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Aortic dissection is a tear in the wall of the aorta (the largest artery of the body). This tear causes blood to flow between the layers of the wall of the aorta and forces the layers apart. Aortic dissection is a medical emergency and can quickly lead to death, even with optimal treatment. If the dissection tears the aorta completely open (through all three layers) massive and rapid blood loss occurs. Aortic dissections resulting in rupture have a 90% mortality rate even if intervention is timely. Image File history File links Size of this preview: 498 × 599 pixels Full resolution (540 × 650 pixel, file size: 292 KB, MIME type: image/png) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Aortic dissection ...
The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ...
The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ...
// I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic...
The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ...
The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ...
The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ...
MedlinePlus (medlineplus. ...
eMedicine is an online clinical medical knowledge base that was founded in 1996. ...
The aorta (generally pronounced or ay-orta) is the largest artery in the human body, originating from the left ventricle of the heart and bringing oxygenated blood to all parts of the body in the systemic circulation. ...
Section of an artery For other uses, see Artery (disambiguation). ...
Human blood smear: a - erythrocytes; b - neutrophil; c - eosinophil; d - lymphocyte. ...
A medical emergency is an injury or illness that poses an immediate threat to a persons health or life which requires help from a doctor or hospital. ...
Overview
 Blood penetrates the intima and enters the media layer. As with all other arteries, the aorta is made up of three layers. The layer that is in direct contact with the flow of blood is the tunica intima, commonly called the intima. This layer is made up of mainly endothelial cells. Just deep to this layer is the tunica media, known as the media. This "middle layer" is made up of smooth muscle cells and elastic tissue. The outermost layer (furthest from the flow of blood) is known as the tunica adventitia or the adventitia. This layer is composed of connective tissue. Image File history File links No higher resolution available. ...
Image File history File links No higher resolution available. ...
Section of an artery For other uses, see Artery (disambiguation). ...
The tunica intima (or just intima) is the innermost layer of an artery. ...
The endothelium is the layer of thin, flat cells that lines the interior surface of blood vessels, forming an interface between circulating blood in the lumen and the rest of the vessel wall. ...
The tunica media (or just media) is the middle layer of an artery. ...
Cultured Smooth muscle of the aorta. ...
The tunica adventitia (or just adventitia) is the outermost layer of an artery. ...
Connective tissue is one of the four types of tissue in traditional classifications (the others being epithelial, muscle, and nervous tissue. ...
In an aortic dissection, blood penetrates the intima and enters the media layer. The high pressure rips the tissue of the media apart, allowing more blood to enter. This can propagate along the length of the aorta for a variable distance, dissecting either towards or away from the heart or both. The initial tear is usually within 100 mm of the aortic valve. Biological tissue is a collection of interconnected cells that perform a similar function within an organism. ...
The heart and lungs, from an older edition of Grays Anatomy. ...
The metre, or meter (U.S.), is a measure of length. ...
The aortic valve is one of the valves of the heart. ...
The risk in aortic dissection is that the aorta may rupture, leading to massive blood loss resulting in death.
Classification systems |
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 | | Percentage | 60 % | 10-15 % | 25-30 % | | Type | DeBakey I | DeBakey II | DeBakey III | | Stanford A | Stanford B | | | Proximal | Distal | | Classification of aortic dissection | Several different classification systems have been used to describe aortic dissections. The systems commonly in use are either based on the anatomy of the dissection or the duration of onset of symptoms prior to presentation. Image File history File links No higher resolution available. ...
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DeBakey classification system The DeBakey system is an anatomical description of the aortic dissection. It categorizes the dissection based on where the original intimal tear is located and the extent of the dissection (localized to either the ascending aorta or descending aorta, or involves both the ascending and descending aorta.[1] - Type I - Originates in ascending aorta, propagates at least to the aortic arch and often beyond it distally.
- Type II – Originates in and is confined to the ascending aorta.
- Type III – Originates in descending aorta, rarely extends proximally.
Stanford classification system Divided into 2 groups; A and B depending on whether the ascending aorta is involved.[2] - A = Type I and II DeBakey
- B = Type III Debakey
Pathophysiology | | | | Aortic dissection | | An echocardiogram displaying the true lumen and false lumen of an aortic dissection. In the image to the left, the intimal flap can be seen separating the two lumens. In the image to the right, color flow during ventricular systole suggests that the upper lumen is the true lumen. | The initiating event in an aortic dissection is a tear in the intimal lining of the aorta. Due to the high pressures in the aorta, blood enters the media at the point of the tear. The force of the blood entering the media causes the tear to extend. It may extend proximally (closer to the heart) or distally (away from the heart) or both. The blood will travel through the media, creating a false lumen (the true lumen is the normal conduit of blood in the aorta). Separating the false lumen from the true lumen is a layer of intimal tissue. This tissue is known as the intimal flap. Download high resolution version (848x602, 41 KB)An echocardiogram of the descending aorta (in longitudinal view) displaying an aortic dissection. ...
Download high resolution version (848x603, 46 KB)Echocardiogram of aortic dissection - Color File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ...
The echocardiogram is an ultrasound of the heart. ...
Systole can mean the following: Systole (medicine) is a term describing the contraction of the heart. ...
A sphygmomanometer, a device used for measuring blood pressure. ...
The vast majority of aortic dissections originate with an intimal tear in either the ascending aorta (65%), the aortic arch (10%), or just distal to the ligamentum arteriosum in the descending thoracic aorta (20%). The arch of the aorta, and its branches. ...
For the embryological structure, see Aortic arches. ...
The ligamentum arteriosum is a small ligament between the pulmonary artery and aortic trunk. ...
