Type B Aortic Dissection: Causes, Symptoms, Diagnosis, Treatment, Complications & Prevention
Type B aortic dissection is a type of aortic dissection beginning in the first part of the aorta. This disorder is potentially life-threatening and is characterized by bleeding along and into the aorta wall. This disorder is relatively uncommon and most often affects men between the ages of 60 and 70, though people of all ages and genders may develop it. The sooner this condition is diagnosed and treated, the better chance a patient has at survival.
Causes
This disorder develops in an area where the aortic wall is weakened. Chronic high blood pressure may result in stressing the aortic tissue, resulting in it being more vulnerable to tearing. Marfan syndrome may also be a cause. In rare circumstances, traumatic injury affecting the chest area may be the reason. Other risk factors and potential causes include:
- Aging
- Coarctation of the aorta
- Ehlers-Danlos syndrome
- Pregnancy
- Vascular inflammation associated with conditions like syphilis and arteritis
- Bicuspid aortic valve
- Connective tissue disorders
- Heart surgery or procedures
- Pseudoxanthoma elasticum
Signs and Symptoms
The signs and symptoms of type B aortic dissection usually include severe chest pain. They also typically begin suddenly. Other signs and symptoms may include:
- Confusion, disorientation, and changes in thought ability
- Decreased sensation anywhere in the body
- Dry mouth
- Fainting
- Pallor
- Rapid, weak pulse
- Decreased movement anywhere in the body
- Dizziness
- Dry skin
- Nausea and vomiting
- Profuse sweating
- Shortness of breath and/or orthopnea
Diagnosis
The patient’s doctor will begin by using a stethoscope to listen to the lungs, heart, and abdomen. They will be listening for things, such as a heart murmur, a blowing murmur over the aorta, or any type of abnormal sound. The blood pressure in the left arm and right arm, or between the legs and arms, may be different. The patient may have bulging neck veins, low blood pressure, or signs similar to those of a heart attack. The patient may have normal blood pressure, but the signs of shock. Aortic aneurysm or aortic dissection may be seen on:
- Chest x-ray
- CT scan of the chest using dye
- Echocardiogram
- Aortic angiography
- Chest MRI
- Doppler ultrasonography
- Transesophageal echocardiogram
Treatment
This condition is life-threatening and less than half of the patients who experience a ruptured aorta survive. There are ways to manage this condition and the sooner treatment begins, the better chance a patient has at recovery. Treatment requires hospitalization and is focused on preventing complications. Type B may be treated first with medications. Intravenous blood pressure-lowering drugs may be given. Some symptoms may be reduced by beta-blockers and other heart medications. Strong pain relieving medications are typically needed as well. Valve replacement is necessary if the aortic valve is damaged. A coronary bypass will be done if the heart arteries are involved.
Complications
Patients are at risk for certain complications, such as:
- Bleeding from the aorta
- Cardiac tamponade
- Inadequate flow past the dissection
- Stroke
- Rapid blood loss, shock, from aortic rupture
- Blood clots
- Heart attack
- Permanent kidney failure
Prevention
Properly controlling and treating high blood pressure and atherosclerosis may help to decrease the patient’s risk of experiencing an aortic dissection. Certain drugs may help to reduce the risk, such as ACE inhibitors, angiotensin receptor blockers, and beta-blockers. Preventing injuries, specifically those in the chest area, can help to prevent this condition. In many cases of this condition, it cannot be prevented.
Resources
MedlinePlus. (2010). Aortic Dissection. Retrieved on January 10, 2011 from MedlinePlus: https://www.nlm.nih.gov/medlineplus/ency/article/000181.htm
MayoClinic. (2009). Aortic Dissection. Retrieved on January 10, 2011from MayoClinic: https://www.mayoclinic.com/health/aortic-dissection/DS00605
