Aortic Dissection
Information You Need to Know About Type B Aortic Dissection
Suppose you are someone who has aortic dissection and looking for credible information related to Type B Aortic Dissection and its management. In that case, this article is for you.
What is the Aorta?
The main pipe that carries oxygen-rich blood from the heart to everywhere else in the body is the aorta. It is the largest artery of the human body. It first arises from the upper surface of the heart and then descends, supplying the structures present in the torso. Finally, just below the navel, it divides into two branches, each for one leg.
What is Aortic Dissection?
The aorta wall comprises three layers, intima (inner), media (middle) and adventitia (outer). A tear can occur in the intima of someone who has a weakened aorta wall. Blood surges through this tear and dissects the inner and the middle layers, hence aortic dissection.
Aortic dissection hinders the normal flow of blood to the tissues. Moreover, it can rarely result in aortic rupture, a life-threatening condition.
Are There Different Types of Aortic Dissection?
According to the Stanford classification, there are two types of aortic dissection. However, another classification system (DeBakey Classification) classifies aortic dissection in three different types. Still, this system is not in common use. Therefore, our discussion is according to the former classification.
Type A Aortic Dissection
Type A aortic dissection occurs in the part of the aorta that lies immediately near the heart. As the heart pumps blood with high pressure, such aortic dissection may extend to the entire length of the aorta. It is an emergency. You would need immediate treatment unless it proved fatal. Surprisingly, this type of aortic dissection is more common than the second one.
Type B Aortic Dissection
This type of dissection occurs away from the heart in the descending aorta. It can reach the abdominal aorta but does not affect the first section of the aorta near the heart. In some cases, you may not even require surgery and are treated with medication and strong follow-up. However, the dissection management is still dependent on the symptoms and blood vessels involved and your risk of aneurysm formation and rupture. Some patients require a stent-graft surgical procedure to treat type B aortic dissection.
How it’s Different from Aortic Aneurysm and Aortic Rupture?
Aortic dissection involves pooling the blood between the inner and the middle layers of the aorta. In contrast, an aortic aneurysm is the ballooning of the aorta due to the weakening of the vessel wall. Both aortic aneurysms and aortic dissection can result in aortic rupture. Aortic rupture is an emergency that involves a tear in all three layers of the aorta.
How Does a Patient of Aortic Dissection Usually Present?
Aortic dissection is a harsh condition that can occur while doing something or resting. It is a life-threatening condition with chances of survival reducing after every passing hour if not adequately managed.
Patients with aortic dissection usually present with the following signs and symptoms.
- Sudden, severe, stabbing or tearing pain that begins in the chest. The pain can radiate to the back and neck, mimicking the pain of a heart attack.
- Breathlessness
- The patient may get unconscious
- Extreme low blood pressure or high blood pressure
- Heavy Sweating
- Stroke symptoms, such as weakening or paralysis of muscles and vision loss, may also occur.
Call the ambulance whenever you notice any of the above signs and symptoms.
Are There Any Risk Factors?
This article gives you all the information about the common risk factors that you can manage to reduce your likelihood of having an aortic dissection.
- High Blood Pressure: Not a big surprise that most aortic dissection patients are hypertensive. Long-standing high blood pressure damages the aorta wall, slowly weakening it until a tear occurs in the inner layer. That’s how hypertension paves the way for aortic dissection.
- Congenital Diseases: If you are born with heart defects or connective tissue diseases, you are at a higher risk of having aortic dissection.
- Atherosclerosis: High blood cholesterol also plays a significant role in weakening the aorta.
- Smoking: It is an evil that damages the aorta and every other blood vessel in your body
- Age and Gender: Aortic dissection is more common in individuals 60 years or more. Men are at higher risk than women.
- Aortic Aneurysm: Aortic aneurysm can progress to dissection and may result in rupture.
What are the Complications?
Aortic dissection is a devastating condition that can lead to multiple fatal outcomes. Some of the important ones are the following.
- Organ Damage: It is evident that blood doesn’t flow adequately to the organs in aortic dissection. As a result of poor blood supply, multiple organ damage can occur.
