The aorta is the biggest artery in our body. It originates from the heart, makes a U-turn in the upper chest and ends around the umbilical area, with branches of artery supplying the whole body. Therefore, conditions that affect the aorta may affect the blood supply to certain organs, depending on which part of the aorta is involved.
Disease in the aorta can cause narrowing or, more commonly, abnormal dilatation of the artery. But the most dreaded disease that affects the aorta is aortic dissection, which is potentially life threatening. This is caused by disruption of the aorta wall, which allows blood to flow between the layers of the blood vessel wall. The origins of major branches from the aorta at the site of the dissection may be affected, thus compromising blood flow to the respective major organs. Death, heart attack or stroke may ensue if arteries to the heart or brain are affected.
This condition is usually associated with high blood pressure or conditions that weaken the wall of the blood vessel (e.g. Marfan’s syndrome). Rarely, it can also happen during pregnancy in normal women.
The symptoms of acute aortic dissection are usually dramatic with sudden, severe ripping chest or back pain. The pain may travel if there is extension of the dissection.
Other symptoms, depending on whether the origins of major arteries are involved, include heart attack, stroke, heart failure or shock.
Aortic dissection is due to splitting of the layers of the wall (dissection) of the aorta, the main artery in the body and is usually related to very high blood pressure. The pain is usually described as a tearing pain in the chest, radiating to the back. The dissection may extend into the origin of the aorta and block off one or more of the coronary arteries, leading to a heart attack. Aortic dissection is a medical emergency.
Patients with severe chest or back pain, especially those suffering from high blood pressure, are suspected of having aortic dissection. Chest x-ray showing widening of the tissue in the middle of the chest is suggestive of aortic dissection. However, a CT (Computed Tomography) scan, MRI (Magnetic Resonance Imaging) or ultrasound is usually needed to confirm the diagnosis.
The most important treatment of aortic dissection is to reduce the blood pressure to prevent further extension of the dissection. This may be through oral medications, or intravenous medications if the initial blood pressure is high or not controlled with oral medications. Dissection affecting the initial part of the aorta will require surgery, sometimes urgently, as arteries to the heart and brain are usually involved. Dissection of other parts of the aorta are usually stabilised medically first. Surgery is required only if there is persistent pain or worsening dissection.
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