Aortic dissection

DEFINITIONS

Aortic dissection (aneurysm is split, the split Hematoma) is a condition that is often fatal, where the inner lining of the aorta wall tear suffered while the outer layer intact; blood flow through the rips and split the middle layer and forming a new channel in the aortic wall.

CAUSE

Most of aortic dissection is a result of damage to the arterial wall.

The most common cause damage to the arterial wall is high blood pressure, which is found in more than 65% of patients.

Other causes are:

- Disease of connective tissue derivatives (marfan syndrome and Ehlers-Danlos syndrome)

- Congenital abnormality of the heart and blood vessels (koartasio aorta, patent ductus arteriosus and aortic valve abnormalities)

- Arteriolosklerosis

- Injury.

Although rare, a dissection can occur when doctors insert a tube into the artery (eg aortografi or angiography) or while performing heart surgery and blood vessels.

SYMPTOMS

Patients experiencing pain that is extraordinary, which arise suddenly.

Most people describe his chest like torn or ripped.

Pain is often felt in the back, between his shoulders.

Pain often following the course of cleavage along the aorta.

Division continues, could lead to terututupnya areas where one or more associated with aortic artery.

Depending on which arteries are blocked, there could be a stroke, heart attack, sudden abdominal pain, nerve damage that causes numbness and inability to move limbs.

Diagnosis

Diagnosis based on symptoms are typical.

On physical inspection, 65% of patients had a weak pulse or no palpable in the legs and arms.

Aortic dissection who turned him to the heart, can cause murmurs, which can be heard through the stethoscope.

Blood accumulation may occur in the chest.

A dissection of blood from seeping into the surrounding heart can interfere with heart rate and cause cardiac tamponade.

X-ray showed widening aota at 90% of patients who have symptoms.

To confirm the diagnosis can be performed ultrasound examination.

TREATMENT

Patients treated in intensive care, where the vital signs (pulse, blood pressure and respiratory rate) closely monitored.

Death can occur within a few hours after the occurrence of aortic dissection. Therefore immediately given drugs to lower heart rate and blood pressure to the lowest level, to maintain adequate blood supply to the brain, heart and kidneys.

Immediately after being given medication, it was decided whether to do surgery or simply by continuing the use of drugs.

Almost always advisable to do surgery involving the aortic dissection that is located very close to the heart.

For the dissection of more distant, usually overcome by continuing the use of drugs; except if dissection causes leaking of blood from the artery and the patient has marfan syndrome, then surgery.

During the surgery performed:

- Appointment of as many regions are experiencing aortic dissection

- Prevention of entry of blood into the wrong channel

- Repair of the aorta with a graft made.

If the aortic valve to leak, can be repaired or replaced at the same time.

Prognosis

Approximately 75% of untreated patients will die within the first 2 weeks.

60% of patients treated and survived the first 2 weeks, surviving to 5 years after treatment; 40% survive to 10 years after treatment.

Patients who died within the first 2 weeks, approximately 30% died of complications from dissection and the rest died of other diseases,.

Given the long-term drug therapy to maintain blood pressure remains low, thereby reducing pressure on the aorta.