Aortic dissection most often affects people.old age. But there are cases 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 know everything about the causes, symptoms and treatment of aortic dissection.
What causes the disease
Congenital and acquired causesthe occurrence of aortic aneurysm. The first ones are associated with the presence of human pathologies of the cardiovascular system, 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, the cause may be congenital or acquired heart disease. In addition, the following diagnosed diseases associated with pathologies of connective tissues affect the development of aneurysms:
- Ehlers-Danlos syndrome;
- annuaricular ectasia;
- polycystic kidney disease;
- osteogenesis;
- Turner syndrome;
- homocystinuria.
Etiopathogenic factors also influence the local expansion of the main artery, such as:
- blood pressure fluctuation caused by hypertension,
- atherosclerosis;
- syphilis;
- chest and abdominal trauma;
- 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:
- drug injecting;
- smoking;
- chronic inflammatory processes;
- late pregnancy;
- aging.
Symptoms
Aortic dissection can be both acute and chronic. They are distinguished by pain during attacks.
For the acute form is characterized by a sudden manifestationsymptoms of aortic dissection (this can be both acquired and congenital), which cause pain, and this condition lasts up to two weeks.
The chronic form is also painful, but the duration can last indefinitely without treatment or even death. Due to the fact
that during aortic dissection, the blood circulation of the nearest organs is lost, there may be a stroke or fainting, as well as severe shortness of breath and unexplained weakness.
При проксимальной форме боли имеют сжимающий или piercing character in the chest and chest area. In this case, they can also give back. In the distal form, symptoms of abdominal aorta dissection occur: pain in the stomach, back, which often gives to the neck.
In the acute form of the disease, high pressure and an increase in pulse occur. If the ailment was not cured at this stage, the symptoms become chronic.
Ascending aortic dissection
Violations in this department of the aorta are divided into:
- Aortic aneurysm dissection, that is, inflammation of the area from the fibrous ring of the aortic valve to the synotubular crest. Often such a diagnosis is accompanied by aortic aortic valve insufficiency.
- The dissection of the tubular part of the ascending aorta, that is, the inflammation of the area from the sinotubular crest to its arch. This type of disease of the ascending aorta is not accompanied by valve insufficiency.
- Ascending aortic dissection is treateddrug if its diameter does not exceed 45 mm. If this parameter is exceeded, it is recommended to carry out surgical intervention. This is due to the fact that, according to statistics, when the ascending department stratifies in diameter of 55 mm and more, the risk of rupture increases.
- Aortic aneurysm dissection breaks more often than others. If in this department bilateral stratification is found, then a third of patients with such a disease die.
- At stratification of the ascending part, a reverse throwing of the contrast material from the aorta into the left ventricle is observed. This is due to increased pressure in the aorta.
Descending aorta
Stratification of the descending aorta is more likely to occur in people in old age who suffer from cardiovascular diseases.
Reverse direction of the descending aortic dissectiondoes not occur, so that aortic regurgitation is not observed. During the dissection, the pulse on the carotid arteries and the arterial pressure in the upper part remain unchanged.
The first symptom of the initial stage of delaminationthe 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 bundle, as a rule, are not prescribed emergency surgery, but are undergoing drug treatment. 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 surgery. This is due to the fact that if there is an excess of this diameter, the risk increases many times over.
Classification
Michael Ellis DeBakey is an American heart surgeon who studied the disease and suggested the following classification of aortic dissection by type:
- The first is that the dissection begins from Valsava’s sinus and extends higher to the aortic flexure, 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 can approach the left subclavian artery.
Recently, Stanford University has developed a simpler classification that includes two options:
- A type aortic dissection is a disease that is localized in the ascending part of the aorta.
- Type B aortic disease is a lesion that descends below the discharge of the left subclavian artery.
Traditional surgical treatment of aortic dissection has a poor prognosis. In an uncritical state, this approach is traumatic for the patient and is fraught with great difficulty in the operation.
Modern therapeutic techniques for treating aortic dissection have a better prognosis. The technology of such intervention is constantly improving, which facilitates the rehabilitation of the patient.
Diagnostics
Aortic dissection - one of the most serious defects of the vessel, is a lethal danger to human existence.
According to statistics from 65–70% of cases,who did not apply for support, die from internal bleeding. Of those who carried out the operation, approximately 30% of patients die. Projections for such a disease is far from pleasant. Exceptionally necessary for the survival of aortic dissection is considered to be a timely diagnosis. Despite the rather ordinary ways of finding a defect, episodes of unrecognition are not uncommon.
The aorta contains three covers:external, medium and internal. The bundle is combined with the inferiority of the average cover over a particular site. Due to this defect, an internal cover (intima) is likely to break and a wrong lumen develops in the middle of its epithelium. The tear can occupy part of the aorta or spread over the whole internal volume.
Bundle, in other words exfoliatedaneurysm, has the ability to form in an arbitrary lobe of the aorta and ends with a vessel breakage at any time. Predominantly sensitive areas are the initial segments of the aortic arch.
