A complete description of aortic dissection causes treatment diagnosis

In this serious condition, there is a violation of the integrity of the aortic wall. Blood from the aorta reaches the media and divides the aorta into two layers, forming a false lumen along the true lumen.

The aortic valve and aortic branches may be damaged. Often the false lumen then re-enters the true lumen and creates a two-chamber, or two-lumen aorta, or breaks into the left pleural space or pericardial cavity with fatal consequences.

The primary phenomenon is spontaneous or iatrogenic tearing of the aortic intima; in addition, the presence of several gaps is typical. On the other hand, many bundles begin with hemorrhage into the aortic media; this hemorrhage breaks through the intima into the true lumen.

This spontaneous bleeding from a vessel of vessels is sometimes limited by the wall of the aorta and is manifested by a painful intra-wall hematoma.

Chronic dissections lead to aneurysmal dilatation of the aorta, thoracic aneurysms can be complicated by dissection; for this reason, it can be difficult to determine which pathological condition was primary.

The peak of occurrence is between the 6th and 7th decade of life. In young people, stratification occurs mainly in Marfan syndrome, pregnancy and trauma; men are sick twice as often as women.

Aortic dissection has an anatomical classification and classification according to the treatment methodology – type A, in which the ascending aorta is affected, and type B without damage to the ascending part.

Type A stratifications account for two-thirds of all cases and often extend to the descending aorta. The pain follows along the bundle, migrates from the starting point along the bundle path.

Stratification can lead to a life-threatening rupture of the aorta or begin to spread in different directions with the formation of a space filled with blood between the separated layers.

Blood flow to the main arteries (including coronary arteries) can be difficult.

Aortic dissection is the separation of the membranes from each other, with which the vessel is covered from the inside, with a previous rupture. Through the hole formed, blood flows rush between the layers of the artery wall, expanding the tear and exacerbating the detachment.

This forms an additional false path for blood flow, its width and length vary. The divergence of the membranes may exist by itself, but most often this is the complication of the dissecting aortic aneurysm (protrusion of a weakened wall) in the chest or abdominal part of the vessel.

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Violation of the membranes of the vessel leads to a deterioration in blood circulation, and a complete rupture of the aorta inevitably leads to extensive internal bleeding and a tragic outcome.

Most often, the disease is diagnosed in the elderly. But young people are also prone to such phenomena if they have a congenital pathology of Marfan.

The concepts of “delamination” and “delamination” should be distinguished. The last term is used to denote the process of isolating the aorta from nearby tissues during a surgical operation.

There is the most commonly used classification of the types of De Beica exfoliation, depending on the location of the pathology:

  • In the ascending aorta, with possible spread to the thoracic and abdominal zones.
  • In the descending section, two options are possible – damage to the artery to the diaphragm or below this area.

ICD-10 disease code: 171.0-171.9

Aortic dissection usually occurs in older people, in most cases in males. The aorta is the largest of all vessels. Through it, blood goes to other vessels, supplying the entire body with this “life-giving fluid”.

The load on this vessel is very high. Atherosclerotic changes, inflammatory processes and other factors lead to thinning of the walls, due to which the aorta can not withstand the pressure exerted on it, the inner shell is torn and the vessel is stratified.

The condition of the walls is disturbed where the blood exerts the greatest pressure. If the dissection occurs at the site of expansion of the vessel, then they say that this is a stratified aortic aneurysm.

In most cases, this condition ends in death, since it is impossible to stop bleeding and restore normal blood flow. Most people die before they arrive at the hospital.

) protrusion of the wall or diffuse (

) an increase in the lumen of the vessel by several times as a result of structural disruption in inflammatory processes, mechanical damage to the vessel, congenital and acquired pathologies (

Marfan syndrome, atherosclerosis, syphilis

Thoracic aortic aneurysms are classified depending on its location, form, etiology (

), clinical course and other factors. When formulating a diagnosis, classification is used to more fully describe the pathology.

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Due to aortic aneurysm disease, there are:

  • inflammatory etiology (causes) – with syphilis, nonspecific aortoarteritis (Takayasu disease – an autoimmune inflammatory disease of the aorta and its branches), fungal infection and others;
  • non-inflammatory etiology – with atherosclerosis, trauma, arterial hypertension;
  • congenital – with Marfan syndrome (a hereditary disease of connective tissue), coarctation (congenital local narrowing of the lumen) of the aorta, hypoplasia (underdevelopment of a tissue or organ) and others.

Aortic aneurysm can be localized in any area – from the exit of the aorta from the left ventricle of the heart to its transition into the abdominal part of the aorta.

Depending on the localization, there are:

  • aneurysm of the aortic sinuses (Valsalva sinuses);
  • aneurysm of the aortic sinuses (Valsalva sinuses) and the ascending aorta (cardio-aorta);
  • aneurysm of the ascending aorta (cardio-aorta);
  • aneurysm of the ascending aorta and its arch;
  • aneurysm of the aortic arch;
  • aneurysm of the ascending aorta, arch and descending aorta;
  • aneurysm of the arch and descending thoracic aorta;
  • descending aortic aneurysm (thoracoabdominal aneurysm).

It is known that aortic dissection occurs due to the course of other changes in the middle membrane. There are mechanical causes, for example, lifting heavy weights, severe injuries – in short, everything that can cause a sharp increase in blood pressure.

Also, the aorta may stratify due to past diseases, as a result of which the degeneration of vascular tissue begins.

Of course, the most common causes of the disease are precisely the diseases, these include:

  • atherosclerosis, especially with severe vascular damage;
  • hypertension, as well as other diseases characterized by sharp jumps in blood pressure;
  • aortitis often affects patients with syphilis;
  • state of stress, tendency to depression;
  • various congenital malformations.

The rarest causes are foreign bodies entering the vessel under direct mechanical pressure.

In addition to the above reasons, there are several more:

  • male gender;
  • hereditary predisposition;
  • age after 60.

By the way, recent studies have shown that men are more prone to rupture of the aorta, almost 3 times more often this disease is diagnosed in the stronger sex.

Perhaps this reason is affected by a greater tendency of men to bad habits, increased physical activity and often neglect of their own health.

Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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