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'''For the WikiDoc page for this topic, click [[Aortic dissection|here]]'''


{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}


==What is aortic dissection?==
==Overview==
Aortic dissection is when the layers within the aortic wall separate, which cause bleeding into and along the walls of the aorta, the major artery carrying blood out of the heart.
Aortic dissection is a serious condition in which there is a separation of the [[aorta]] walls. The small tear can come larger. It can lead to [[bleeding]] into and along the wall of the [[aorta]], the major [[artery]] carrying blood out of the heart.


==What are the symptoms of aortic dissection?==
==What are the symptoms of Aortic dissection?==
The symptoms usually begin suddenly, and include severe [[chest pain]]. The pain may:
The [[symptom]]s usually begin suddenly, and include severe [[chest pain]]. The pain may feel like a [[heart attack]], and can:
:*Be described as sharp, stabbing, tearing, or ripping
*Be described as sharp, stabbing, tearing, or ripping
:*Be felt below the chest bone, then moves under the shoulder blades or to the back
*Be felt below the chest bone, then move under the [[shoulder blade]]s or to the back
:*Move to the shoulder, neck, arm, jaw, abdomen, or hips
*Move to the shoulder, neck, arm, jaw, abdomen, or hips
:*Change position -- pain typically moves to the arms and legs as the aortic dissection gets worse
*Change position -- pain typically moves to the arms and legs as the aortic dissection gets worse


Other symptoms may include:
[[Symptom]]s are caused by a decrease of blood flowing to the rest of the body, and can include:
:*Changes in thought ability, confusion, disorientation
*[[Anxiety]] and a feeling of doom
:*Decreased movement in any part of the body
*[[Fainting]] or [[dizziness]]
:*Decreased sensation in any part of the body
*Heavy sweating ([[clammy skin]])
:*[[Dizziness]]
*[[Nausea]] and [[vomiting]]
:*[[Dry mouth]]
*Pale skin ([[pallor]])
:*[[Dry skin]]
*Rapid, weak [[pulse]]
:*[[Fainting]]
*[[Dyspnea|Shortness of breath]] -- trouble breathing when lying flat ([[orthopnea]])
:*[[Nausea and vomiting]]
:*[[Pallor]]
:*Profuse sweating (clammy skin)
:*Rapid, weak pulse
:*Shortness of breath -- difficulty breathing when lying flat ([[orthopnea]])


==What causes aortic dissection?==
Other [[symptom]]s may include:
The exact cause is unknown, but risks include atherosclerosis (hardening of the arteries) and high blood pressure. Traumatic injury is a major cause of aortic dissection, especially blunt trauma to the chest. Hitting the steering wheel of a car during an accident is a common traumatic cause.
*[[Pain]] in the [[abdomen]]
*[[Stroke]] [[symptom]]s
*[[dysphagia|Swallowing difficulties]] from pressure on the [[esophagus]]
 
==What causes Aortic dissection?==
When it leaves the heart, the [[aorta]] first moves up through the chest toward the head (the [[ascending aorta]]). It then bends or arches, and finally moves down through the chest and [[abdomen]] (the [[descending aorta]]). Aortic dissection most often happens because of a tear or damage to the inner wall of the [[aorta]]. This usually occurs in the chest ([[thoracic]]) part of the [[artery]], but it may also occur in the [[abdominal]] part.
 
When a tear occurs, it creates two channels:
*One in which blood continues to travel
*Another where blood stays still
 
If the channel with nontraveling blood gets bigger, it can push on other branches of the [[aorta]]. This can narrow the other branches and reduce blood flow through them. An aortic dissection may also cause abnormal widening or ballooning of the [[aorta]] ([[aneurysm]]).
 
==Who is at highest risk?==
The exact cause is unknown, but more common risks include:
*Aging
*[[Atherosclerosis]]
*Blunt trauma to the chest, such as hitting the steering wheel of a car during an accident
*High [[blood pressure]]


Other risk factors and conditions associated with the development of aortic dissection include:
Other risk factors and conditions associated with the development of aortic dissection include:
:*Aging
*[[Bicuspid aortic valve]]
:*[[Bicuspid aortic valve]]
*[[Coarctation of the aorta|Coarctation (narrowing) of the aorta]]
:*[[Coarctation]] (narrowing) of the aorta
*[[Connective tissue disorder]]s
:*[[Connective tissue disorders]]
*[[Heart surgery]] or procedures
:*[[Ehlers-Danlos syndrome]]
*[[Marfan syndrome]] and rare [[genetic disorder]]s
:*[[Heart surgery]] or procedures
*[[Pregnancy]]
:*[[Marfan syndrome]]
*[[Swelling]] of the [[blood vessel]]s due to conditions such as [[arteritis]] and [[syphilis]]
:*[[Pregnancy]]
 
