The cardiovascular diseases

THE AORTIC DISSECTION

- Definition
- A few explanations
- The Symptoms
- How to make the diagnosis?
- The Causes
- Prognosis
- Treatment
- Conclusion

THE SYMPTOMS

1 - Typical symptoms:

The pain is the most frequent symptom (90% of the cases). Its characteristics are as follows:

- Spontaneous occurrence, rarely provoked by an effort;

- Its intensity is immediately maximal;

- Its preferential site is localized under the sternum;

- Its irradiation is localized in the back, between the 2 scapulas, and rather often downward;

- The migration of the pain is classic but inconstant, seeming to follow the anatomical course of the aorta.

The neurological symptoms such as a loss of consciousness, disorders of the superiorfunctions, a reduction of the sensitibility and motor function, a peripheral paralysis, a paraplegia or a haemiplegia can be in the forefront and can mislead the diagnosis.

The extension of the dissection to the carotid arteries (arteries localized at the level of the neck) is responsible for it.

2 - The initial symptom is a complication:

Some characteristics of the pain steer to a possible complication:

- The painful resumption after a remission questions about a secondary extension, a myocardial infarction by attack of the heart arteries, or an acute pericarditis by rupture of the aorta in the pericardium (envelope surrounding the heart).

- A pain in the chest localized on the left, evokes a rupture of the dissection in the pleura (tissue surrounding the lung).

- An associated lumbar pain evokes a renal arterial attack, with utmost a renal insufficiency in case of bilateral attack.

- An abdominal pain, due to an attack of a digestive artery.

The aortic rupture is the major risk of the aortic dissection, immediately lethal. The different sites concerned are presented in descending order: first the pericardium, which is concerned in 70% of the cases and involves a tamponade (existence of a too important quantity of liquid around the heart which cannot fill up correctly any longer), then the left pleura, the mediastinum (cavity of the thorax), the peritoneal cavity (the stomach), the digestive duct, the right atrium and the right ventricle.

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File last reviewed on dec 18, 2011