Aortic dissection is a condition of the aorta (the largest artery of the body) where blood gets into the vessel wall and starts ripping the layers of the aorta apart. Aortic dissection is an extremely serious medical emergency.
The aorta is made up of three layers (as are all arteries): a tunica intima (mainly endothelial cells), a middle layer called the tunica media (that consists of smooth muscle and elastic tissue), and an outer layer, the tunica adventitia composed of connective tissue.
In an aortic dissection, blood penetrates the intima, and enters the aortic media. The high pressure rips the layers of the media apart, allowing more blood to enter. This can propagate along the length of the aorta for a variable distance, creating a blood filled channel that may rupture and kill the patient. Actor John Ritter died in 2003 from this.
The initial tear is usually within 10 cm of the aortic valve, and may propagate backwards (towards the heart) as well as down the thoracic aorta.
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2 Diagnosis 3 First Aid 4 Field Care (for EMTs) 5 Clinical Treatment 6 References 7 External Links |
Aortic dissection is uncommon and associated with hypertension (high blood pressure) and sometimes connective tissue disorders. It can also be the result of chest trauma.
The pain has been described as excruciating, often migrating with the path of tearing and has been known to have been mistaken for the pain of a heart attack. Patients have described feeling the ripping of the aortic wall. A pulse may be absent (sometimes just on one side).
Echocardiography is a great aid in diagnosing an aortic dissection. A CT scan would also be of use.
It is unlikely that a first-aider will recognize this condition. Call for help and arrange for immediate transport to advanced medical care. In wilderness first aid, immediate evacuation is imperative, by MEDEVAC to an advanced medical facility if available.
Transport immediately to a facility capable of emergency cardiac surgery such as a trauma center, not a community hospital without a surgical service. "Load and go". Provide oxygen therapy and supportive care.
Medication as appropriate for control of high blood pressure if present. Immediate surgery by a cardiac surgeon to repair the tearing in the aorta.
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Diagnosis
First Aid
Field Care (for EMTs)
Clinical Treatment
References
External Links