Aortic dissection

dissecting aortic aneurysmdissectionthoracic aortic dissectiondissectionsDissection of aortaabdominal aortic dissectionAorta dissectionaorticaortic rupturedissection of the aorta
Aortic dissection (AD) occurs when an injury to the innermost layer of the aorta allows blood to flow between the layers of the aortic wall, forcing the layers apart.wikipedia
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Acute aortic syndrome

Acute Aortic Syndromeschest or back pain
In most cases, this is associated with a sudden onset of severe chest or back pain, often described as "tearing" in character.
These include aortic dissection, intramural thrombus, and penetrating atherosclerotic aortic ulcer.

Aortic rupture

ruptured aortaruptureruptured aortic aneurysm
Aortic dissection can quickly lead to death from not enough blood flow to the heart or complete rupture of the aorta.
Aortic rupture is distinct from aortic dissection, which is a tear through the inner wall of the aorta that can block the flow of blood through the aorta to the heart or abdominal organs.

Dissection (medical)

dissectionarterial dissectiondissecting aneurysm
Aortic dissection (AD) occurs when an injury to the innermost layer of the aorta allows blood to flow between the layers of the aortic wall, forcing the layers apart.
For example, in an aortic dissection, if the left subclavian artery orifice were distal to the origin of the dissection, then the left subclavian would be said to be perfused by the false lumen, while the left common carotid (and its end organ, the left hemisphere of the brain) if proximal to the dissection, would be perfused by the true lumen proximal to the dissection.

Stroke

ischemic strokestrokescerebrovascular accident
Other symptoms may result from decreased blood supply to other organs, such as stroke or mesenteric ischemia. Less common symptoms that may be seen in the setting of AD include congestive heart failure (7%), fainting (9%), stroke (6%), ischemic peripheral neuropathy, paraplegia, and cardiac arrest.

Open aortic surgery

aortic surgeryabdominal aortic aneurysm repairaneurysmectomy
Surgery may be done either by an opening in the chest or from inside the blood vessel.
OAS is used to treat aneurysms of the abdominal and thoracic aorta, aortic dissection, acute aortic syndrome, and aortic ruptures.

Marfan syndrome

Marfan's syndromeMarfanMarfanoid
AD is more common in those with a history of high blood pressure, a number of connective tissue diseases that affect blood vessel wall strength including Marfan syndrome and Ehlers Danlos syndrome, a bicuspid aortic valve, and previous heart surgery. Connective tissue disorders such as Marfan syndrome, Ehlers-Danlos syndrome, and Loeys–Dietz syndrome increase the risk of aortic dissection.
Sometimes, no heart problems are apparent until the weakening of the connective tissue (cystic medial degeneration) in the ascending aorta causes an aortic aneurysm or aortic dissection, a surgical emergency.

Syncope (medicine)

syncopefaintingfainted
Less common symptoms that may be seen in the setting of AD include congestive heart failure (7%), fainting (9%), stroke (6%), ischemic peripheral neuropathy, paraplegia, and cardiac arrest.
Heart related causes may include an abnormal heart rhythm, problems with the heart valves or heart muscle and blockages of blood vessels from a pulmonary embolism or aortic dissection among others.

Thoracic aortic aneurysm

aneurysm of the aortic rootthoracicthoracic aorta
Major trauma, smoking, cocaine use, pregnancy, a thoracic aortic aneurysm, inflammation of arteries, and abnormal lipid levels are also associated with an increased risk.
The principal causes of death due to thoracic aneurysmal disease are dissection and rupture.

Ehlers–Danlos syndromes

Ehlers-Danlos syndromeEhlers–Danlos syndromeEhlers Danlos Syndrome
AD is more common in those with a history of high blood pressure, a number of connective tissue diseases that affect blood vessel wall strength including Marfan syndrome and Ehlers Danlos syndrome, a bicuspid aortic valve, and previous heart surgery. Connective tissue disorders such as Marfan syndrome, Ehlers-Danlos syndrome, and Loeys–Dietz syndrome increase the risk of aortic dissection.
Complications may include aortic dissection, joint dislocations, scoliosis, chronic pain, or early osteoarthritis.

Aortic insufficiency

aortic regurgitationaortic valve insufficiencyAortic valve regurgitation
Aortic insufficiency (AI) occurs in half to two-thirds of ascending AD, and the diastolic heart murmur of aortic insufficiency is audible in about 32% of proximal dissections.
In terms of the cause of aortic insufficiency, is often due to the aortic root dilation (annuloaortic ectasia), which is idiopathic in over 80% of cases, but otherwise may result from aging, syphilitic aortitis, osteogenesis imperfecta, aortic dissection, Behçet's disease, reactive arthritis and systemic hypertension.