:*[[Pseudoxanthoma elasticum]]
Aortic dissection occurs in about 2 out of every 10,000 people. It can affect anyone but is most often seen in men ages 40 to 70.
:*Vascular inflammation due to conditions such as [[arteritis]] and [[syphilis]]
 
==Diagnosis==
The health care provider will take your family history and listen to your heart, lungs, and [[abdomen]] with a [[stethoscope]]. The examination may find:
*A "blowing" [[murmur]] over the [[aorta]], [[heart murmur]], or other abnormal sound
*A difference in [[blood pressure]] between the right and left arms, or between the arms and legs
*Low [[blood pressure]]
*Signs resembling a [[heart attack]]
*Signs of [[shock]], but with normal [[blood pressure]]
 
Aortic dissection or [[aortic aneurysm]] may be seen on:
*[[Aortic]] [[angiography]]
*[[Chest x-ray]]
*Chest [[MRI]]
*[[CT scan]] of chest with dye
*[[Doppler]] [[ultrasonography]] (occasionally performed)
*[[Echocardiogram]]
*[[Transesophageal echocardiogram|Transesophageal echocardiogram (TEE)]]
 
Blood work to rule out a [[heart attack]] is needed.


==When to seek medical care==
==When to seek urgent medical care?==
If you have symptoms of aortic dissection or severe chest pain, call 911 or your local emergency number, or go to the emergency room as quickly as possible.
If you have [[symptom]]s of aortic dissection or severe [[chest pain]], call 911 or your local emergency number or go to the emergency room as quickly as possible.


==Treatment options==
==Treatment options==
Aortic dissection is a life-threatening condition and needs to be treated right away.
*Dissections that occur in the part of the [[aorta]] that is leaving the heart (ascending) are treated with [[surgery]].
*Dissections that occur in other parts of the [[aorta]] (descending) may be managed with [[surgery]] or medications.
Two different techniques may be used for [[surgery]]:
*Standard, open [[surgery]] -- a [[surgery|surgical]] cut is made in the chest or [[abdomen]]
*[[Endovascular]] [[aortic]] repair -- [[surgery]] is done without any major [[surgery|surgical]] cut
Drugs that lower [[blood pressure]] may be prescribed. These drugs may be given through a vein ([[IV|intravenously]]). [[Beta-blockers]] are the first drugs of choice. Strong pain relievers are usually needed. If the [[aortic valve]] is damaged, [[valve replacement]] is needed. If the heart [[artery|arteries]] are involved, a [[CABG|coronary bypass]] is also performed.
==Where to find medical care for Aortic dissection?==
[http://maps.google.com/maps?q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|map+top+hospital+Condition}}}}&oe=utf-8&rls=org.mozilla:en-US:official&client=firefox-a&um=1&ie=UTF-8&sa=N&hl=en&tab=wl Directions to Hospitals Treating Aortic dissection]
==Prevention==
Proper treatment and control of hardening of the [[artery|arteries]] ([[atherosclerosis]]) and high [[blood pressure]] may reduce your risk of aortic dissection. It is very important for patients at risk for dissection to tightly control their [[blood pressure]].
Take safety precautions to prevent injuries, which can cause dissections.
Many cases of aortic dissection cannot be prevented.
If you have been diagnosed with [[Marfan syndrome|Marfan]] or [[Ehlers-Danlos syndrome]], make sure you regularly follow-up with your doctor.


Type A aortic dissections require immediate surgery to repair the aorta. Type B aortic dissections may be treated with medication first.
==What to expect (Outlook/Prognosis)?==
Drugs that lower blood pressure may be prescribed. These drugs may be given through a vein (intravenously). Strong pain relievers are usually needed. Heart medications such as beta-blockers may reduce some of the symptoms.
Aortic dissection is life-threatening. The condition can be managed with [[surgery]] if it is done before the [[aorta]] ruptures. Less than half of patients with a ruptured [[aorta]] survive.
If the aortic valve is damaged, valve replacement is necessary. If the heart arteries are involved, a coronary bypass is also performed. Treatment options will be based on whether the patient has type A or type B aortic dissection.


==What to expect (Outlook/Prognosis)==
Those who survive will need lifelong, aggressive treatment of high [[blood pressure]]. They will need to be followed up with [[CT scan]]s every few months to monitor the [[aorta]].
Aortic dissection is life threatening. However, the condition may be managed with surgery if it is done before the aorta ruptures. Less than half of patients with ruptured aorta survive.


