cardiovascular disorders
Aortic Dissection
Introduction
Aortic dissection is the surging of blood through a tear in the aortic intima with separation of the intima and media and creation of a false lumen (channel). The intimal tear may be a primary event or secondary to hemorrhage within the media. The dissection may occur anywhere along the aorta and extend proximally or distally into other arteries. Hypertension is an important contributor. Symptoms and signs include abrupt onset of tearing chest or back pain, and dissection may result in aortic regurgitation and compromised circulation in branch arteries. Diagnosis is by imaging tests (eg, transesophageal echocardiography, CT angiography, MRI, contrast aortography). Treatment involves strict blood pressure control and serial imaging to monitor progression of dissection. Surgical repair of the aorta and placement of a synthetic graft are needed for ascending aortic dissection and for certain descending aortic dissections. Endovascular stent grafts are an option for selected patients with descending dissections, especially when dissection involves the descending thoracic aorta. Black patients, men, older patients, and patients with Hypertension are especially at risk ( 