Surgery
Surgical treatment is indicated for acuteaortic dissection. During this period, the risk of its rupture. It is also acceptable surgical intervention for the treatment of chronic forms of the disease, which has passed from acute.
In the initial stage of development, the operation of stratificationthe aorta is not justified, as it is amenable to medical treatment. At this stage, it can be appointed only if there is a threat of damage to vital organs.
In the chronic form, the operation is indicated for a separation of more than 6 cm in diameter.
According to statistics, if you hold a surgicalintervention immediately after detection of the acute form, 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;
- the elimination of false clearance;
- restoration of the excised aorta fragment.
Treatment with medicines
Drug treatment for aortic dissection is recommended for all patients in all forms of aortic aneurysm. This approach is shown to stop the progression of the disease.
Aortic dissection therapy is aimed at reducing pain syndrome by administering non-narcotic and narcotic analgesics, getting rid of shock and reducing blood pressure.
During drug treatmentheart rate and pressure dynamics are monitored. To reduce the cardiac volume of blood circulation and reduce the rate of expulsion of the left ventricle, b and p blockers are used to reduce the heart rate to 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 in 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 i / v every 5 minutes.
Also for the treatment of aortic dissection, Labetalol is used drip from 50 to 200 mg / day for 200 ml of saline.
Folk treatment
To get to the obstructive abscess and to treat it with folk remedies, you must regularly use the following decoctions and tinctures inside:
- Tincture of jaundice.For the preparation of means take two spoons of dried and chopped herbs and pour it with a cup of boiling water. The resulting mixture is wrapped with a thick cloth and put in a warm place, for example, near the battery. After two hours of infusion, the mixture must be drained and you can use one tablespoon up to five times a day. If your tincture is bitter, then you can add sugar.
- Tincture of viburnum. In the presence of attacks of suffocation should be used infusion of viburnum berries. They can also be eaten raw, mixed with honey or sugar.
- Tincture of dill.For the preparation of means take a spoonful of fresh or dried dill, if desired, you can add its seeds. On one part of the green will need about three hundred milliliters of boiling water. After infusion for about an hour, the mixture is consumed three times throughout the day.
- Infusion of hawthorn.To prepare, take four tablespoons of crushed dried hawthorn fruit and pour three cups of boiling water. The resulting mixture insist for several hours, after which it must be divided into two days, and one part consumed in three doses within a day for half an hour before meals.
- Broth of elderberry.To prepare the broth, take the dried root of the Siberian elderberry and grind. Then pour a spoonful of powder with a cup of salt water. The resulting mixture set to brew, and then finish cooking by boiling for fifteen minutes in a water bath. Strain the mixture and take one tablespoon.
- Primrose decoction.To prepare, we take the crushed dry rhizomes of the plant. Spoon of powder pour a cup of hot water and continue boiling for half an hour in a water bath. Strain the broth, then squeeze the moisture from the prepared powder. To use the finished product should be three times a day, a tablespoon.
If in the acute form of the disease is observedincreasing the temperature, then to reduce it, you can take the means of garlic and leaf gold whiskers. To do this, we take garlic peeled from the husk and finely chop. Then it is necessary to chop the leaves of golden whiskers and mix with garlic. In the resulting composition add thirty grams of honey. Leave the mixture to infuse in a warm place. Then mix and use one tablespoon with water.
Complications
Осложнением расслоения аорты является ее полный gap. 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 rupture occurs when its strength is lost. This can occur when the internal or external pressure is greater than the wall can withstand.
The pressure occurs during the progression of the tumor. Bleeding can be retroperitoneal or intraperitoneal and can create a fistula between the aorta and the intestine.
Prevention
In order to warn yourself against this disease, it is necessary to do prevention, namely:
- promptly treat atherosclerosis;
- check blood lipids;
- observe an active, healthy lifestyle;
- to make a proper diet, without the content of fried and fatty foods in the menu. Exclude from the diet of semi-finished products, fast food, soda, alcohol, all foods exceeding the cholesterol content;
- give up cigarettes;
- monitor blood pressure, cholesterol in the blood;
- Every year, mostly after forty, to undergo an examination of the body to detect cardiovascular abnormalities;
- to take time for exercise, but at the same time do not allow overwork.
In order to prolong the life of the heart for a long time, it is also necessary to carry out the prevention of infectious and catarrhal diseases, since they in turn give it complications.
Food is recommended to be taken in small portions,so that the stomach and intestines do not squeeze the heart, which leads to a deterioration in the blood circulation of the vessels, heart and abdominal organs. In the body, there is an accumulation of toxins that increase the load on the heart. To avoid this, you need time to release the intestines.
Although recommended physical activity, butpeople with a disease of the cardiovascular system need to reduce them and not lift weights. Otherwise, there will be an overload of the vessels, which further leads to stroke and heart attack.
