Aortic dissection most often affects the elderly. But there are times 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 learn all about the causes, symptoms and treatment of aortic dissection.
What causes the disease
There are congenital and acquired causes of aortic aneurysm. The first are associated with the presence of pathologies of the cardiovascular system in humans, which are manifested in the defective development of the aortic valve or its narrowing (stenosis) and congenital defects of the aorta itself - tortuosity and coarctation. In addition, a congenital or acquired heart defect can serve as a cause. In addition, the following diagnosed diseases associated with pathologies of connective tissues affect the development of aneurysm:
- Ehlers-Danlos syndrome;
- annuarticular ectasia;
- polycystic kidney disease;
- osteogenesis;
- Turner syndrome;
- homocystinuria.
Etiopathogenetic factors, such as:
- fluctuation in blood pressure caused by hypertension,
- atherosclerosis;
- syphilis;
- trauma to the chest and abdominal cavity;
- 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 inflammatory processes;
- late pregnancy;
- aging.
Symptoms
Aortic dissection can be either acute or chronic. They are distinguished by pain during seizures.
The acute form is characterized by a sudden manifestation of symptoms of aortic dissection (the reasons for this can be either acquired or 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 unlimited time without treatment until death. Due to
that with aortic dissection, the blood circulation of the nearest organs is lost, strokes or fainting may develop, as well as severe shortness of breath and unexplained weakness.
In the proximal form, the pains are compressive or stitching in the areas of the chest and chest cavity. In this case, they can also give back. In the distal form, symptoms of dissection of the abdominal aorta arise: pain in the stomach, back, which often give to the neck.
In the acute form of the course of the disease, high pressure and increased heart rate are manifested. If at this stage the disease was not cured, then the symptoms become chronic.
Ascending aortic dissection
Violations in this section of the aorta are divided into:
- Stratification of the aortic aneurysm, that is, inflammation of the site from the fibrous ring of the aortic valve to the sinotubular crest. Often, such a diagnosis is accompanied by aortic insufficiency of the aortic valve.
- Stratification of the tubular part of the ascending aorta, that is, inflammation of the site from the sinotubular crest to its arc. This type of disease of the ascending aorta is not accompanied by valve insufficiency.
- Stratification of the ascending aorta is treated with medication 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, with the separation of the ascending section in a diameter of 55 mm or more, the risk of rupture increases.
- Stratification of the aortic aneurysm is torn more often than others. If bilateral stratification is found in this department, then a third of patients with such a disease die.
- With stratification of the ascending region, a reverse reflux of the contrast agent from the aorta to the left ventricle is observed. This is due to increased pressure in the aorta.
Descending aorta
Stratification of the descending aorta more often occurs in elderly people who suffer from cardiovascular diseases.
The reverse direction of stratification of the descending aorta does not occur, as a result of which aortic regurgitation is not observed. During stratification, the pulse on the carotid arteries and blood pressure in the upper part remains unchanged.
The first symptom of the initial stage of dissection of the descending aorta is the occurrence of sudden pain behind the sternum or between the shoulder blades, transmitted to the front of the chest. Patients with such a stratification, as a rule, are not prescribed emergency surgery, and drug treatment is performed. 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 there is an excess of this diameter, then the risk increases many times.
Classification
Michael Ellis DeBakey is an American heart surgeon who studied the disease and proposed the following classification of aortic dissection by type:
- First, the stratification begins from the sinus of Valsava and spreads higher until the aorta bends, that is, it can leave the border of the ascending aorta.
- The second type - the disease is localized in the ascending aorta.
- The third is a bundle that descends below the discharge of the left subclavian artery.
The third type is divided into:
- 3A - stratification is localized in the thoracic aorta.
- 3B - the disease is located below the thoracic aorta. Sometimes the third type may approach the left subclavian artery.
Recently, Stanford University has developed a simpler classification, which includes two options:
- A-type aortic dissection is a disease that is localized in the ascending aorta.
- Type B aortic disease is damage that descends below the discharge of the left subclavian artery.
Traditional surgical treatment for aortic dissection has a poor prognosis. In a non-critical state, this approach is traumatic for the patient and involves great difficulties during surgery.
Modern therapeutic methods for treating aortic dissection have a better prognosis. The technology of such an intervention is constantly improving, which facilitates the rehabilitation of the patient.
Diagnostics
Aortic dissection is one of the most serious defects in a vessel, which poses a mortal danger to human existence.
According to statistics, 65–70% of patients who did not seek support in any way die from internal bleeding. Of those who have undergone surgery, approximately 30% of patients die. The prognosis for such a disease is far from pleasant. A timely diagnosis is considered essential for survival during aortic dissection. Despite the rather ordinary ways of finding a defect, episodes of unrecognition are not uncommon.
