June 26, 2012
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Dissecting aortic aneurysm - A pathological condition in which the wall of the aorta at the site of aneurysmal expansion and damage stratified.
The largest artery in the human body is aorta . It is through her bloodstream comes from the heart to all the tissues and organs of our body. The aorta leaves the heart and through its thoracic occurs bloodstream to organs which are located in this zone. Then the aorta passes through the diaphragm to form the abdominal aorta. Below the aorta divides into two iliac artery Which provide blood supply to the legs, abdomen, genitals.
Aortic aneurysm - An extension of the wall of the aorta saccular type which arises from the gradual thinning of the aortic wall. According to medical statistics, about a quarter of cases, the aneurysm occurs in the thoracic region. If the weakened aortic wall, and thus there is a strong enough blood pressure, the result ballonoobrazno wall portion extends. If the aorta is in the normal state, its diameter is equal to two centimeters. But if the patient appears aortic aneurysm, the diameter expands to the size, threatening human health and life. An aneurysm that develops in any of the aorta, can exfoliate and even rupture, resulting in severe bleeding occurs inside and death.
Causes of dissecting aortic aneurysm
Dissecting aortic aneurysm - is a special form of aneurysm, which occurs in humans as a result of the increase blood pressure . Possible spread of the bundle across the aorta, causing blockage of blood flow to the kidneys, limbs, brain, as well as to other organs. Layering - a very dangerous condition that threatens human life.
In most cases, the disease develops in people who are over 50 years old. The illness usually diagnosed in males.
The main cause of the patient dissecting aortic aneurysm is prolonged arterial hypertension . Another factor provoking aortic dissection, is a hereditary pathology of connective tissue. The risk of developing this disease as people with defects of the cardiovascular system, or having an open arteriovenous flow.
The defeat of the aorta atherosclerosis It is also a contributing factor to the emergence and stratification of the aneurysm. The disease can occur at syphilis Rarely develops in illness syndrome Morthal .
In more rare cases, the process of separation of the aortic wall is due to the introduction of the catheter during some diagnostic tests or during operations on the aorta and heart.
The mechanism of dissecting aortic aneurysm
Initially, the patient blood pressure increases, then there is an increase in pressure in the aorta. The pressure acts on the wall of the aorta, whereupon it is stretched. As a result, the inner layer of the aorta is damaged, and blood enters under pressure in the middle layer. Thus, the layers were separated, and between them there hematoma Consisting of the accumulated blood. If the pressure rises further, it may break the shell-thirds of the aorta, resulting in inevitable death.
Sometimes, delamination occurs in the distant direction, more rarely in the proximal direction. This eventually provokes hemopericardium . separation of the aortic valve . coronary occlusive disease . severe aortic insufficiency . Also, delamination can occur due to re-break the inner lining of the aorta. Such a breakthrough occurs downstream of the point where there was an initial delamination.
How does dissecting aortic aneurysm
In medicine are three stages of development of dissecting aortic aneurysm. At acute phase disease process of separation takes place over two days, with most of a person's death occurs in the first few minutes or hours after it began bundle.
Duration subacute stage disease continues for two to four weeks. At chronic stage dissecting aortic aneurysm process of differentiation continues for months, sometimes even years. In this case, we have the most favorable development of the disease in terms of the possibility of surgical care. After all, in the acute stage of the disease, doctors do not have time to perform the necessary actions for the treatment of the patient. At the same time after the acute symptoms of damping can make surgery.
Symptoms of dissecting aortic aneurysm
The most telling symptom of a dissecting aortic aneurysm is a dramatic manifestation of pain in the chest. Man suffers from bursting pain, which is manifested in the chest and hands in the back. These pains are permanent and grow with time if the dissection continues. Pain can also be felt mainly in the heart, to give to his left hand. Blood pressure is usually lowered abruptly, and, more rarely, the pressure increases.
The patient may not be palpable pulse in the extremities, and if in the process of aortic rupture occurs getting the blood to the lungs and bronchi may Harkany blood. If blood enters the esophagus, the patient may experience bloody vomit.
If aortic dissection is also the case breathlessness , Signs of aortic insufficiency. This is not observed in the ECG changes. If, during the progression of this condition to produce x-rays, it is possible to detect extension of the shadow of the aorta, which is observed over several days.
In such diagnosis, most people die immediately or within a few days, until the disease progresses. The main cause of death - internal bleeding.
Complications dissecting aortic aneurysm
Complications of this condition can be stroke . myocardial infarction . It is also possible abnormalities in the legs due to changes in blood flow through the arteries podvozdoshnym. If the blood supply to the spinal cord is broken and damaged the walls of the vertebral arteries, the possible impairment of the function of the spinal cord. Furthermore, with this illness have pains in the abdomen and the back, if the blocked blood flow in other vessels.
