Aortic dissection most often affects the elderly. But there are cases when such a disease is detected among young people. Therefore, in order to prevent the development of complications, it is necessary to know how this disease manifests itself.
And for this you need to know everything about the causes, symptoms and treatment of aortic dissection.
What causes illness
There are congenital and acquired causes of aortic aneurysm. The former are associated with the presence of pathologies of the cardiovascular system in humans, which manifest themselves in the defective development of the aortic valve or its narrowing (stenosis) and congenital malformations of the aorta itself - tortuosity and coarctation. In addition, congenital or acquired heart disease can serve as a cause. In addition, the following diagnosed diseases associated with connective tissue pathologies affect the development of an aneurysm:
- Ehlers-Danlos syndrome;
- annuarticular ectasia;
- polycystic kidney disease;
- osteogenesis;
- Turner syndrome;
- homocystinuria.
Etiopathogenic factors also affect the local expansion of the main artery section,such as:
- blood pressure fluctuation caused by hypertension
- atherosclerosis;
- syphilis;
- thoracic and abdominal injury;
- damage to the aorta by a foreign body or an adjacent pathological process (esophageal cancer, spondylitis, peptic ulcer of the esophagus).
Risk factors also include:
- injecting drug use;
- smoking;
- chronic inflammation;
- late pregnancy;
- aging.
Symptoms
Aortic dissection can be either acute or chronic. They are distinguished by pain during attacks.
The acute form is characterized by a sudden onset of symptoms of aortic dissection (the reasons for this can be both acquired and congenital), which cause pain, and this condition lasts up to two weeks.
The chronic form is also characterized by pain, but the duration can last indefinitely without treatment until death. Because of this
that an aortic dissection cuts off circulation to nearby organs, may cause strokes or fainting, and cause severe shortness of breath and unexplained weakness.
With the proximal form, the pains are compressive or stabbing in the chest and retrosternal space. In this case, they can also give in the back. In the distal form, symptoms of abdominal aortic dissection occur:pain in the stomach, back, which often radiate to the neck.
In the acute form of the course of the disease, high blood pressure and increased heart rate are manifested. If at this stage the disease has not been cured, then the symptoms become chronic.
Ascending aortic dissections
Disturbances in this section of the aorta are divided into:
- Dissection of an aortic aneurysm, that is, inflammation of the area from the fibrous ring of the aortic valve to the sinotubular ridge. Often this diagnosis is accompanied by aortic valve insufficiency.
- Tubular dissection of the ascending aorta, that is, inflammation of the area from the sinotubular ridge to its arch. This type of ascending aortic disease is not accompanied by valve insufficiency.
- Ascending aortic dissection is treated medically if its diameter does not exceed 45 mm. If this parameter is exceeded, then surgical intervention is recommended. This is due to the fact that, according to statistics, when the ascending section is stratified with a diameter of 55 mm or more, the risk of rupture increases.
- Aortic aneurysm dissection ruptures more often than others. If a bilateral dissection is found in this area, then a third of patients with such a disease die.
- When dissecting the ascending section, there is a reverse reflux of the contrast agent from the aorta into the left ventricle. This is due to increased pressure in the aorta.
Descending aorta
Descending aortic dissection is more common inpeople in old age who suffer from cardiovascular diseases.
Reverse descending aortic dissection does not occur, resulting in no aortic regurgitation. During dissection, the carotid pulse and upper arterial pressure remain unchanged.
The first symptom of the initial stage of descending aortic dissection is the onset of sudden pain behind the sternum or between the shoulder blades, transmitted to the front of the chest. Patients with such a bundle, as a rule, are not prescribed emergency surgery, but drug treatment is carried out. With such therapy, a prerequisite is the normalization of blood pressure.
If the diameter has reached four centimeters, then the doctor has the right to prescribe surgical treatment. This is due to the fact that if this diameter is exceeded, then the risk increases many times over.
Classification
Michael Ellis DeBakey is an American cardiac surgeon who studied the disease and proposed the following classification of aortic dissection by type:
- First - the dissection starts from the sinus of Valsava and extends higher to the bending of the aorta, that is, it can leave the border of the ascending aorta.
- Second type - the disease is localized in the ascending aorta.
- Third is a dissection that descends below the origin of the left subclavian artery.
The third type is divided into:
- 3A - dissection is localized in the thoracic aorta.
- 3B - the disease is located below the thoracic aorta. Sometimes the third type can approach the left subclavianarteries.
Recently, Stanford University has developed a simpler classification that includes two options:
- Aortic dissection type A is a disease that is localized in the ascending aorta.
- Type B aortic disease is a lesion that descends below the origin of the left subclavian artery.
Traditional surgical treatment of aortic dissection carries a poor prognosis. In a non-critical condition, this approach is traumatic for the patient and is associated with great difficulties during the operation.
Modern therapeutic techniques for the treatment of aortic dissection have a better prognosis. The technology of such intervention is constantly improving, which facilitates the rehabilitation of the patient.
Diagnosis
Aortic dissection is one of the most serious vessel defects, posing a lethal danger to human existence.
According to statistics, 65-70% of patients who do not seek support die from internal bleeding. Of those who undergo surgery, approximately 30% of patients die. The prognosis for such a disease is far from pleasant. A timely diagnosis is considered essential for survival in aortic dissection. Despite the rather ordinary ways of finding a defect, episodes of non-recognition are not uncommon.
The aorta contains three covers: outer, middle and inner. The stratification is combined with the inferiority of the middle cover over this or that particular place. Due to this defect, a tear of the inner cover (intima) is likely anddevelopment of an erroneous lumen in the middle of its epithelium. The tear may occupy part of the aorta or spread throughout the entire internal volume.