Aorta

aorticaortic archaortic root
Aortic dissection (AD) occurs when an injury to the innermost layer of the aorta allows blood to flow between the layers of the aortic wall, forcing the layers apart.

Pleurisy

pleuritispleuriticpleuritic chest pain
If the pain is pleuritic in nature, it may suggest acute pericarditis caused by bleeding into the sac surrounding the heart.

Giant-cell arteritis

temporal arteritisgiant cell arteritisCranial arteritis
Similarly, vasculitides such as Takayasu's arteritis, giant cell arteritis, polyarteritis nodosa, and Behcet's disease have been associated with a subsequent aortic dissection.
Complication can include blockage of the artery to the eye with resulting blindness, aortic dissection, and aortic aneurysm.

Michael DeBakey

Michael E. DeBakeyDr. Michael DeBakeyMichael Ellis DeBakey
Surgery for AD was introduced in the 1950s by Michael E. DeBakey.
On December 31, 2005, at age 97, DeBakey suffered an aortic dissection.

Myocardial infarction

heart attackheart attacksacute myocardial infarction
While the pain may be confused with that of a heart attack, AD is usually not associated with the other suggestive signs, such as heart failure and ECG changes.
Rarer severe differential diagnoses include aortic dissection, esophageal rupture, tension pneumothorax, and pericardial effusion causing cardiac tamponade.

Cardiac arrest

sudden cardiac deathsudden deathcardiopulmonary arrest
Less common symptoms that may be seen in the setting of AD include congestive heart failure (7%), fainting (9%), stroke (6%), ischemic peripheral neuropathy, paraplegia, and cardiac arrest.

George II of Great Britain

George IIKing George IIKing George II of Great Britain
The first case of AD was described in the examination of King George II of Great Britain following his death in 1760.
A post-mortem revealed that the king had died as the result of a thoracic aortic dissection.

Pericarditis

Chronic adhesive pericarditisChronic constrictive pericarditisinflammation around the heart
If the pain is pleuritic in nature, it may suggest acute pericarditis caused by bleeding into the sac surrounding the heart.

Cardiac tamponade

pericardial tamponadeCardiac '''T'''amponadepericardial tamponades
This is a particularly dangerous eventuality, suggesting that acute pericardial tamponade may be imminent.
This commonly occurs as a result of chest trauma (both blunt and penetrating), but can also be caused by myocardial rupture, cancer, uremia, pericarditis, or cardiac surgery, and rarely occurs during retrograde aortic dissection, or while the person is taking anticoagulant therapy.

Loeys–Dietz syndrome

Loeys-Dietz syndromeLoeys-DietzLoeys-Deitz aortic aneurysm syndrome
Connective tissue disorders such as Marfan syndrome, Ehlers-Danlos syndrome, and Loeys–Dietz syndrome increase the risk of aortic dissection.
There is overlap in the manifestations of Loeys–Dietz and Marfan syndromes, including increased risk of ascending aortic aneurysm and aortic dissection, abnormally long limbs and fingers, and dural ectasia (a gradual stretching and weakening of the dura mater that can cause abdominal and leg pain).

Turner syndrome

Turner's syndrome45,Xmonosomy X
Turner syndrome also increases the risk of aortic dissection, by aortic root dilatation.
Even if not every aortic root dilatation necessarily goes on to an aortic dissection (circumferential or transverse tear of the intima), complications such as dissection, aortic rupture resulting in death may occur.

Intra-aortic balloon pump

intra-aortic balloon pump managementBalloon Pump management and transportIABP
Iatrogenic causes include trauma during cardiac catheterization or due to an intra-aortic balloon pump.

Familial thoracic aortic aneurysm

cystic medial necrosiscystic medial degeneration
Proximal AD tends to be associated with weakening of the vascular wall due to cystic medial degeneration.
There is also increased risk of aortic dissection.

Aortography

aortogram
The procedure is known as aortography.
The diagnosis of aortic dissection can be made by visualization of the intimal flap and flow of contrast material in both the true lumen and the false lumen.

Beta blocker

beta blockersbeta-blockersbeta-blocker
Beta blockers are the first-line treatment for patients with acute and chronic aortic dissection.