==Possible complications==
==Possible complications==
:*Aortic rupture causing rapid blood loss, [[shock]]
Aortic dissection may decrease or stop the blood flow to many different parts of the body. This may result in short-term or long-term problems or damage to the:
:*Bleeding from the aorta
*[[Brain]]
:*[[Blood clots]]
*[[Heart]]
:*[[Cardiac tamponade]]
*[[Intestine]]s or bowels
:*[[Heart attack]]
*[[Kidney]]s
:*Not enough blood flow past the dissection
*Legs
:*Permanent [[kidney failure]]
:*[[Stroke]]


== Sources ==
== Sources ==
http://www.nlm.nih.gov/medlineplus/ency/article/000181.htm
* http://www.nlm.nih.gov/medlineplus/ency/article/000181.htm
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[[CME Category::Cardiology]]


[[Category:Disease]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]
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[[Category:Up-To-Date cardiology]]
[[Category:Patient information]]

Latest revision as of 20:35, 20 December 2019

Aortic dissection

Overview

What are the symptoms?

What are the causes?

Who is at highest risk?

Diagnosis

When to seek urgent medical care?

Treatment options

Where to find medical care for Aortic dissection?

Prevention

What to expect (Outlook/Prognosis)?

Possible complications

Aortic dissection On the Web

Ongoing Trials at Clinical Trials.gov

Images of Aortic dissection

Videos on Aortic dissection

FDA on Aortic dissection

CDC on Aortic dissection

Aortic dissection in the news

Blogs on Aortic dissection

Directions to Hospitals Treating Aortic dissection

Risk calculators and risk factors for Aortic dissection

For the WikiDoc page for this topic, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Aortic dissection is a serious condition in which there is a separation of the aorta walls. The small tear can come larger. It can lead to bleeding into and along the wall of the aorta, the major artery carrying blood out of the heart.

What are the symptoms of Aortic dissection?

The symptoms usually begin suddenly, and include severe chest pain. The pain may feel like a heart attack, and can:

  • Be described as sharp, stabbing, tearing, or ripping
  • Be felt below the chest bone, then move under the shoulder blades or to the back
  • Move to the shoulder, neck, arm, jaw, abdomen, or hips
  • Change position -- pain typically moves to the arms and legs as the aortic dissection gets worse

Symptoms are caused by a decrease of blood flowing to the rest of the body, and can include:

Other symptoms may include:

What causes Aortic dissection?

When it leaves the heart, the aorta first moves up through the chest toward the head (the ascending aorta). It then bends or arches, and finally moves down through the chest and abdomen (the descending aorta). Aortic dissection most often happens because of a tear or damage to the inner wall of the aorta. This usually occurs in the chest (thoracic) part of the artery, but it may also occur in the abdominal part.

When a tear occurs, it creates two channels:

  • One in which blood continues to travel
  • Another where blood stays still

If the channel with nontraveling blood gets bigger, it can push on other branches of the aorta. This can narrow the other branches and reduce blood flow through them. An aortic dissection may also cause abnormal widening or ballooning of the aorta (aneurysm).

Who is at highest risk?

The exact cause is unknown, but more common risks include:

Other risk factors and conditions associated with the development of aortic dissection include:

Aortic dissection occurs in about 2 out of every 10,000 people. It can affect anyone but is most often seen in men ages 40 to 70.

Diagnosis

The health care provider will take your family history and listen to your heart, lungs, and abdomen with a stethoscope. The examination may find:

Aortic dissection or aortic aneurysm may be seen on:

Blood work to rule out a heart attack is needed.

When to seek urgent medical care?

If you have symptoms of aortic dissection or severe chest pain, call 911 or your local emergency number or go to the emergency room as quickly as possible.

Treatment options

Aortic dissection is a life-threatening condition and needs to be treated right away.

  • Dissections that occur in the part of the aorta that is leaving the heart (ascending) are treated with surgery.
  • Dissections that occur in other parts of the aorta (descending) may be managed with surgery or medications.

Two different techniques may be used for surgery:

Drugs that lower blood pressure may be prescribed. These drugs may be given through a vein (intravenously). Beta-blockers are the first drugs of choice. Strong pain relievers are usually needed. If the aortic valve is damaged, valve replacement is needed. If the heart arteries are involved, a coronary bypass is also performed.

Where to find medical care for Aortic dissection?

Directions to Hospitals Treating Aortic dissection

Prevention

Proper treatment and control of hardening of the arteries (atherosclerosis) and high blood pressure may reduce your risk of aortic dissection. It is very important for patients at risk for dissection to tightly control their blood pressure.

Take safety precautions to prevent injuries, which can cause dissections.

Many cases of aortic dissection cannot be prevented.

If you have been diagnosed with Marfan or Ehlers-Danlos syndrome, make sure you regularly follow-up with your doctor.

What to expect (Outlook/Prognosis)?

Aortic dissection is life-threatening. The condition can be managed with surgery if it is done before the aorta ruptures. Less than half of patients with a ruptured aorta survive.

Those who survive will need lifelong, aggressive treatment of high blood pressure. They will need to be followed up with CT scans every few months to monitor the aorta.

Possible complications

Aortic dissection may decrease or stop the blood flow to many different parts of the body. This may result in short-term or long-term problems or damage to the:

Sources

Template:WH Template:WS CME Category::Cardiology