Introduction
A dissection occurs when the inner lining of the artery tears and allows blood to enter between the layers of the vessel wall. The strength of the wall is compromised and there is an increased risk of rupture. The blood supply can also be compromised to the brain, vital organs or the limbs. Most commonly they occur in the aorta and the carotid artery and are categorised as spontaneous or traumatic. Management may involve observation, medication and surgery.
Causes
- The exact cause in unknown, although risk factors have been identified:
- Chronic high blood pressure.
- Traumatic injury.
- Atherosclerosis.
- Bulging or weakened artery.
- Aortic valve defect.
- Aortic coarctation (narrowing).
- Genetic diseases: Turner’s syndrome, Marfan syndrome, connective tissue disorders, inflammatory or infectious conditions.
Signs and Symptoms
- Symptoms may be similar to other heart problems, such as heart attack.
- Severe chest or upper back pain.
- Shortness of breath.
- Sudden weakness, vision loss, difficulty speaking.
- Weak pulse.
- Loss of consciousness.
- Lower back pain.
- Altered colour, sensation or weakness of the limb.
Diagnosis
- Ultrasound.
- Trans-oesophageal echocardiogram (TEE).
- CT scan.
- MRA.
Treatment
- Intensive blood pressure control.
- Stenting.
- Stent-grafting.