The most dangerous complication of aortic wall of the bundle is its rupture and internal bleeding that threatens the life of the patient.
Diagnosis of dissecting aortic aneurysm
For the diagnosis of the patient with the above symptoms should immediately seek emergency medical help. To diagnose rassloyku aorta, the patient is prescribed a range of diverse research. Patients underwent an electrocardiogram. Note, however, that the results of such studies are not always reflect the severity of the human condition. Even when complaints are very strong pain in the ECG may not be significant changes, it becomes a signal for the possible development of specialist dissecting aortic aneurysm. However, there are often bundles and cases of aortic aneurysm, when the changes of the myocardium on an electrocardiogram pronounced. In this case, the study did not allow to differentiate between acute myocardial infarction by dissecting aortic aneurysm.
Holding X-ray examination of the chest to determine how much expanded aorta, and see whether it has changed the situation.
Also, patients underwent echocardiography, or ultrasound of the heart, allowing Bole learn in detail about the status of large vessels and the heart of man, and find a place of aortic lesions.
With transesophageal electrocardiography can see the thoracic aorta, as well as to evaluate the degree of atherosclerosis and learn about the state of the aortic valve.
To determine the presence of dissecting aortic aneurysm allows computer tomography and magnetic resonance imaging. The latter method is the most accurate and can pinpoint the place where the separation occurred.
The presence of aortic insufficiency can be found through phonocardiography, allowing to estimate the noise in the heart and blood vessels.
In addition, a comprehensive study may include Doppler ultrasound blood vessels, as well as angiography, which was performed in patients who are ready to conduct operations. Angiography lets you know exactly where the bundle is located and what is its length.
In the process of diagnosing this condition should be differentiated from myocardial infarction. This is a fairly complicated process, as the signs and symptoms of these diseases are similar, which is especially characteristic of the early stages of diseases. To establish the correct diagnosis is very important because when dissecting aortic aneurysm is impossible to treat using anticoagulants and thrombolytics And myocardial infarction, these agents are used in the complex therapy.
Treatment of dissecting aortic aneurysm
It is important to patients with suspected aortic dissection development immediately admitted to the hospital, where held complete control of their vital functions.
In the process of dissecting aortic aneurysm therapy, it is important to appoint a medication drugs that reduce heart rate and help to lower blood pressure. A case in point is about Beta-blockers . Calcium antagonists . ACE inhibitors . nitroglycerin preparations . It is important that blood pressure does not exceed 100/60 mm Hg. Art. In this case, the pressure is lower, the lower the pressure exerted on the wall of the aorta. However, in this case, it should be monitored closely to ensure that the pressure does not drop so much that there will be a depression of the functioning of other organs. So, even at the "upper" pressure readings of 40 mm Hg. Art. begin irreversible changes in a number of organs.
If the aorta was struck as a result of syphilis, the patient is assigned treatment antibiotics .
In the treatment of aortic rassloyki extremely important to maintain a constant and careful monitoring of blood pressure, heart rate monitor urine output. To control the process, which occurs in the aorta, it should be every 12 hours to carry out X-ray of the thorax. This is necessary in order to determine the severity of the process, as in the acute stage of the operation dissecting aortic aneurysm carries a high risk.
There are a number of indications for urgent surgery patient dissecting aortic aneurysm. First of all, it is a threat rupture of the aortic wall, the process of separation, which is actively progressing, the appearance of the aortic aneurysm sac. No surgical intervention can not be avoided, and if the medication is ineffective or not relieves pain. The indication for surgery is - hemopericardium (getting blood in the outer lining of the heart).
The operation was carried out and uncontrollable hypertension - a state where the drop in blood pressure and keeping it on the indicators is impossible.
Conducting surgery when aortic dissection involves the aortic synthetic plastic prosthesis or endovascular prosthesis and placement of the stent.
Operation proceeds from 3 to 6 hours. If the process is successful, the recovery of the patient in hospital after surgery lasts about 10 days. During the recovery process, you should regularly take medications that prevent the increase of pressure and frequency of contractions of the heart muscle.
According to doctors, without surgery 75% of patients with aortic dissection die within 2 weeks.
Prevention dissecting aortic aneurysm
In order to prevent the occurrence of this disease is extremely important to observe all measures for the prevention of cardiovascular diseases. Daily activity, a healthy diet with a diet containing beneficial for the heart and vascular products, will help prevent the emergence of an aneurysm. It is equally important to monitor the level of cholesterol blood and give up smoking completely. People exposed to regular high blood pressure should monitor its level and apply drugs to reduce blood pressure, which will appoint a physician.
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