Aortic dissection is a serious cardiovascular disease, which refers to a pathological change in which blood in the aortic lumen enters the aorta through a tear in the aortic intima and spreads along the long axis of the aorta, causing the separation of the true and false lumens of the aorta. Below, we will provide a detailed explanation of aortic dissection from seven aspects: definition, etiology, pathophysiology, clinical manifestations, diagnosis and differential diagnosis, treatment, and prevention.
1、 Definition
Aortic dissection refers to a pathological change in which blood in the aortic lumen enters the aorta through a tear in the aortic intima and spreads along the long axis of the aorta, causing the separation of the true and false lumens of the aorta. This disease is commonly referred to as "aortic dissection", also known as "aortic intimal tear syndrome" or "aortic dissection aneurysm".
2、 Etiology
The etiology of aortic dissection mainly includes hypertension, atherosclerosis and genetic factors. Hypertension is one of the most important risk factors for aortic dissection, with approximately 70% of aortic dissection patients suffering from hypertension. Atherosclerosis is also one of the risk factors of aortic dissection, but it is less important than hypertension. In addition, genetic factors may also be associated with the occurrence of aortic dissection.
3、 Pathophysiology
The pathophysiological mechanism of aortic dissection mainly includes the following aspects:.
2. False lumen formation: The blood entering the middle layer of the aorta gradually expands under pressure, forming a false lumen opposite to the true lumen.
3. Stripped endometrial patches: Teared endometrial patches flow with blood, forming floating endometrial patches between the true and false lumens, which can block branch blood vessels and cause ischemia of corresponding organs.
4. Remote re-entry: As the false lumen expands and pressure increases, remote re-entry can lead to the formation of new channels between the true and false lumens, resulting in complex sandwich lesions.
5. Ischemia of affected organs: With the movement of endometrial patches and the formation of false lumens, the blood flow of affected organs is obstructed, which can lead to ischemia of the corresponding organs.
4、 Clinical manifestations: The symptoms of aortic dissection mainly include pain, shock, and organ ischemia. Pain is the most common symptom of aortic dissection, often a sudden and intense pain that appears as a knife cut or tear. The symptoms of shock include pale complexion, profuse sweating, rapid breathing, and decreased blood pressure. The symptoms of organ ischemia depend on the location and severity of the affected organ, for example, thoracic aortic dissection can lead to acute heart failure, respiratory distress syndrome, etc; Abdominal aortic dissection can lead to acute intestinal ischemia syndrome, renal ischemia syndrome, etc.
5、 Diagnosis and differential diagnosis
The diagnosis of aortic dissection mainly relies on imaging examination methods, including echocardiography, CT angiography, and magnetic resonance angiography. Echocardiography can detect blood flow signals in intimal tears and true and false lumens; CT angiography can clearly display the characteristics of lesions such as intimal tear, true and false lumens, and wall thrombus; Magnetic resonance angiography can also display the characteristics of the above-mentioned lesions, and can also determine the type of dissection and the ischemic condition of the affected organs. During the diagnosis process, doctors also need to pay attention to differential diagnosis with diseases such as acute myocardial infarction and acute pancreatitis.
6、 The clinical treatment methods for aortic dissection mainly include the following three types:
1. Drug therapy: The main purpose is to reduce myocardial contractility, heart rate, and blood pressure, reduce left ventricular systolic velocity and intensity, thereby reducing blood flow velocity in the aorta, reducing the degree of dissection, and preventing dissection rupture. At the same time, analgesic treatment can be performed to alleviate pain.
2. Interventional therapy: Under the guidance of imaging equipment, the interlayer is dilated or stents are implanted using tools such as catheters to restore normal blood flow to the affected vessels. This method has minimal trauma, but requires certain technical and equipment support.
3. Surgical treatment: For patients who are not suitable for interventional treatment, surgical treatment may be considered. The surgical method includes removing the diseased vascular segment and performing artificial blood vessel replacement to restore blood flow and prevent recurrence. Surgical treatment can cause significant trauma, but is suitable for more severe cases.
7、 Prevention
The preventive measures for aortic dissection mainly include the following aspects:
1. Control blood pressure: Maintaining stable blood pressure within the normal range is one of the key measures to prevent aortic dissection. Patients should regularly monitor their blood pressure and adjust the dosage and usage of medication according to the doctor's advice.
2. Healthy lifestyle: maintain a healthy lifestyle, including low salt and low-fat diet, moderate exercise, smoking cessation and alcohol restriction, which will help maintain stable blood pressure and reduce the risk of atherosclerosis.
3. Control related diseases: actively control diseases related to aortic dissection, such as hypertension, atherosclerosis, etc. Regularly undergo relevant examinations and treatments to maintain physical health.
4. Avoid overwork: Overwork may increase the burden on the heart and blood pressure levels, so patients should pay attention to rest and avoid overwork.
In conclusion, aortic dissection is a serious cardiovascular disease, but the incidence rate increases with age. The mortality rate in the acute phase is high, about 65%~70% of patients die of cardiac tamponade, arrhythmia, etc. in the acute phase; About 70% of patients with aortic dissection suffer from hypertension. If you have the above clinical symptoms, please contact me in a timely manner, Xiao Changbo (Department 10 of Cardiovascular Surgery, Henan Chest Hospital), for treatment.