Aortic dissection is a tear or partial tear in the lining of the largest blood vessel in the body, the aorta.
This tear allows blood (and the pressure of the blood flow) to penetrate the arterial wall. Over time, this continuous flow can cause the aorta to rupture–a condition that most people do not survive. There are two types of aortic dissections, although sometimes both conditions occur:
Type A: A dissection to the ascending aorta is classified as a Type A dissection. These dissections can be treated with interventional catheterization or open surgical techniques.
Type B: A dissection of the descending aorta is classified as a Type B dissection. These dissections are most often treated medically with routine monitoring and prescribed medications. There is a surgical option, but it carries substantially increased risk of paralysis.
What are the warning signs and symptoms of aortic dissection?
Aortic dissections are commonly found in people with atherosclerosis, high blood pressure, in individuals with a family history of aortic (or thoracic) dissection and are more rarely associated with congenital cardiovascular disorders (Marfan’s syndrome, Ehlers-Danlos syndrome, and congenital valvular disorders).
“Stabbing” pain in the back is a common symptom of an aortic dissection. In some cases, people present with pain in the chest. This pain may be confused with angina (commonly referred to as “chest pain” and a warning sign of a possible heart attack). The main difference between pain resulting from dissection of the aorta, and angina due to lack of blood supply to the heart muscle, is its sudden and intense onset. The pain is characterized as a “ripping” or “tearing” sensation. This sudden pain can be felt in the back, chest, neck, or jaw.
These are important differences to understand. Why? Because a common recommendation to those with angina or “chest pain” (that may result in a heart attack) is to chew an aspirin to thin the blood. This is NOT the case if you are experiencing an aortic dissection. Thinning the blood for a person with aortic dissection may cause more blood to leak out of the aorta. This internal bleeding can lead to death.
In some cases, people do not experience any pain. Instead, you may experience distorted mental capacity (due to lack of blood supply to the brain) or numbness or tingling sensation in the arms or legs (due to lack of blood supply to the spinal cord). If you or someone you know is experiencing any of the above symptoms, call 9-1-1 immediately to get to a hospital. The survival rate increases dramatically the sooner a person is treated for an aortic dissection.
How is an aortic dissection detected?
The key to diagnosing an aortic dissection is to confirm that it is in fact a dissection and not a heart attack, and which type it is (as the treatment options vary significantly).
The gold standard for diagnosing aortic dissection is a computed topography (CT) scan. Other imaging studies may be required to identify the type and location of the dissection. These include:
Echocardiogram
Magnetic Resonance Imaging (MRI)
Peripheral Angiography
What are the treatment options for an aortic dissection?
Three treatment options are offered for an aortic dissection: 1) medical management, 2) interventional catheterization, and 3) cardiovascular surgery. Depending upon the location and severity of the dissection, your physician will decide which option is best for you.
A small percent of cases (5 – 10%) are Type B dissections (dissections of the descending aorta). This condition can be treated with surgical repair, but it carries significant risk. Typically, your doctor will monitor the condition periodically and prescribe medications to control the dissection.
The techniques used to treat dissections are as follows: Medical Therapy: Blood pressure and cholesterol lowering drugs, and treatment to reverse arteriosclerosis
Endovascular Intervention: This minimally invasive procedure requires small incisions in the groin. Small wire-like, catheter devices called endoluminal stent grafts are threaded to the location of the dissection. These devices have a woven synthetic graft tip, which is deployed at the site of dissection and left in place. This provides a channel for blood to flow freely, repairing arterial leakage, and preventing pressure from rupturing the aorta. This procedure is much less invasive than the traditional open surgery. Please note: This procedure can only be performed on specific patients based on clinical criteria, and no long-term data exists regarding its effectiveness compared to open surgery.
Open Surgical Repair: The traditional treatment technique involves opening the chest and surgically removing the dissected aorta. A synthetic graft is sewn in its place for blood to flow freely to the rest of the arterial system.
Aneurysms can occur in any blood vessel in the body, but the most common type arises in the largest artery in the body—the aorta. This condition affects over 200,000 Americans and is referred to as an Abdominal Aortic Aneurysm (AAA).
An aneurysm is a bulging of an artery caused by uncontrolled hypertension or injury or weakness to the artery itself. The pressure from blood flow against the arterial wall causes the aneurysm to slowly grow in size, giving it its bulging characteristic. Typically, atherosclerosis (plaque buildup within the arterial wall) is present.
An AAA is a very serious condition that claims the lives of 15,000 Americans every year. As the aneurysm continues to grow, it has the potential to rupture or leak. If this occurs, more than half of these individuals go into shock and die as a result of massive internal bleeding. The key is to detect an AAA at its earliest stage so it can be properly treated.
What are the warning signs and symptoms of an Aneurysm?