The descending aorta is divided into two portions, the thoracic and abdominal, in correspondence with the two great cavities of the trunk in which it is situated. ...
As blood flows down the false lumen, it may cause secondary tears in the intima. Through these secondary tears, the blood can re-enter the true lumen.
While it is not always clear why an intimal tear may occur, quite often it involves degeneration of the collagen and elastin that make up the media. This is known as cystic medial necrosis and is most commonly associated with Marfan syndrome and is also associated with Ehlers-Danlos syndrome. Tropocollagen triple helix. ...
Elastin, also known as elasticin, is a protein in connective tissue that is elastic and allows skin to return to its original position when it is poked or pinched. ...
Cystic medial necrosis (also referred to as cystic medial degeneration) is a disorder of large arteries, in particular the aorta, where there is a focal degeneration of the elastic tissue and the muscle in the tunica media (the middle layer of the artery), with the presence of mucoid material in...
Marfan syndrome is an autosomal dominant genetic disorder of the connective tissue characterized by unusually long limbs, great stature, or long toes (or fingers) in proportion to the persons height, as well as a predisposition to cardiovascular disease. ...
Ehlers-Danlos syndrome is a group of rare genetic disorders that diminish the bodys ability to make connective tissues. ...
In about 13% of aortic dissections, there is no evidence of an intimal tear. It is believed that in these cases the inciting event is an intramural hematoma (caused by hemorrhage within the media). Since there is no direct connection between the true lumen and the false lumen in these cases, it is difficult to diagnose an aortic dissection by aortography if the etiology is an intramural hematoma. An aortic dissection secondary to an intramural hematoma should be treated the same as one caused by an intimal tear. Hematoma on an elbow, nine days after a blood sample was taken Hematoma on a forearm, one day after repeated shocks A hematoma, or haematoma, is a collection of blood, generally the result of hemorrhage. ...
To meet Wikipedias quality standards, this article or section may require cleanup. ...
Etiology (alternately aetiology, aitiology) is the study of causation. ...
Etiology Aortic dissection is associated with hypertension (high blood pressure) and many connective tissue disorders. Vasculitis (inflammation of an artery) is rarely associated with aortic dissection. It can also be the result of chest trauma. 72 to 80% of individuals who present with an aortic dissection have a previous history of hypertension. This article or section does not adequately cite its references or sources. ...
Connective tissue is one of the four types of tissue in traditional classifications (the others being epithelial, muscle, and nervous tissue. ...
In medicine, vasculitis (plural: vasculitides) is a group of diseases featuring inflammation of the wall of blood vessels due to leukocyte migration and resultant damage. ...
An abscess on the skin, showing the redness and swelling characteristic of inflammation. ...
The highest incidence of aortic dissection is in individuals who are 50 to 70 years old. The incidence is twice as high in males as in females (male-to-female ratio is 2:1). Half of dissections in females before age 40 occur during pregnancy (typically in the 3rd trimester or early postpartum period). A pregnant woman near the end of her term Pregnancy is the carrying of one or more embryos or fetuses by female mammals, including humans, inside their bodies. ...
The human gestation period of approximately 40 weeks between the time of the last menstrual cycle and delivery is traditionally divided into three periods of three months, or trimesters. ...
Postnatal (Latin for after birth) is the period beginning immediately after the birth of a child and extending for about six weeks. ...
A bicuspid aortic valve (a type of congenital heart disease involving the aortic valve) is found in 7-14% of individuals who have an aortic dissection. These individuals are prone to dissection in the ascending aorta. The risk of dissection in individuals with bicuspid aortic valve is not associated with the degree of stenosis of the valve. A bicuspid aortic valve is a heart condition that is usually due to a congenital deformity. ...
Cross-section of a healthy heart. ...
The aortic valve is one of the valves of the heart. ...
Aortic valve stenosis (AS) is a heart condition caused by the incomplete opening of the aortic valve. ...
Marfan syndrome is noted in 5-9% of individuals who suffer from aortic dissection. In this subset, there is an increased incidence in young individuals. Individuals with Marfan syndrome tend to have aneurysms of the aorta and are more prone to proximal dissections of the aorta. Marfan syndrome is an autosomal dominant genetic disorder of the connective tissue characterized by unusually long limbs, great stature, or long toes (or fingers) in proportion to the persons height, as well as a predisposition to cardiovascular disease. ...
Chest trauma leading to aortic dissection can be divided into two groups based on etiology: blunt chest trauma (commonly seen in car accidents) and iatrogenic. Iatrogenic causes include trauma during cardiac catheterization or due to an intra-aortic balloon pump. This article or section does not adequately cite its references or sources. ...
An iatrogenic (pronounced , IPA) condition is a state of ill health or adverse effect caused by medical treatment, usually due to mistakes made in treatment. ...
Cardiac catheterization (heart cath) is the insertion of a catheter into a chamber or vessel of the heart. ...
The Intra-aortic balloon pump (IABP) is a mechanical device that is used to increase myocardial oxygen supply and decrease myocardial oxygen demand as well as increase cardiac output. ...
Aortic dissection may be a late sequalae of cardiac surgery. 18% of individuals who present with an acute aortic dissection have a history of open heart surgery. Individuals who have undergone aortic valve replacement for aortic insufficiency are at particularly high risk. This is because aortic insufficiency causes increased blood flow in the ascending aorta. This can cause dilatation and weakening of the walls of the ascending aorta. Cardiac surgery is surgery on the heart, typically to treat complications of ischemic heart disease (e. ...
Aortic insufficiency (AI), also known as aortic regurgitation (AR), is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle. ...
