Diagnostic dissection can be done using several methods of visual examination: CT with angiography, MRI, aortography with contrast and transesophageal echocardiography. During treatment, the patient must be in the hospital, since constant monitoring of blood pressure and monitoring in the dynamics is required.
Learn more about the dangers of this disease and the measures taken to save the life of the patient.
What is it?
The aortic dissection is primary or secondary, but in any case it is due to a hemorrhage within the middle shell of the .A crack can occur in any segment of the aorta, and then distally and proximally spread through other arteries. An important sign is hypertension.
A sign of the aortic fissure can be considered sharp pain in the lumbar region or in the sternum .Stratification leads to aortic regurgitation, as a result of which there is a disturbance of blood flow in the arterial branches.
Surgery and prosthetics with synthetic implants are necessary for a crack in the ascending aorta and for specific delaminations of the descending sections.
Causes and risk factors
Bundling can occur if the patient has a history of degenerative diseases of the middle aortic shell. The causes may be anomalies of connective tissue or trauma. A third of patients with had earlier signs of atherosclerosis and hypertension.
As a result of rupture of the inner membrane, which becomes the primary factor in the separation in some patients, and secondary to the hemorrhage in the middle shell in others, the blood stream enters the middle layers. A false blood flow channel is created, resulting in dilatation of the distal or proximal arterial site.
can form a vascular lumen of through an intima rupture in a region remote from the center of the aorta, and thus the initial intensity of blood flow is maintained. But the person has practically no chance to survive, as serious consequences develop: the process of blood flow in the dependent arteries is disrupted, the aortic valve expands, regurgitation, heart failure and fatal rupture occur.
This is called an acute stratification and is dangerous if the prescription is at least two weeks old .The risk of death is significantly reduced if the gap was more than two weeks ago and there are clear signs of thrombosis in the area of false lumen and loss of communication between the true and false vessel.
Classification of species
The stratification process is classified according to anatomical features, for this the conventional DeBakey system is used:
- The stratification begins in the ascending part and extends to the aortic arch;
- Begins and is limited only within the ascending department;
- Begins in the descending section of the thoracic aorta, somewhat below the outgoing subclavian left artery and extends proximally and distally;
- Pregnant women can be localized in a particular single artery, for example, carotid or coronary.
Danger and Complications
Every patient who undergoes a surgical operation must periodically undergo courses of antihypertensive therapy for the rest of his life. Often the treatment scheme includes: ACE inhibitor, ß-adrenoblocker, calcium channel blocker.
These drugs are combined with antihepertensive drugs. It is recommended that abstain from excessive physical exertion of .Every two years the patient is required to undergo a full examination by means of an MRI.
As a late complication, recurrence of recurrent bundles, the emergence of limited aneurysm in the body of the weakened aorta , the progression of regurgitatory aortic processes. With the development of such pathologies, the patient again inevitably falls on the surgical table.
Symptoms of
The very first symptom of aortic dissection is the sharp pain between the shoulder blades or in the precordial region of the , patients often describe it as "tearing".It often radiates, following the spread of the aortic fissure.
The pain is so severe that some people lose consciousness from the painful shock of , as well as due to irritation of aortic baroreceptors and extracranial brain arterial obstructions. A cardiac tamponade develops.
Some patients have partial loss of pulse on the artery .AD significantly differs for each limb. Noises of regurgitation are heard.
In a third of cases, acute heart failure appears. Blood, falling into the left pleural cavity, provokes pleural effusion. Arterial occlusions cause signs of ischemia or neuralgia in the extremities, anuria and oliguria, if the renal artery is involved.
When and to which doctor should I go?
The bundle is so dangerous and painful that the patient himself is not able to attend to emergency medical care. It is necessary immediately to call the doctors or to deliver the victim himself to the medical institution, where he will be put in the intensive care unit or intensive care unit.
The urgent consultation of a surgeon, vascular surgeon, cardiologist and anesthesiologist is required.
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Diagnosis
Symptoms differentiate with stroke, intestinal infarction and myocardium, paraparesis and paraplegia in cases of blood flow disorders in the spinal cord, limb ischemia due to acute distal occlusion of the arteries.
The patient is assigned an emergency radiograph of the sternum , which will show an extension of the mediastinum shadow and a limited convexity characteristic of the aneurysm. In most cases, pleural effusion is found on the left side.
After stabilization, the patient needs to do transesophageal echocardiography, MRA and KTA .The result of which can become data on the severity of the tear of the inner lining and the formation of a double lumen.
Contrast angiography is performed immediately before surgery. With its help, determine the degree of involvement of the major aortic branches. Aortography is needed to confirm the diagnosis and helps to establish whether the patient needs aortocoronary bypass. With the help of echocardiography determine the intensity of regurgitation processes, as well as the need for replacement of the valve.
Laboratory determine the serum and troponin level of the serum and troponin , this will help differentiate the bundle from infarction, except in cases when the rupture was caused by the infarction itself. A general blood test shows the presence of leukocidosis and anemia.
Treatment methods
If the patient does not die during transportation to the hospital, his is placed in the intensive care unit and an intraarterial pressure monitor is connected. A catheter is used to isolate the urine. Immediately determine the blood group and Rh factor, because during the operation there is a need for erythrocyte mass. Human unstable hemodynamics are intubated.
Assign drugs to lower blood pressure, stopping arthritic wall spasm, pain syndrome and ventricular contractility .The list of drugs usually includes b-adrenoblockers, for example, "Propranolol", or "Metroprolol" and "Labetalol".As an alternative, blockers of calcium channels - "Verapamil" and "Diltiazem" - are used.
The use of exclusively medicamentous treatment is justified only with uncomplicated and stable stratification. Surgical operation is indicated in 98% of cases of .Indications for surgical intervention are:
- Ischemia of the limb or organ;
- Uncontrolled AG;
- Continuous aortic dilatation;
- Spreading the bundle;
- Signs of aortic rupture;
- Marfan syndrome.
During the operation of , the surgeon eliminates the entrance to the false channel and prosthetics of the aorta .With regurgitation, the aortic valve undergoes plastic or prosthetics.
Forecasts and prevention measures
Some patients do not live up to the arrival of an ambulance. If no action is taken, the person will die within the next 24 hours in 3% of the total number of cases, in the first week - in 30%, in two weeks - in 80%, and within one year - in 90%.
Hospital mortality rates are slightly lower, with proximal separation on the surgical table, 30% of patients die, while in the distal one, 12% die.
As prevention of delamination it is recommended to undergo an annual medical examination of for the detection of diseases of the cardiovascular system. Aortic fissure can be prevented through continuous cardiac monitoring, including daily monitoring of blood pressure and cholesterol level. And also by periodically undergoing procedures of UZD or UZDG.
Symptoms of aortic dissection are found in approximately 3% of the total number of autopsies. The group of special risk includes men, elderly people of both sexes and representatives of the Negroid race. Peak indices fall on the age of 55-65 years, and for pathologies of connective tissues - for 25-45 years.