Dissection, in other words, a dissecting aneurysm, has the ability to form in an arbitrary lobe of the aorta and ends with a vessel break at any time. Predominantly sensitive areas are the original segments of the aortic arch.
Surgical treatment
Surgical treatment is indicated for acute aortic dissection. During this period, the risk of its rupture is possible. Surgery is also acceptable to treat the chronic form of the course of the disease, which has passed from the acute one.
In the initial stage of development, the operation of aortic dissection is not justified, since it is amenable to drug treatment. At this stage, it can be prescribed only if there is a threat of damage to vital organs.
In the chronic form, surgery is indicated for dissection of more than 6 cm in diameter.
According to statistics, if surgery is performed immediately after an acute form is detected, the risk of death is only three percent, and if the preparation for surgery is longer, then a 20 percent risk of death is possible.
Surgery includes:
- resection of the aorta at the dissection site;
- elimination of false clearance;
- restoration of the excised fragment of the aorta.
Medication treatment
Drug treatment for dissectionaortic aneurysm is recommended for all patients with any form of development of aortic aneurysm. This approach is indicated to stop the progression of the disease.
Therapy for aortic dissection is aimed at reducing pain by administering non-narcotic and narcotic analgesics, getting rid of shock and lowering blood pressure.
During drug treatment, monitoring of heart rate and pressure dynamics is mandatory. To reduce the cardiac volume of blood circulation and reduce the rate of expulsion of the left ventricle, b and p blockers are used to reduce the heart rate within 70 beats per minute.. In the treatment of aortic dissection, "Propranolol" is administered intravenously at a dose of 1 mg every 3-5 minutes. The maximum effective rate should not exceed 0.15 mg/kg. With maintenance therapy, Propranolol is administered every 4-6 hours at a dose of 2 to 6 mg, which depends on the heart rate. You can also use Metoprolol 5 mg IV every 5 minutes.
Also, for the treatment of aortic dissection, Labetalol is used drip from 50 to 200 mg / day per 200 ml of saline.
Folk treatment
To get to the pharyngeal abscess and treat it with folk remedies, you must regularly use the following decoctions and tinctures inside:
- Tincture of jaundice. To prepare the product, we take two tablespoons of dried and chopped herbs and pour it with a cup of steepboiling water. We wrap the resulting mixture with a dense cloth and put it in a warm place, for example, near the battery. After two hours of infusion, the mixture must be filtered and one tablespoon can be consumed up to five times a day. If your tincture is bitter, you can add sugar to it.
- Tincture of viburnum. In the presence of attacks of suffocation, an infusion of viburnum berries should be used. They can also be eaten raw, mixed with honey or sugar.
- Dill tincture. To prepare the product, we take a spoonful of fresh or dry dill, if desired, you can add its seeds. One part of the greens will require about three hundred milliliters of boiling water. After infusion for about an hour, the mixture is consumed three times throughout the day.
- Infusion of hawthorn. To prepare, take four tablespoons of chopped dry hawthorn fruits and pour three cups of boiling water. We infuse the resulting mixture for several hours, after which it must be divided into two days, and one part should be consumed in three divided doses during the day, half an hour before meals.
- Decoction of elderberry. To prepare a decoction, we take the dried root of Siberian elderberry and grind it. Then pour a spoonful of powder with a cup of dill. We put the resulting mixture to infuse, and then finish cooking by boiling for fifteen minutes in a water bath. We filter the finished mixture and take one tablespoon each.
- Decoction of primrose. For cooking, we take the crushed dry rhizomes of the plant. Pour a spoonful of powder with a mug of hot water and continue boiling for half an hour in a water bath. Decoctionstrain, then squeeze out the moisture from the prepared powder. Use the finished product should be three times a day for a tablespoon.
If in the acute form of the course of the disease there is an increase in temperature, then to reduce it, you can take remedies from garlic and a golden mustache leaf. To do this, take the peeled garlic and finely chop. Then you need to grind the leaves of the golden mustache and mix with garlic. Add thirty grams of honey to the resulting composition. Leave the finished mixture to brew in a warm place. Then mix and consume one tablespoon with water.
Complications
A complication of aortic dissection is its complete rupture. Mortality from aortic rupture is up to 90%. 65-75% of patients die before they arrive at the hospital, and the rest before they reach the operating room. The walls of the aorta are an elastic structure that requires complete integrity. A gap occurs when its strength is lost. This can happen when the internal or external pressure is greater than the walls can withstand.
Pressure occurs during tumor progression. Bleeding can be retroperitoneal or intraperitoneal and can create a fistula between the aorta and intestines.
Prevention
In order to warn yourself against this disease, it is necessary to do prevention, namely:
- treat atherosclerosis in time;
- check blood lipid levels;
- keep an active, he althy lifestyle;
- to make proper nutrition, without the content of fried and fatty foods in the menu. Exclude processed foods, fast food, soda, alcohol, all foods that exceed the cholesterol content from the diet;
- give up cigarettes;
- to control blood pressure, blood cholesterol;
- every year, mostly after forty, undergo an examination of the body to detect cardiovascular abnormalities;
- setting aside time for exercise, but not overworking.
To prolong the life of the heart for a long time, it is also necessary to prevent infectious and cold diseases, as they, in turn, give complications to it.
Food is recommended to be taken in small portions so that the stomach and intestines do not squeeze the heart, which leads to a deterioration in the blood circulation of the vessels, heart and abdominal organs. The body accumulates toxins, which increase the load on the heart. To avoid this, you need to empty the intestines in time.
Although physical activity is recommended, but people with a disease of the cardiovascular system need to reduce them and not lift weights. Otherwise, there will be an overload of blood vessels, which will later lead to a stroke and heart attack.
