Aortic dissection is a transverse tear in the intima of a vessel. The blood enters the media and creates a false lumen and hematoma that propagates longitudinally. The most common sites of origin are above the aortic valve and distal to the left subclavian artery. It occurs often in age 40-60 years of age and a greater frequency in men than in women.Etiology:
Hypertension (most)
Signs and Symptoms:
- Sudden tearing / stabbing pain in the anterior chest in ascending dissection
- Interscapular back pain in descending dissection
- Hypertensive
- Signs of pericarditis or pericardial tamponade may be seen
- A murmur of aortic regurgitation may be heard
- Neurologic deficits may be seen
- If hypertensive, reduce the BP and heart rate. Do not use thrombolytics
- Surgical emergency for ascending aortic dissection
- Medical therapy for descending dissection aorta
The problem with this entry is that it does not address the multiple other causes of aortic dissection, including genetic conditions such as Marfan syndrome, Loeys-Dietz Syndrome, Bicuspid Aortic Valve, Familial Aortic Aneurysm, etc. It is imperative that family history be considered as aortic dissetions are frequently genetic in nature!
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