulmonary edema
- Carotid artery obstruction – resulting in hemiplegia, paraplegia
- Sudden onset of severe pain with sweating.
- 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.
- Thrombectomy Balloon angioplasty.
- Syphilitic aortitis
- Rheumatic aortitis
- Ankylosing spondylitis
- Reiter’s syndrome
- Takayasu arteritis
- Giant cell arteritis.