Signs and symptoms About 96% of individuals with aortic dissection present with severe pain that had a sudden onset. It may be described as tearing in nature, or stabbing or sharp in character. 17% of individuals will feel the pain migrate as the dissection extends down the aorta. The location of pain is associated with the location of the dissection. Anterior chest pain is associated with dissections involving the ascending aorta, while intrascapular (back) pain is associated with descending aortic dissections. If the pain is pleuritic in nature, it may suggest acute pericarditis due to hemorrhage into the pericardial sac. In zootomy, several terms are used to describe the location of organs and other structures in the body of bilateral animals. ...
Pericarditis is inflammation of the sac surrounding the heart, the pericardium. ...
While the pain may be confused with the pain of a myocardial infarction (heart attack), aortic dissection is usually not associated with the other signs that suggest myocardial infarction, including heart failure, and ECG changes. Also, individuals suffering from an aortic dissection usually do not present with diaphoresis (profuse sweating). Acute myocardial infarction (AMI or MI), commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ...
ECG may also refer to the East Coast Greenway Lead II An Electrocardiogram (ECG or EKG, abbreviated from the German Elektrokardiogramm) is a graphic produced by an electrocardiograph, which records the electrical voltage in the heart in the form of a continuous strip graph. ...
Diaphoresis is excessive sweating commonly associated with shock and other medical emergency conditions. ...
Individuals with aortic dissection who do not present with pain have chronic dissection.
Less common symptoms that may be seen in the setting of aortic dissection include congestive heart failure (7%), syncope (9%), cerebrovascular accident (3-6%), ischemic peripheral neuropathy, paraplegia, cardiac arrest, and sudden death. If the individual had a syncopal episode, about half the time it is due to hemorrhage into the pericardium leading to pericardial tamponade. Congestive heart failure (CHF), also called congestive cardiac failure (CCF) or just heart failure, is a condition that can result from any structural or functional cardiac disorder that impairs the ability of the heart to fill with or pump a sufficient amount of blood throughout the body. ...
The term Faint redirects here. ...
A stroke or cerebrovascular accident (CVA) occurs when the blood supply to a part of the brain is suddenly interrupted by occlusion (an ischemic stroke- approximately 90% of strokes), by hemorrhage (a hemorrhagic stroke - less than 10% of strokes) or other causes. ...
Paraplegia is a condition in which the lower part of a persons body is paralyzed and cannot willfully function. ...
This article or section does not cite its references or sources. ...
Cardiac tamponade is a medical emergency condition where a large amount of a liquid accumulates in the pericardium in a relatively short time. ...
Neurologic complications of aortic dissection (i.e., cerebrovascular accident (CVA) and paralysis) are due to involvement of one or more arteries supplying portions of the central nervous system. A stroke or cerebrovascular accident (CVA) occurs when the blood supply to a part of the brain is suddenly interrupted by occlusion (an ischemic stroke- approximately 90% of strokes), by hemorrhage (a hemorrhagic stroke - less than 10% of strokes) or other causes. ...
Paralysis is the complete loss of muscle function for one or more muscle groups. ...
A diagram showing the CNS: 1. ...
If the aortic dissection involves the abdominal aorta, compromise of the branches of the abdominal aorta are possible. In abdominal aortic dissections, compromise of one or both renal arteries occurs in 5-8% of cases, while mesenteric ischemia (ischemia of the large intestines) occurs 3-5% of the time. Human kidneys viewed from behind with spine removed The renal arteries normally arise off the abdominal aorta and supply the kidneys with blood. ...
In medicine, ischemia (Greek ισχαιμία, isch- is restriction, hema or haema is blood) is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. ...
The large intestine, or the organ which is now more commonly referred to as the colon, is the last part of the digestive system: the final stage of the alimentary canal in vertebrate animals. ...
Blood pressure changes While many patients with an aortic dissection have a history of hypertension, the blood pressure is quite variable at presentation with acute aortic dissection, and tends to be higher in individuals with a distal dissection. In individuals with a proximal aortic dissection, 36% present with hypertension, while 25% present with hypotension. In those that present with distal aortic dissections, 70% present with hypertension while 4% present with hypotension. Arterial hypertension, or high blood pressure is a medical condition where the blood pressure is chronically elevated. ...
Arterial hypertension, or high blood pressure is a medical condition where the blood pressure is chronically elevated. ...
In physiology and medicine, hypotension refers to an abnormally low blood pressure. ...
Severe hypotension at presentation is a grave prognostic indicator. It is usually associated with pericardial tamponade, severe aortic insufficiency, or rupture of the aorta. Accurate measurement of the blood pressure is important. Pseudohypotension (falsely low blood pressure measurement) may occur due to involvement of the brachiocephalic artery (supplying the right arm) or the left subclavian artery (supplying the left arm). Cardiac tamponade is a medical emergency condition where a large amount of a liquid accumulates in the pericardium in a relatively short time. ...
Aortic insufficiency (AI), also known as aortic regurgitation (AR), is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle. ...
The brachiocephalic artery (or brachiocephalic trunk or innominate artery) is an artery of the mediastinum that supplies blood to the right arm and the head and neck. ...
The subclavian artery is a major artery of the upper thorax that mainly supplies blood to the head and arms. ...
Aortic insufficiency Aortic insufficiency (AI) occurs in 1/2 to 2/3 of ascending aortic dissections, and the murmur of aortic insufficiency is audible in about 32% of proximal dissections. The intensity (loudness) of the murmur is dependent on the blood pressure and may be inaudible in the event of hypotension. Aortic insufficiency (AI), also known as aortic regurgitation (AR), is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle. ...
Front of thorax, showing surface relations of bones, lungs (purple), pleura (blue), and heart (red outline). ...