The aorta contains three integuments: external, middle and internal. The stratification is combined with the inferiority of the middle cover over a particular place. Due to this defect, tearing of the inner cover (intima) and the development of an erroneous lumen in the middle of its epithelium are likely. The tear can occupy part of the aorta or spread throughout the entire internal volume.
Stratification, in other words, stratified aneurysm, has the ability to form in an arbitrary lobe of the aorta and ends with a rupture of the vessel at any time. Mostly sensitive areas are the original segments of the aortic arch.
Surgery
Surgical treatment is indicated for acute aortic dissection. During this period, the risk of its rupture is possible. Surgical intervention is also acceptable for the treatment of a chronic form of the course of the disease, which has passed from acute.
In the initial stage of development, the operation of aortic dissection is not justified, since it can be treated with medication. At this stage, it can only be prescribed if there is a threat of damage to vital organs.
In the chronic form, the operation is indicated with a stratification of more than 6 cm in diameter.
According to statistics, if surgery is performed immediately after the acute form is detected, the risk of death is only three percent, and if you prepare for the operation for a longer time, then a 20 percent risk of death is possible.
Surgical intervention includes:
- resection of the aorta at the site of dissection;
- elimination of false clearance;
- restoration of the excised aortic fragment.
Drug treatment
Drug treatment for aortic dissection is recommended for all patients with any form of aortic aneurysm. This approach is shown to stop the progression of the disease.
Aortic dissection therapy is aimed at reducing pain by administering non-narcotic and narcotic analgesics, getting rid of the shock state and lowering blood pressure.
During drug treatment, heart rate and pressure dynamics are monitored. To reduce cardiac circulatory volume 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 frequency of the heartbeat. You can also use Metoprolol at a dose of 5 mg iv every 5 minutes.
Also, for the treatment of aortic dissection, Labetalol is used dropwise from 50 to 200 mg / day per 200 ml of physiological saline.
Alternative treatment
To get to the pharyngeal abscess and treat it with folk remedies, it is necessary to regularly use the following decoctions and tinctures inside:
- Jaundice tincture. To prepare the product, take two tablespoons of dried and chopped herbs and fill it with a cup of boiling water. Wrap the resulting mixture with a thick cloth and put in a warm place, for example, near the battery. After two hours of infusion, the mixture must be filtered and you can use one tablespoon up to five times a day. If your tincture is bitter, then you can add sugar to it.
- Tincture of viburnum. If there are attacks of strangulation, you should use an infusion of viburnum berries. They can also be eaten raw, mixed with honey or sugar.
- Dill tincture. To prepare the product, take a spoonful of fresh or dry dill, if desired, you can add its seeds. One part of the green will require about three hundred milliliters of boiling water. After insisting for about an hour, the mixture is consumed three times throughout the day.
- Infusion of hawthorn. For cooking, take four tablespoons of chopped dried fruits of hawthorn and pour three glasses of boiling water. The resulting mixture is infused 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.
- Elderberry broth. To prepare the broth, take the dried root of Siberian elderberry and grind it. Then pour a spoonful of powder with a cup of dill. We set the resulting mixture to infuse, and then finish cooking by boiling for fifteen minutes in a water bath. Filter the finished mixture and take one tablespoon.
- Broth from primrose. For cooking, we take 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. Strain the broth, then squeeze the moisture out of 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 products from garlic and a leaf of a golden mustache. To do this, take peeled garlic and finely chop. Then you need to chop the leaves of a golden mustache and mix with garlic. Add thirty grams of honey to the resulting composition. Leave the finished mixture infused 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:
- timely treat atherosclerosis;
- check the level of lipids in the blood;
- observe an active, healthy lifestyle;
- make a proper diet, without the content of fried and fatty foods in the menu. Exclude processed foods, fast food, soda, alcohol, all foods that exceed cholesterol from the diet;
- give up cigarettes;
- monitor blood pressure, cholesterol in the blood;
- every year, mainly after forty, undergo an examination of the body to detect cardiovascular abnormalities;
- Allow time for exercise, but avoid overwork.
To prolong the life of the heart for a long time, it is also necessary to carry out the prevention of infectious and colds, as they, in turn, give it complications.
It is recommended to take food in small portions so that the stomach and intestines do not squeeze the heart, which entails a deterioration in blood circulation in the vessels, heart and abdominal organs. An accumulation of toxins occurs in the body, which increase the load on the heart. To avoid this, you need to empty the intestines on time.
Although physical activity is recommended, people with a disease of the cardiovascular system need to reduce them and not lift weights. Otherwise, vascular overload will occur, which in the future will lead to stroke and heart attack.