- Stroke: Stroke is also one of the most typical complications of aortic dissection. It is one of the factors that contribute to the patient’s death.
- Heart Defects: Aortic dissection can lead to damaged heart valves. In some cases, it can weaken the heart wall, ultimately resulting in rupture. The rupture of the heart wall causes the pooling of blood around it, a condition known as cardiac tamponade.
- Bleeding: Aortic wall dilatation that results in aneurysm formation and rupture
- Death: Patients with acute aortic dissection may die if they do not receive recommended emergency treatment.
How Can You Prevent Aortic Dissection?
There are certain risk factors for aortic dissection, such as birth abnormalities which you have no control over. But the others are the ones that you can easily manage with proper lifestyle modifications.
High blood pressure is the leading cause of aortic dissection. So first, you need to keep your blood pressure in tight control. Next, you should focus on your diet by eating a balanced diet. Finally, quitting smoking would also be a good step towards a healthier aorta.
How to Diagnose a Patient with Aortic Dissection?
Aortic dissection is an emergency. Therefore, your doctor would need to develop a diagnosis immediately after the attack to start the treatment. The goal of the diagnosis is to differentiate the patients of aortic dissection from heart attack and stroke patients, as they also present with quite similar symptoms.
Your doctor will start with the medical history and physical examination to develop a diagnosis. Then he will move forward with investigations. Some of the investigations that are important for the diagnosis involve the following.
- Chest X-ray: Chest X-ray uses radiations to visualise the interior of your chest cavity. Although findings of X-rays are pretty ambiguous, they may direct the diagnosis.
- CT Scan: CT scan with a dye injected into the blood to visualise the blood vessels is a favourable approach to develop a confirmed diagnosis of a case of aortic dissection.
- Echocardiogram: The echo involves the ultrasound heart scan that helps visualise the inner condition of heart valves or the first part of the aorta.
- MRI: MRI takes more time and is only advised when CT or X-ray has not developed the diagnosis.
What Does its Management Involve?
Acute aortic dissection needs immediate intervention. But, first, you have to be admitted to either the intensive care unit or the high dependency care unit, depending upon the severity of your disease. The nurses and doctors there will manage your health status. The management of patients with aortic dissection involves the following steps.
General Measures
General measures of the management involve the following
- Pain-relieving medications: Aortic dissection presents severe stabbing pain that most people can’t tolerate. Thus, the earliest management is the administration of painkillers in the blood to save the patient from torture.
- Management of High Blood Pressure: Persistent hypertension increases your risk of aortic rupture after the aortic dissection. Therefore, doctors will aggressively manage your blood pressure in intensive care or high dependency care units.
Surgical Intervention
In the case of Type A aortic dissection, you would need emergency cardiothoracic surgery to repair the defect in the starting part of the aorta. In contrast, Acute Type B aortic dissections are usually treated medically and require surgical intervention when there is an interruption to the blood supply of your vital organs or a high risk of rupture. In that case, you might need a thoracic endovascular aortic repair (TEVAR) to place the stent graft in the defected vessel.
What You Should Know About TEVAR?
TEVAR stands for Thoracic Endovascular Aortic Repair. It is a non-invasive treatment option. In this procedure, your vascular surgeon will make a small incision in the groin. Then he will introduce the graft vessel through the artery in the groin to place it in the defective part of the aorta. Your surgeon can perform this procedure under local anaesthesia.
TEVAR, with proper medical treatment, prevent the progression of the disease. It also improves the chances of survival of a patient with aortic dissection. However, TEVAR doesn’t offer long-term benefits in some cases. In that case, open surgery to repair the aorta would be the treatment of choice.
What is the Outlook of Aortic Dissection?
Early diagnosis and management are essential survival tools for patients with aortic dissection. Patients may develop aortic rupture in these absences, and death can occur. Tight control of blood pressure also helps prevent the worsening of aortic dissection. Those who have survived also need follow-up investigations to look for the progression of the disease.