In physiology and medicine, hypotension refers to an abnormally low blood pressure. ...
There are multiple etiologies for AI in the setting of ascending aortic dissection. The dissection may dilate the annulus of the aortic valve, so that the leaflets of the valve cannot coapt. Another mechanism is that the dissection may extend into the aortic root and detach the aortic valve leaflets. The third mechanism is that if there was an extensive intimal tear, the intimal flap may prolapse into the LV outflow tract, causing intimal intussusception into the aortic valve preventing proper valve closure. The aortic valve is one of the valves of the heart. ...
An intussusception is a situation in which a part of the intestine has prolapsed into another section of intestine, similar to the way in which the parts of a collapsible telescope slide into one another. ...
Myocardial infarction Myocardial infarction (heart attack) occurs in 1-2% of aortic dissections. The etiology of the infarction is involvement of the coronary arteries (the arteries that supply the heart) in the dissection. The right coronary artery is involved more commonly than the left coronary artery. If the myocardial infarction is treated with thrombolytic therapy, the mortality increases to over 70%, mostly due to hemorrhage into the pericardial sac causing pericardial tamponade. Acute myocardial infarction (AMI or MI), commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ...
The coronary circulation consists of the blood vessels that supply blood to, and remove blood from, the heart. ...
Section of an artery For other uses, see Artery (disambiguation). ...
Thrombolysis is the breakdown (lysis) by pharmacological means, of blood clots. ...
Cardiac tamponade is a medical emergency condition where a large amount of a liquid accumulates in the pericardium in a relatively short time. ...
Because aortic dissection may present to the emergency room physician similar to a myocardial infarction, the physician must be careful to make the proper diagnosis prior to initiating treatment for myocardial infarction, since the treatment regimen for myocardial infarction can be lethal to an individual presenting with aortic dissection. The emergency room is the American English term for a room, or group of rooms, within a hospital that is designed for the treatment of urgent and medical emergencies. ...
The Doctor by Samuel Luke Fildes This article is about the term physician, one type of doctor; for other uses of the word doctor see Doctor. ...
Pleural effusion A pleural effusion (fluid collection in the space between the lungs and the chest wall or diaphragm) can be due to either blood from a transient rupture of the aorta or fluid due to an inflammatory reaction around the aorta. If a pleural effusion were to develop due to aortic dissection, it is more commonly in the left hemithorax rather than the right hemithorax. Pleural effusion Chest x-ray of a pleural effusion. ...
Respiratory system The lungs flank the heart and great vessels in the chest cavity. ...
In the anatomy of mammals, the diaphragm is a shelf of muscle extending across the bottom of the ribcage. ...
Diagnosis Because of the varying symptoms and signs of aortic dissection depending on the initial intimal tear and the extent of the dissection, the proper diagnosis is sometimes difficult to make.
In an individual with chest pain radiating to the back, the differentials to consider include:
While taking a good history from the individual may be strongly suggestive of an aortic dissection, the diagnosis cannot always be made by history and physical signs alone. Often the diagnosis is made by visualization of the intimal flap on a diagnositic imaging test. Common tests used to diagnose an aortic dissection include a CAT scan of the chest with iodinated contrast material and a trans-esophageal echocardiogram. Other tests that may be used include an aortogram or magnetic resonance angiogram (MRA) of the aorta. Each of these test have varying pros and cons and they do not have equal sensitivities and specificities in the diagnosis of aortic dissection. Acute myocardial infarction (AMI or MI), commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ...
Aortic insufficiency (AI), also known as aortic regurgitation (AR), is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle. ...
An aortic aneurysm is a general term for any swelling (dilatation or aneurysm) of the aorta, usually representing an underlying weakness in the wall of the aorta at that location. ...
Pericarditis is inflammation of the sac surrounding the heart, the pericardium. ...
The human musculoskeletal system is the musculoskeletal system that gives us the ability to move. ...
Hurting redirects here. ...
FIG. 967– Transverse section through the upper margin of the second thoracic vertebra The mediastinum is a non-delineated group of structures in the thorax (chest), surrounded by loose connective tissue. ...
Tumor (American English) or tumour (British English) originally means swelling, and is sometimes still used with that meaning. ...
CAT apparatus in a hospital Computed axial tomography (CAT), computer-assisted tomography, computed tomography, CT, or body section roentgenography is the process of using digital processing to generate a three-dimensional image of the internals of an object from a large series of two-dimensional X-ray images taken around...
The transesophageal echocardiogram (TEE) is used over the transthoracic echocardiogram (TTE) whenever better, more detailed images of the heart are needed by the cardiologist. ...
In general, the imaging technique chosen is based on the pre-test likelihood of the diagnosis, availability of the testing modality, patient stability, and the sensitivity and specificity of the test.
Chest X-ray Widening of the mediastinum on an x-ray of the chest has moderate sensitivity (67%) in the setting of an ascending aortic dissection[3]. However, it has low specificity, as many other conditions can cause a widening of the mediastinum on chest x-ray. FIG. 967– Transverse section through the upper margin of the second thoracic vertebra The mediastinum is a non-delineated group of structures in the thorax (chest), surrounded by loose connective tissue. ...
In the NATO phonetic alphabet, X-ray represents the letter X. An X-ray picture (radiograph) taken by Röntgen An X-ray is a form of electromagnetic radiation with a wavelength approximately in the range of 5 pm to 10 nanometers (corresponding to frequencies in the range 30 PHz...
The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ...
The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ...
The calcium sign is a finding on chest x-ray that suggests aortic dissection. It is the separation of the intimal calcification from the outer aortic soft tissue border by 10 mm.
