Obesity, addiction, inactivity… all these bad habits can lead to high blood pressure. The scary thing about high blood pressure is the complications. Among the list of conditions, aortic dissection is a quick fatal risk that requires special attention.
What is aortic dissection?
Aortic dissection is an acute cardiovascular condition. Aortic vessels have a multilayered structure that can be divided into inner, middle, and outer membranes. However, certain factors can cause cracks in the inner membrane of the vessel, and blood from the cracks will leak into the middle membrane. The excess blood expands the intima, creating a new space for blood to flow, medically known as a “false lumen”.
Once the blood flows into the false lumen, the original blood flow to the aorta (the true lumen) is reduced, affecting the blood supply to other parts of the body and leading to organ ischemia.
The typical symptom of an aortic dissection is severe chest pain. Depending on the extent of the dissection and the organs involved, other symptoms may occur, and if left untreated, there is a high risk of death.
Classification of Aortic Dissection
Anatomically, the aorta can be divided into four segments: the ascending aorta (which connects to the left ventricle and the coronary arteries), the descending aorta (which lies in the chest cavity), the abdominal aorta (which lies in the abdominal cavity and connects to the descending aorta), and a curved section of the aorta called the aortic arch, which connects to the carotid artery and carries blood to the brain.
Aortic dissection is classified into two categories, DeBakey and Stanford, based on the location of the false lumen (the extent of the invasion), and this classification helps doctors decide how to treat the condition.
Symptoms of Aortic Dissection
A typical symptom of aortic dissection is chest pain, which may be felt as a force ripping through the chest cavity and radiating to the upper back.
In addition, aortic dissection can cause ischemia in the organs. Depending on the location of the ischemia, the following symptoms may occur:
1.Gastrointestinal ischemia: abdominal pain
2.Renal ischemia: back pain
3.Brain ischemia: inability to speak, fainting, loss of vision, weakness in half of the limb.
4.Others: difficulty breathing, weak pulse on one side of the body
Consequences
If the ischemia is severe, patients may also experience the following sequelae:
1.Acute heart failure
2.Stroke
3.Lower body paralysis
4.Acute kidney failure
5.Intestinal necrosis
6.The most serious condition is aortic dissection, which has a very high mortality rate.
Who is at Risk for Aortic Dissection?
Aortic dissection occurs in people over the age of 60, and there are many risk factors for the disease. If you have any of the following conditions, you should go to the hospital for regular check-ups so that you can prevent it before it happens.
1.High blood pressure
2.Family history
3.Aortic aneurysm
4.Mitral valve prolapse
5.Cocaine abuse (stimulates increase in blood pressure)
6.Marfan’s disease (a genetic disorder characterized by tall stature and long, slender limbs)
7.High-intensity weight training (increases blood pressure)
8.Hyperlipidemia
9.External shock
10.vasculitis
11.Cigarette smoking
Preventing Aortic Dissection
If you want to protect yourself from a fatal aortic dissection, you should take preventive measures in general, and the following are ways to prevent it in your daily life:
1.Control Blood Pressure
High blood pressure is a major risk factor for aortic dissection, so regularly monitoring your blood pressure is an effective way to prevent the disease.
If you have chronic high blood pressure (systolic blood pressure greater than 120 mmHg and diastolic blood pressure greater than 80 mmHg), you should see a doctor immediately to determine whether you need to take blood pressure-lowering medication; if you start taking medication, you must follow the doctor’s instructions and not reduce or stop the medication on your own.
Watching what you eat is another way to control blood pressure. A low-fat, low-salt diet can help prevent high blood pressure and reduce the risk of aortic dissection.
2.Smoking cessation
Smoking causes vasoconstriction, increased blood pressure, and hardening of the blood vessels, which increases the risk of wall rupture, so quitting smoking is one way to prevent aortic dissection.
3.Weight Control
Obesity affects health, and the “three highs” (hypertension, hyperglycemia, and hyperlipidemia) are all related to obesity. You should pay attention to whether your body weight is within the norm and develop the habit of exercising.
It is worth mentioning that high-intensity weight training increases blood pressure, and if you are in such a training state for a long time, it may increase the risk of aortic dissection. If you want to do strength training, you should do it according to your ability or seek the help of a professional trainer.
How is aortic dissection diagnosed?
Computed tomography (CT) is the most commonly used test to diagnose aortic dissection and has the highest diagnostic yield. Patients receive an intravenous injection of iodine contrast before the scan, and the images are interpreted by a physician.
In addition to computed tomography, physicians may use other tests, such as chest x-rays, magnetic resonance imaging (MRI), and cardiac ultrasound, to rule out other conditions and increase the chances of confirming the diagnosis.
Treatment of Aortic Dissection
Aortic dissection can be treated with medication or surgery. Before treatment, the doctor must first diagnose the type of disease the patient is suffering from in order to formulate an appropriate treatment strategy.
The site of disease includes the ascending aorta.
Patients with DeBakey I and DeBakey II (equivalent to Stanford A) are good candidates for surgery, with a success rate of about 70% and a survival rate of 90% within three years of surgery.
During surgery, the surgeon will remove the lesion depending on the status of the dissection and place an artificial blood vessel to improve the ischemic condition of the organ.
The site of disease does not include the ascending aorta.
In DeBakey IIIA and DeBakey IIIB (equivalent to Stanford B), medications are the mainstay of treatment with the goal of controlling blood pressure.
Common medications include beta-blockers such as esmolol, metoprolol, and labetalol, or vasodilators such as sodium nitroprusside and glyceryl trinitrate.