Aortic Dissection
Acute Aortic Dissection covers a spectrum of potentially life-threatening aortic diseases and often requires immediate medical attention.
Aortic dissection occurs when an injury to the innermost layer of the major blood vessel of the body (aorta) allows blood to flow between the layers of aortic wall, forcing the layers apart. In this disease process, there is reduced or absent blood supply to the various vital organs at times.
This disease have been increasing in incidence over the years. This can be attributed to the ageing population and increasing use of CT scans in Singapore.
These patients are usually elderly, smokers and male with high blood pressure. A lot of them do not take their medications and in some cases, undiagnosed.
However, there are risk factors to contribute to the development of this condition.
1. Connective tissue disorders (mainly Marfan syndrome and Ehlers-Danlos syndrome)
2. Bicuspid aortic valve (Two door aortic valve instead of usual Three door aortic valve)
Patient often describe sudden onset of tearing chest pain radiating to the back. At times, they have pain in the back and abdomen. You can imagine that this can be confused with having heart attack. Differentiating can be quite difficult.
They have very high blood pressure. However if their blood pressure is low, this is a bad sign and the risk of death can be imminent.
When the patients arrive at the emergency department, ultrasound is readily available which can give a clue to the diagnosis. CT scan will be a quick scan to definite diagnosis.
The diagnosis of the extent determines its management.
Not all conditions require immediate or early interventions. In mild cases, patients are serially monitored with the use of scans. Blood pressure control helps slow the disease process, and stopping smoking further helps the patient’s cause.
In the event of the dissection being in the aortic root or ascending aorta, patients require emergency high-risk open surgery. Emergency surgery includes the replacement of the affected aorta under extreme cold body temperatures.
In conditions that affect the descending and abdominal aorta with no compromise to blood supply of vital organs, patients can be treated with medications to manage the blood pressure.