Pleural effusions may be seen on chest x-ray. They are more commonly seen in descending aortic dissections. If seen, they are typically in the left hemithorax.
Another findings are obliteration of the aortic knob, depression of the left mainstem bronchus, loss of the paratracheal stripe, and tracheal deviation.
About 12%-20% of individuals presenting with an aortic dissection have a "normal" chest x-ray.
ECG There are no specific electrocardiographic findings associated with aortic dissection. About 1/3 of the time, the ECG will show signs of left ventricular hypertrophy, which is due to the long-standing hypertension seen in these individuals. Another 1/3 of the time the ECG would be considered "normal". If the ECG suggests cardiac ischemia in the setting of aortic dissection, involvement of the coronary arteries should be suspected. “QRS†redirects here. ...
Left ventricular hypertrophy (LVH) is the abnormal thickening of the myocardium (muscle) of the left ventricle of the heart. ...
This article or section does not adequately cite its references or sources. ...
In medicine, ischemia (Greek ισχαιμία, isch- is restriction, hema or haema is blood) is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. ...
Biochemical markers While there are currently no blood tests that can accurately diagnose aortic dissection, research has been performed into the serial measurement of monoclonal antibodies to smooth muscle myosin heavy chains that appears to be both sensitive and specific for aortic dissection.[4] The sensitivity of this test is about 90% and the specificity is 97% within the first 12 hours of the beginning of the dissection, and this assay can accurately differentiate myocardial infarction from aortic dissection. This test is not currently available for the diagnosis of aortic dissection in the clinical setting. Monoclonal antibodies (mAb) are antibodies that are identical because they were produced by one type of immune cell, all clones of a single parent cell. ...
Cultured Smooth muscle of the aorta. ...
Myosin is a motor protein filament found in muscle tissue. ...
Transesophageal echocardiography The transesophageal echocardiogram (TEE) is a relatively good test in the diagnosis of aortic dissection, with a sensitivity of up to 98% and a specificity of up to 97%. It is a relatively non-invasive test, requiring the individual to swallow the echocardiography probe. It is especially good in the evaluation of AI in the setting of ascending aortic dissection, and to determine whether the ostia (origins) of the coronary arteries are involved. While many institutions give sedation during transesophageal echocardiography for added patient-comfort, it can be performed in cooperative individuals without the use of sedation. Disadvantages of the TEE include the inability to visualize the distal ascending aorta (the beginning of the aortic arch), and the descending abdominal aorta that lies bellow the stomach. A TEE may be technically difficult to perform in individuals with esophageal strictures or varicies. The transesophageal echocardiogram (TEE) is used over the transthoracic echocardiogram (TTE) whenever better, more detailed images of the heart are needed by the cardiologist. ...
The term non-invasive in medicine has two meanings: A medical procedure which does not penetrate or break the skin or a body cavity, i. ...
For the embryological structure, see Aortic arches. ...
In anatomy, the stomach is a bean-shaped hollow muscular organ of the gastrointestinal tract involved in the second phase of digestion, following mastication. ...
Aortogram An aortogram involves placement of a catheter in the aorta and injection of contrast material while taking x-rays of the aorta. 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. Catheter disassembled In medicine, a catheter is a tube that can be inserted into a body cavity duct or vessel. ...
The aorta (generally pronounced or ay-orta) is the largest artery in the human body, originating from the left ventricle of the heart and bringing oxygenated blood to all parts of the body in the systemic circulation. ...
The aortogram was previously considered the gold standard test for the diagnosis of aortic dissection, with a sensitivity of up to 88% and a specificity of about 94%. It is especially poor in the diagnosis of cases where the dissection is due to hemorrhage within the media without any initiating intimal tear. In medicine, a gold standard test is the diagnostic test that is regarded as definitive in determining whether an individual has a disease process. ...
The advantage of the aortogram in the diagnosis of aortic dissection is that it can delineate the extent of involvement of the aorta and branch vessels and can diagnose aortic insufficiency. Aortic insufficiency (AI), also known as aortic regurgitation (AR), is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle. ...
The disadvantages of the aortogram are that it is an invasive procedure and it requires the use of iodinated contrast material.
Spiral CT with contrast
 |
 | | Computed tomography (CT) | Legend | Aortic dissection Type Stanford A
1 Aorta ascendens, true Lumen - 2 false Lumen - 3 Pulmonary artery
4 Aorta descendens - 5 thoracic vertebra | The spiral CT scan with contrast is a fast non-invasive test that will give an accurate three-dimensional view of the aorta. It is performed by taking rapid-cut radiographs of the chest and combining them in the computer to create cross-sectional slices of the chest. In order to delineate the aorta to the accuracy necessary to make the proper diagnosis, an iodinated contrast material is injected into a peripheral vein at a properly timed moment so that it will enter the aorta at the time that the aorta is being imaged. Image File history File links Size of this preview: 630 × 600 pixels Full resolution (1153 × 1098 pixel, file size: 273 KB, MIME type: image/jpeg) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Aortic dissection ...
Image File history File links Size of this preview: 630 × 600 pixels Full resolution (1153 × 1098 pixel, file size: 235 KB, MIME type: image/jpeg) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Aortic dissection ...
The pulmonary arteries carry blood from the heart to the lungs. ...
CT apparatus in a hospital Computed axial tomography (CAT), computer-assisted tomography, computed tomography, CT, or body section roentgenography is the process of using digital processing to generate a three-dimensional image of the internals of an object from a large series of two-dimensional X-ray images taken around...
It has a sensitivity of 96 - 100% and a specificity of 96 to 100%. Disadvantages include the need for iodinated contrast material and the inability to diagnose the site of the intimal tear.
