Medical Notes

What Is Aortic Dissection;Symptoms,Diagnosis And Types

What Is Aortic Dissection;Symptoms,Diagnosis And Types

Aortic dissection is produced by a tearing of the inner layer of the aortic wall (aorta main artery of the body). The blood separates (dissects) the inner and outer layers from each other. In this way a “false” blood flow channel is produced. The organs (especially the heart or the brain) no longer receive a sufficient supply of blood. 

What Is Aortic Dissection;Symptoms,Diagnosis And Types

Symptoms of Aortic Dissection

The most common symptom of aortic dissection is that of a retrosternal chest pain , which can be confused with pain of cardiac origin.This pain may sometimes radiate to the neck, jaw or shoulders (if the ascending aorta is involved), or to the abdomen, back or lower limbs (typical of the descending aorta).  

Pain can also be felt in the back, the abdomen and even in the arms and legs. Depending on the area of the tear and the circulatory alteration, for example, a sense of breathlessness, shock (tearing near the heart) or signs of a cerebral stroke may occur.

Aortic dissection and risk factors

  • Male sex
  • Hypertension
  • Connettivopatie (eg Marfan syndrome)
  • traumas
  • Syphilis
  • Abuse of narcotic substances

Diagnostics for Aortic Dissection

The diagnostics to be submitted to the patient with suspected dissection may vary depending on the patient’s condition.

In order of sensitivity, the imaging modes are as follows:

  1. Nuclear Magnetic Resonance  ( MRI ): sensitivity and specificity of 98%
  2. Transesophageal echocardiography: sensitivity of 98% and specificity of 77%
  3. CT scan  with contrast medium: 94% sensitivity and 87% specificity
  4. Aortography: 88% sensitivity and 94% specificity

Symptoms of Aortic Dissection

The most common symptom manifesting the patient with aortic dissection is that of a retrosternal chest pain , which can be confused with pain of cardiac origin.

This pain may sometimes radiate to the neck, jaw or shoulders (if the ascending aorta is involved), or to the abdomen, back or lower limbs (typical of the descending aorta).

This pain  tends to be extremely acute and is typically described by the patient with adjectives such as “dilaniante” or “lacerante”.

The intensity of the pain usually tends to be severe for the whole duration of its duration, even if sometimes it can recede spontaneously for hours or days; however, the pathology is not silent at this time and, when the pain makes its reappearance, its intensity is even greater.

Classification of aortic dissection

There are two classifications of aortic dissection: according to Stanford and according to De Bakey.

Classification according to Stanford

  • Type A dissection: involvement of the ascending aorta;
  • Type B dissection: without involvement of the ascending aorta (the dissection starts from the anonymous artery or from the left subclavian artery)

Classification according to De Bakey

  • Type I dissection : extended to the descending aorta
  • Type II dissection : localized to the ascending aorta
  • Type III dissection : it originates after the left subclavian artery
  • Type IV dissection : up to the diaphragm
  • Type IV bisection : up to the iliac.

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