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DOCTORS' OPINION


Dr. Rachit Saxena


Aortic dissection

This purpose of this brief account of aortic dissection is to create awareness in the community about the life threatening nature of the  disease and also to help the common man to  be able to suspect aortic dissection and to seek medical help even if there is slightest doubt.

Introduction

Aortic dissection in simple terms is a life threatening accident. It has the potential to cause instantaneous death. It is exactly like a time bomb and the worse part is that one does not know when the bomb would explode.

Medically speaking aortic dissection is a tear in the aortic wall which carries blood supply to the entire body. This tear is likely to be associated with rupture of the aortic valve and also disruption of the blood supply to the brain or any other organ or limb of the body. There is very high risk of death either due to complete rupture of the aorta causing exsanguinating bleeding or death due to severe aortic valve leakage causing cardiac failure or death due to disruption of blood supply to brain or other body parts. The risk of death due to the disease is estimated to be around 2% per hour meaning thereby that 50% patients will be dead in 24 hours if not treated.

There are only 2 good things associated with the disease.  One that it relatively rare disease and second that the results after surgical treatment are descent.

Symptoms

1.       Sudden onset chest pain which is very sharp, tearing pain localised in the middle of the chest and spreads across the back or the neck usually.

2.       Chest pain can be associated with loss of consciousness, headache, confusion or abnormal behaviour, severe pain in abdomen or any of the limbs.

3.       Sudden onset breathing difficulty

Causes

1.       Hypertension – uncontrolled hypertension is believed to be the most common cause of aortic dissection. Therefore all the patients of high blood pressure should ensure that they maintain their blood pressure well controlled with medicines so as to prevent the occurance of the disease.

2.       Connective tissue disorders-  connective tissue disorders are hereditary disorders most common of which is known as the marfans syndrome which is easily recognized by very tall stature, long and thin fingers, long arm span etc. Patients with these disorders have intrinsic weakness of the aortic wall which predisposes to dissection

3.       Bicuspid aortic valve: sometime the aortic valve has 2 cusps instead of the usual 3 cups. This 2 cusped valve is called as bicuspid valve is can be diagnosed on echocardiography. The presence of bicuspid aortic valve causes strain on the aortic wall and predisposes to dissection.

4.       Pre-existing aortic aneurysm:  Aneurysm is an abnormal enlargement of the aorta which can be due to several reasons. Once the aorta is enlarged (aneurysmal) it gets predisposed to dissection.

5.        Post traumatic: high velocity sudden deceleration injuries can cause aortic dissection.
 
Precautions

The precaution which the general population can take is to strictly control blood pressure. Those born with marfans syndrome or bicuspid aortic valve should undergo regular screening to look for any abnormal increase in size of aorta. Never ignore any chest pain specially if it is very severe and sudden onset and associated with any of the above mentioned conditions

Treatment

Emergency surgical treatment can be life saving. Type of surgical intervention depends upon the extent of the disease. Aggressive blood pressure management is important after the surgical repair.
 Dr. Rachit Saxena

Dr. Puneet Misra


Professor of Centre for Community Medicine, AIIMS, New Delhi
 
To lead healthy life cardiovascular health is very important, your heart is one organ which starts working in womb and keeps on working till your last breath day and night years after years without rest, so it is important to take good care of your heart.
Just follow simple steps like regular exercise, healthy diet which have lots of seasonal fruits and vegetable with less oil with required calories as per your age, work and health profile, avoid sugars, restrict salt intake to 5 grams per day, keep stress away by doing meditation or other activities to reduce stress like developing some hobby or walking, or talking to near and dear ones etc etc. Avoid junk food. If you have heart disease, please consult your doctor before doing any exercise. Keep your BP under control if hypertensive and sugar, if diabetic. Strictly no tobacco and alcohol or at least avoid harmful use of alcohol. Keep your weight and BMI in normal range. Even if you are completely healthy, get preventive health check ups regularly, always discuss with your physician or health worker about health options keeping yourself and your family healthy.
 Dr Punit Mishra