MRI
 MRI of an aortic dissection 1 Aorta descendens with dissection 2 Aorta isthmus Magnetic resonance imaging (MRI) is currently the gold standard test for the detection and assessment of aortic dissection, with a sensitivity of 98% and a specificity of 98%. An MRI examination of the aorta will produce a three-dimensional reconstruction of the aorta, allowing the physician to determine the location of the intimal tear, the involvement of branch vessels, and locate any secondary tears. It is a non-invasive test, does not require the use of iodinated contrast material, and can detect and quantitate the degree of aortic insufficiency. Image File history File links No higher resolution available. ...
Image File history File links No higher resolution available. ...
Magnetic Resonance Image showing a median sagittal cross section through a human head. ...
Magnetic Resonance Image showing a median sagittal cross section through a human head. ...
In medicine, a gold standard test is the diagnostic test that is regarded as definitive in determining whether an individual has a disease process. ...
Aortic insufficiency (AI), also known as aortic regurgitation (AR), is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle. ...
The disadvantage of the MRI scan in the face of aortic dissection is that it has limited availability and is often located only in the larger hospitals, and the scan is relatively time consuming. Due to the high intensity of the magnetic waves used during MRI, an MRI scan is contraindicated in individuals with metallic implants. In addition, many individuals succumb to claustrophobia while in the MRI scanning tube. Claustrophobia is an anxiety disorder that involves the fear of enclosed or confined spaces. ...
Natural history | Risk of death in untreated aortic dissection |
| | | 25% in first 24 hours | | | | 50% in first week | | | | 75% in first month | | | | 90% in first year | | The risk of death is high in untreated aortic dissection. While the risk is highest in the first 24 hours of the event, those that survive the initial event still have an elevated mortality compared to age- and sex-matched controls. This article or section does not adequately cite its references or sources. ...
First Aid and Pre-Hospital Life Support It is unlikely that a lay-person will recognize this condition. Call for help and arrange for immediate transport via emergency medical services to advanced medical care. In wilderness first aid, immediate evacuation is imperative, by MEDEVAC to an advanced medical facility if available. It has been suggested that this article or section be merged with Distress call. ...
The examples and perspective in this article or section may not represent a worldwide view. ...
Wilderness first aid is the provision of first aid under conditions where the arrival of emergency responders or the patient evacuation may be delayed due to constraints of terrain, weather, and available persons or equipment. ...
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A Beechcraft King Air of the Royal Flying Doctor Service of Australia. ...
Transport immediately to a facility capable of emergency cardiac surgery such as a trauma center is suggested, not a community hospital without a surgical service. Supportive care including pain and blood pressure control should be provided on route to the medical center. Cardiac surgery is surgery on the heart, typically to treat complications of ischemic heart disease (e. ...
A trauma center is a hospital equipped to perform as a casualty receiving station for the emergency medical services by providing the best possible medical care for traumatic injuries 24 hours a day, 365 days per year. ...
For Basic Life Support Providers (EMT-B or equivalent): Treat for shock by placing the patient in a modified Trendelenburg position and administering oxygen therapy. Despite chest pain, do not administer nitrates. Basic life support (BLS) is a specific level of prehospital medical care provided by trained responders, including emergency medical technicians, in the absence of advanced medical care. ...
The examples and perspective in this article or section may not represent a worldwide view. ...
This article is about the medical condition. ...
In the Trendelenburg position the body is laid flat on the back with the head lower than the pelvis, in contrast to the reverse trendelenburg position. ...
Oxygen first aid kit showing a demand valve and a constant flow mask Oxygen therapy is the administration of oxygen as a therapeutic modality. ...
Glyceryl trinitrate (GTN) has been used to treat angina and heart failure since at least 1880. ...
For Advanced Life Support Providers (EMT-I or EMT-P): Initiate the above BLS steps. Apply cardiac monitoring and establish intravenous therapy early. Titrate fluid to blood pressure, but do not use vasopressors. Record a diagnostic electrocardiogram to distinguish between aortic dissection and acute myocardial infarction. Do not administer thrombolytics. Analgesia should be accomplished with regard to the vasodilative effects of opioid analgesics such as morphine, fentanyl, and nalbuphine and should not be provided to a patient in decompensated shock. Advanced Life Support (ALS) is a treatment consensus for cardiopulmonary resuscitation in cardiac arrest and related medical problems, as agreed in Europe by the European Resuscitation Council, most recently in 2005. ...
There are very few or no other articles that link to this one. ...
A Paramedic is a specialized health care professional who responds to medical and trauma emergencies in the pre-hospital (out-of-hospital) environment for the purpose of stabilizing and transporting the patient to an appropriate medical facility, usually by ambulance. ...
Basic life support (BLS) is a specific level of prehospital medical care provided by trained responders, including emergency medical technicians, in the absence of advanced medical care. ...
Intravenous therapy or IV therapy is the administration of liquid substances directly into a vein. ...
A sphygmomanometer, a device used for measuring blood pressure. ...
A vasoconstrictor, also vasopressor or simply pressor, is any substance that acts to cause vasoconstriction (narrowing of the lumena of blood vessels) and usually results in an increase of the blood pressure. ...
“QRS†redirects here. ...
Acute myocardial infarction (AMI or MI), commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ...
Thrombolysis is the breakdown (lysis) by pharmacological means, of blood clots. ...
For other uses of painkiller, see painkiller (disambiguation) An analgesic (colloquially known as painkiller) is any member of the diverse group of drugs used to relieve pain. ...
Vasodilation is where blood vessels in the body become wider following the relaxation of the smooth muscle in the vessel wall. ...
