Aortic dissection

Aortic dissection, also known as aortic dissecting aneurysm, is a rare and fatal disease with many causative factors. In addition to being related to other diseases, pregnancy, severe trauma, and heavy physical labor may all lead to aortic dissection. Because contracting this disease is potentially fatal, we need to learn as much as possible about it and take the best possible precautions.

The cause of the disease is still unknown. Most patients with aortic dissection have hypertension, and many have cystic medial necrosis. Hypertension is not the cause of cystic medial necrosis, but it can promote its development. Clinical and animal experiments have found that it is not the height of blood pressure but the amplitude of blood pressure fluctuation that is related to aortic dissection. Cystic medial necrosis of the aorta is quite common in the hereditary disease Marfan syndrome, and the chance of aortic dissection is also high. Other hereditary diseases such as Turner syndrome and Ehrlich-Danlos syndrome also have a tendency to cause aortic dissection. Aortic dissection is also prone to occur during pregnancy. The reason is unknown. It may be that endocrine changes during pregnancy cause the structure of the aorta to change, making it more prone to rupture. The aortic wall of a normal adult can withstand strong pressure, and it takes more than 66.7kPa (500mmHg) to cause the wall to rupture. Therefore, the prerequisite for dissection dehiscence is a defect in the arterial wall, especially in the middle layer. Generally speaking, in the elderly, the main problem is the degeneration of the middle layer muscles, while in the young, the main problem is the lack of elastic fibers. As for the minority of aortic dissections without intimal ruptures, it may be caused by intramural bleeding due to the rupture of the nourishing vessels in the degenerative lesions of the middle layer. The presence of atherosclerosis is more likely to cause aortic dissection.

Clinical manifestations: This disease usually develops rapidly, with sudden severe pain, shock and symptoms of organ ischemia caused by hematoma compressing the corresponding aortic branch vessels. Some patients died during the acute phase (within 2 weeks) from cardiac complications such as cardiac tamponade and arrhythmia. The peak age is 50 to 70 years old, and the incidence rate in men is higher than that in women. 1. Pain is a prominent and characteristic symptom of this disease. Some patients experience sudden, acute, severe, persistent and intolerable pain, unlike the pain of myocardial infarction which gradually worsens and is not as severe. The location of pain can sometimes indicate the location of the tear; if there is only pain in the anterior chest, more than 90% of the time it is in the ascending aorta, and pain in the neck, throat, jaw or face also strongly suggests ascending aortic dissection. If the pain is strongest between the shoulder blades, more than 90% of the time it is in the descending aorta, and pain in the back, abdomen or lower limbs also strongly suggests descending aortic dissection. A very small number of patients only complain of chest pain, which may be caused by the external rupture of the ascending aortic dissection breaking into the pericardial cavity and causing chest pain of cardiac tamponade. The diagnosis of aortic dissection is sometimes easily overlooked and should be taken seriously.

2. Shock, collapse and blood pressure changes: About half or one-third of patients experience symptoms such as pallor, sweating, cold and clammy skin, shortness of breath, rapid pulse, weak or absent pulse after the onset of the disease, and the degree of blood pressure drop is often inconsistent with the above symptoms. Some patients may even experience severe pain and increased blood pressure. Severe shock only occurs when the dissecting tumor ruptures into the pleural cavity and causes massive internal bleeding. Hypotension is mostly caused by cardiac tamponade or acute severe aortic regurgitation. Obvious asymmetry of blood pressure and pulse in both limbs is often highly suggestive of this disease. 3. Damage to other systems: The expansion of the dissecting hematoma may compress adjacent tissues or affect the major branches of the aorta, resulting in different symptoms and signs, making the clinical manifestations complicated and requiring high attention.

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