Abdominal Aortic Aneurysms (AAAs) are referred to as “the silent killerâ€, as the majority of people do not have symptoms. However, AAA can sometimes present with the following:
AAA’s are most common in people over the age of 60
70% to 80% of AAA’s are in males; however, as more women are diagnosed with cardiovascular disease, this statistic is changing
High blood pressure, smoking, and high cholesterol levels have all been shown to increase the risk of developing an Abdominal Artic Aneurysm.
20% of people with AAA’s have a family history of either cardiovascular disease or aneurysms
If you have one or more of the above risk factors, we recommend that you discuss with your doctor certain tests that can detect an AAA early so it may be properly treated.
Sometimes, people will experience these symptoms that suggest the presence of AAA:
Pain in the abdomen, back, or flank (side)
An overwhelming feeling of “fullness†after eating even a small amount of food
Frequent nausea and vomiting
Pulsating in the abdomen—for example, when reading a book that is resting on the abdomen, the book moves up and down
If you experience any of the above symptoms, you should be evaluated by a doctor immediately. Prompt action may prevent a life-threatening situation.
How is an Aneurysm detected?
Abdominal Aortic Aneurysms are sometimes detected during a routine physical examination. Your physician may hear pulsations in your abdomen (also called bruits) with a stethoscope. However, they are usually difficult to detect (especially in persons who are overweight). If your physician suspects that you may have an aneurysm, either due to pulsations in the abdomen or other risk factors such as family history, high blood pressure, high cholesterol, old age, etc., he or she will likely perform any of the following imaging studies to make the diagnosis:
Doppler Ultrasound
Chest or abdominal X-Ray
CT Scan
Magnetic Resonance Imaging (MRI)
What are the treatment options for an Aneurysm?
Once an Aneurysm (including AAA) is diagnosed, your physician will determine the appropriate treatment depending upon its size and location. If the Aneurysm is small, your physician will likely monitor its growth with repeated ultrasound imaging. If it is large (greater than 5 centimeters), or is growing rapidly and showing signs that it might rupture, an interventional catheterization or surgery may be required.
Dr. Manohar of the Heart and Wellness Institute in Grand Rapids Discusses Who is at Risk for Heart Disease and How it Can be Prevented.
Today’s discussion on Family Health Matters is heart disease.  Dr. Prerana Manohar opens the discussion by stating that heart disease is the leading cause of death among men and women in the nation. This is above all the 13 causes of cancer combined.  Statistics dating from 2005 reveal that 450,000 women died of heart disease while only 250 women died of cancer. This is of particular concern to cardioascular experts.  Lifestyle choices and the fact that we are living longer have, together, increased the prevalence of heart disease.
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What many people do not realize is that heart disease is controllable. The leading killers are Atherosclerosis and coronary heart disease, as well as stroke.  A stroke is an indication of Atherosclerosis and the third leading killer in the nation. Although heart disease is preventable, this nation has not come to that realization.  When we do, the occurrence of heart disease will begin to diminish and eventually, will be non-existent. Â
The leading risk factors of heart disease include:
Smoking
High blood pressure
Physical inactivity
Poor body composition
Diabetes
Metabolic syndrome
Genetic makeup
Dr. Manohar adds that stress, anxiety, and depression can double a person’s risk of heart attack. Studies done in women have shown that stress can increase the risk of heart disease as much as 1½ to 2 times. Dr. Manohar concluded that if we minimize stress, then those risk factors will decrease as well.
Cholesterol can also affect the health of your heart. Most people are aware of LDL (lower density lipid) counts; numbers of 150 or lower are typically acceptable. Higher numbers indicate the possibility of plaque development in the arteries, which can lead to heart disease and strokes.Â
Screening for heart disease begins with looking at the common risk factors. Tests can also be run for those who have no obvious symptoms but want to know if they have any heart problems. Although screening for heart disease is still in the infancy stages and there is no one test,  tests such as ultrasounds of carotid arteries or cat scans of the chest are useful in detecting heart disease.  If you are concerned about your risk of heart disease, you can evaluate your risk by:
Receiving screening from your primary care physician
Having measurements such as body mass and blood pressure checked
Getting blood work done
When getting your cholesterol checked, you can ask your doctor to give you a high sensitivity C-reactive protein. This bio marker is not associated with risk of heart attack or stroke. There are also diagnostic studies that can determine if a person is predisposed to coronary disease.  Soon there will be genetic bio markers as well.
Type I diabetes is a high risk factor for the development of heart disease.  The first issue of concern is glucose levels; it is important for a person with diabetes to maintain a well controlled glucose level.  The second area of concern is the inability to exercise; this is not an uncommon problem among diabetics.  Swimming can be an alternative method of cardiovascular exercise for those who have difficulty walking. Emphasis should be placed on controlling blood sugar levels and maintaining a low carbohydrate diet. Canned fruit should be avoided when possible due to the large amount of sugar in this product.