An opioid is a chemical substance that has a morphine-like action in the body. ...
For other uses of painkiller, see painkiller (disambiguation) An analgesic (colloquially known as painkiller) is any member of the diverse group of drugs used to relieve pain. ...
This article does not adequately cite its references or sources. ...
To meet Wikipedias quality standards, this article or section may require cleanup. ...
Nalbuphine (nalbuphine hydrochloride) is a synthetic opioid used commercially as an analgesic under a variety of trade names, including Nubain. ...
This article is about the medical condition. ...
Treatment The risk of death due to aortic dissection is highest in the first few hours after the dissection begins, and decreases afterwards. Because of this, the therapeutic strategies differ for treatment of an acute dissection compared to a chronic dissection. An acute dissection is one in which the individual presents within the first two weeks. If the individual has managed to survive this window period, his prognosis is improved. About 66% of all dissections present in the acute phase.
In all individuals with aortic dissections, medication should be used to control high blood pressure, if present. This article or section does not adequately cite its references or sources. ...
In the case of an acute dissection, once diagnosis has been confirmed, the choice of treatment depends on the location of the dissection. For ascending aortic dissection, surgical management is superior to medical management. On the other hand, in the case of an uncomplicated distal aortic dissections (including abdominal aortic dissections), medical management is preferred over surgical treatment [5]
Individuals who present two weeks after the onset of the dissection are said to have chronic aortic dissections. These individuals have been self-selected as survivors of the acute episode, and can be treated with medical therapy as long as they are stable.
Medical management is appropriate in individuals with an uncomplicated distal dissection, a stable dissection isolated to the aortic arch, and stable chronic dissections. Patient selection for medical management is very important. Stable individuals who present with an acute distal dissection (typically treated with medical management) still have an 8 percent 30 day mortality.
Medical management The prime consideration in the medical management of aortic dissection is strict blood pressure control. The target blood pressure should be a mean arterial pressure (MAP) of 60 to 75 mmHg. Another factor is to reduce the shear-force dP/dt (force of ejection of blood from the left ventricle). The mean arterial pressure (MAP) is a term used in medicine to describe a notional average blood pressure in an individual. ...
One way of defining pressure is in terms of the height of a column of fluid that may be supported by that pressure; or the height of a column of fluid that exerts that pressure at its base. ...
In the heart, a ventricle is a chamber which collects blood from an atrium (another heart chamber) and pumps it out of the heart. ...
To reduce the shear stress, a vasodilator such as sodium nitroprusside should be used with a beta blocker, such as esmolol, propranolol, or labetalol. The alpha-blocking properties of labetalol make it especially attractive in this situation. Shear stress is a stress state where the stress is parallel to a face of the material, as opposed to normal stress when the stress is perpendicular to the face. ...
Sodium nitroprusside is the chemical compound Na2[Fe(CN)5NO]. It is a potent peripheral vasodilator that affects both arterioles and venules. ...
Beta blockers or beta-adrenergic blocking agents are a class of drugs used to treat a variety of cardiovascular conditions and some other diseases. ...
Esmolol (tradename Brevibloc®) is a cardioselective beta-blocker given by slow injection into the veins. ...
Propranolol (INN) (IPA: ) is a non-selective beta blocker mainly used in the treatment of hypertension. ...
The examples and perspective in this article do not represent a worldwide view. ...
The examples and perspective in this article do not represent a worldwide view. ...
Calcium channel blockers can be used in the treatment of aortic dissection, particularly if there is a contraindication to the use of beta blockers. The calcium channel blockers typically used are verapamil and diltiazem, because of their combined vasodilator and negative inotropic effects. Calcium channel blockers are a class of drugs with effects on many excitable cells of the body, like the muscle of the heart, smooth muscles of the vessels or neuron cells. ...
Verapamil (brand names: Isoptin®, Verelan®, Calan®) is a medical drug that acts as an L-type calcium channel blocker. ...
Diltiazem is a member of the group of drugs known as Benzothiapines , which are a class of calcium channel blockers, used in the treatment of hypertension, angina pectoris, and some types of arrhythmia. ...
Inotropic: Affecting the force of muscle contraction. ...
If the individual has refractory hypertension (persistent hypertension on the maximum doses of three different classes of antihypertensive agents), involvement of the renal arteries in the aortic dissection plane should be considered.
Surgical management Indications for the surgical treatment of aortic dissection include an acute proximal aortic dissection and an acute distal aortic dissection with one or more complications. Complications include compromise of a vital organ, rupture or impending rupture of the aorta, retrograde dissection into the ascending aorta, and a history of Marfan's syndrome. Marfan syndrome is a connective tissue disorder characterized by unusually long limbs. ...
The objective in the surgical management of aortic dissection is to resect (remove) the most severely damaged segments of the aorta, and to obliterate the entry of blood into the false lumen (both at the initial intimal tear and any secondary tears along the vessel). While excision of the intimal tear may be performed, it does not significantly change mortality.
Some methods of repair are:
- Replacement of the damaged section with a tube graft (often made of dacron) when there is no damage to the aortic valve.
- Bentall procedure - Replacement of the damaged section of aorta and replacement of the aortic valve.
- David procedure - Replacement of the damaged section of aorta and reimplantation of the aortic valve.
A number of comorbid conditions increase the surgical risk of repair of an aortic dissection. These include: The term plastics covers a range of synthetic or semi-synthetic organic condensation or polymerization products that can be molded or extruded into objects or films or fibers. ...
The aortic valve is one of the valves of the heart. ...
A Bentall procedure is a cardiac surgery operation involving composite graft replacement of the ascending aorta and aortic valve, with anastomosis of the coronary arteries into the graft. ...
