Aortic Dissection (cont.)
What are the causes of aortic dissection?
It is uncertain as to why the initial tear (rent) occurs in the intima layer
of the aortic wall. Aortic dissection tends to occur most commonly in men
between the ages of 50 and 70.
High blood pressure: Most cases (over 70%) are associated with
high blood
pressure (hypertension). The aorta has to withstand significant pressure
changes with each heart beat, and it may be that over time with hypertension, a
weakening of an area of the intima will occur.
Associated illnesses:
Pregnancy: Pregnancy is also an associated risk factor, especially in the third
trimester and early in the post-partum period.
Trauma: Blunt trauma is known to cause aortic dissection, often seen after car wrecks
in which the patient's chest hits the steering wheel.
Surgical complications: Aortic dissection can be a complication of medical
operations including coronary artery bypass grafting and aortic and mitral valve
repairs. It can also be a complication of heart catheterization.
What are the signs and symptoms of aortic dissection?
- Pain is the most common symptom of aortic dissection and is often described
as tearing or ripping. The pain usually begins suddenly and is centered in the
chest, radiating directly into the upper back.
- There may be associated nausea, sweating, shortness of breath, and
weakness.
- The patient may pass out (syncope)
- Other symptoms may be related to the location of the dissection within the
aorta and whether it affects some of the branch arteries and occludes their
blood supply. For example, if an artery that supplies blood to the brain is
involved, there may be signs of stroke, or if the dissection affects the
anterior spinal artery and blood supply to the spinal cord, the patient may
present with paraplegia.
- The coronary arteries that supply blood to the heart begin at the origin of the
aorta at the aortic valve. If the coronary arteries are involved, the aortic
dissection may cause a heart attack (myocardial infarction).
- The patient may present with congestive heart failure with fluid building
up in the lungs. If the aortic dissection involves the aortic valve and causes
it to fail, blood flows back into the heart with each beat and causes blood flow
to back-up into the lungs
- There may be significant abdominal or flank (the side of the body between
the ribs and hip) pain.
- The pain of aortic dissection can be confused with that of heart attack,
but can sometimes be distinguished because of its sudden onset and normal
electrocardiogram.
- The patient may also have a sense of impending doom.
Next: How is aortic dissection diagnosed? »
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