Valve-sparing aortic root replacement (also known as the David procedure) is a cardiac surgery procedure involving replacement of the ascending aorta without replacement of the aortic valve. ...
Coronary heart disease (CHD), also called coronary artery disease (CAD) and atherosclerotic heart disease, is the end result of the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium (the muscle of the heart). ...
Cardiac tamponade, also known as pericardial tamponade, is a medical emergency condition where liquid accumulates in the pericardium in a relatively short time. ...
This article is about the medical condition. ...
Acute myocardial infarction (AMI or MI), commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ...
A stroke or cerebrovascular accident (CVA) occurs when the blood supply to a part of the brain is suddenly interrupted by occlusion (an ischemic stroke- approximately 90% of strokes), by hemorrhage (a hemorrhagic stroke - less than 10% of strokes) or other causes. ...
Renal failure is the condition in which the kidneys fail to function properly. ...
Long term follow-up The long term follow-up in individuals who survive aortic dissection involves strict blood pressure control. The relative risk of late rupture of an aortic aneurysm is 10 times higher in individuals who have uncontrolled hypertension, compared to individuals with a systolic pressure below 130 mmHg. An aortic aneurysm is a general term for any swelling (dilatation or aneurysm) of the aorta, usually representing an underlying weakness in the wall of the aorta at that location. ...
This article or section does not adequately cite its references or sources. ...
The risk of death is highest in the first two years after the acute event, and individuals should be followed closely during this time period. 29% of late deaths following surgery are due to rupture of either the dissecting aneurysm or another aneurysm. In additions, there is a 17 to 25% incidence of new aneurysm formation. This is typically due to dilatation of the residual false lumen. These new aneurysms are more likely to rupture, due to their thinner walls.
Serial imaging of the aorta is suggested, with MRI being the preferred imaging technique. The mri are a fictional alien species in the Faded Sun Trilogy of C.J. Cherryh. ...
Famous victims Deaths Survivors George II (George Augustus; 10 November 1683 – 25 October 1760) was King of Great Britain and Ireland, Duke of Brunswick-Lüneburg (Hanover) and Archtreasurer and Prince-Elector of the Holy Roman Empire from 11 June 1727 until his death. ...
Liese Prokop (March 27, 1941 — December 31, 2006) was an Austrian athlete who competed mainly in the pentathlon. ...
Lucille Désirée Ball (August 6, 1911 – April 26, 1989) was an iconic American actor, comedian and star of the landmark sitcom I Love Lucy, a four time Emmy Award winner (awarded 1953, 1956, 1967, 1968) and charter member of the Television Hall of Fame. ...
Jonathan Larson (February 4, 1960 – January 25, 1996) was an American composer who lived in New York City and authored musicals, including Rent and Tick, Tick. ...
Rent is an American Tony Award- and Pulitzer Prize-winning rock musical, with music and lyrics by Jonathan Larson. ...
John Southworth Ritter (September 17, 1948 – September 11, 2003) was an American actor best known for his role of Jack Tripper in the sitcom Threes Company. ...
Richard Biggs as Dr. Stephen Franklin in Babylon 5 Richard Biggs as Dr. Marcus Hunter in Days of Our Lives. ...
- Dr. Michael E. DeBakey, who devised the surgery to correct aortic dissection (as well as other cardiovascular and vascular techniques). Dr. DeBakey is also noteworthy for being the oldest patient ever to receive his own operation: he was 97 at the time of his surgery on February 9 and 10 of 2006. He survived and, though currently working with physical therapists to walk on his own again after suffering muscle deconditioning from prolonged physical inactivity during recovery, has all of his mental faculties and is back to working nearly a full day. (See [1] published 25 December, 2006, in the New York Times).
- Daniel Dennett, philosopher
- Gérard Houllier, former manager of Liverpool Football Club, now manages Olympic Lyonnais
Michael Ellis DeBakey Michael Ellis DeBakey (born September 7, 1908, Born Michel Dabaghi (according to the American Lebanese Medical Association (ALMA). ...
Daniel Clement Dennett (b. ...
Gérard Houllier, OBE, (born 3 September 1947, in Thérouanne, Pas-de-Calais, France) is a football manager, currently managing the French champions Lyon. ...
Liverpool Football Club is the most successful English football team, having won 4 European Cups and 18 league (English Premier League, formerly First Division) titles. ...
See also An aortic aneurysm is a general term for any swelling (dilatation or aneurysm) of the aorta, usually representing an underlying weakness in the wall of the aorta at that location. ...
Connective Tissue Disease: Autoimmune diseases involving a disorder of the bodys connective tissues. ...
This article or section does not adequately cite its references or sources. ...
Marfan syndrome is an autosomal dominant genetic disorder of the connective tissue characterized by unusually long limbs, great stature, or long toes (or fingers) in proportion to the persons height, as well as a predisposition to cardiovascular disease. ...
References - ^ DeBakey ME, Henly WS, Cooley DA, Morris GC Jr, Crawford ES, Beall AC Jr. Surgical management of dissecting aneurysms of the aorta. J Thorac Cardiovasc Surg 1965;49:130-49. PMID 14261867.
- ^ Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE. Management of acute aortic dissections. Ann Thorac Surg 1970;10:237-47. PMID 5458238.
- ^ von Kodolitsch Y, Nienaber C, Dieckmann C, Schwartz A, Hofmann T, Brekenfeld C, Nicolas V, Berger J, Meinertz T (2004). "Chest radiography for the diagnosis of acute aortic syndrome.". Am J Med 116 (2): 73-7. PMID 14715319.
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