Aortic dissection natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
Aortic dissection carries a very poor prognosis if left untreated. 90% of patients who are untreated will be dead at one year. Type A dissection is associated with a worse prognosis than type B dissection. aortic dissection can be complicated by extension to the coronary arteries in myocardial infarction, involvement of the aortic arch to cause stroke, dilation of the route to cause aortic insufficiency and heart failure, and aortic rupture. | |||
== Natural History == | == Natural History == | ||
If the patient remains untreated, the mortality is: | If the patient remains untreated, the mortality is: | ||
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*[[Acute aortic regurgitation]]due to the aortic dissection generating into [[Valsalva]] with an aortic valve insufficiency | *[[Acute aortic regurgitation]]due to the aortic dissection generating into [[Valsalva]] with an aortic valve insufficiency | ||
*[[Pulmonary edema]] | *[[Pulmonary edema]] | ||
*[[Myocardial ischemia]] due to involvement from the right or left coronary ostium (but most commonly the [[right coronary artery]] is involved | *[[Myocardial ischemia]] or myocardial infarction due to involvement from the right or left coronary ostium (but most commonly the [[right coronary artery]] is involved | ||
*[[Mesenteric]] and [[renal ischemia]]- can lead to [[hematuria]], [[renal infarction]], [[acute renal failure]], or visceral ischemia | *[[Mesenteric]] and [[renal ischemia]]- can lead to [[hematuria]], [[renal infarction]], [[acute renal failure]], or visceral ischemia | ||
*[[Claudication]] due to an extension of the dissection into the iliac arteries | *[[Claudication]] due to an extension of the dissection into the iliac arteries | ||
Revision as of 23:50, 28 October 2012
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Aortic dissection Microchapters |
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Diagnosis |
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Treatment |
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Special Scenarios |
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Case Studies |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Aortic dissection carries a very poor prognosis if left untreated. 90% of patients who are untreated will be dead at one year. Type A dissection is associated with a worse prognosis than type B dissection. aortic dissection can be complicated by extension to the coronary arteries in myocardial infarction, involvement of the aortic arch to cause stroke, dilation of the route to cause aortic insufficiency and heart failure, and aortic rupture.
Natural History
If the patient remains untreated, the mortality is:
- 1% per hour during the first day
- 75% at 2 weeks
- 90% at 1 year
Complications
The complications of aortic dissection include:
- The aorta may rupture, leading to massive blood loss resulting in death. Indeed, aortic dissection accounts for 3-4% of sudden deaths.
- Hypotension and shock due to aortic rupture
- Pericardial tamponade
- Acute aortic regurgitationdue to the aortic dissection generating into Valsalva with an aortic valve insufficiency
- Pulmonary edema
- Myocardial ischemia or myocardial infarction due to involvement from the right or left coronary ostium (but most commonly the right coronary artery is involved
- Mesenteric and renal ischemia- can lead to hematuria, renal infarction, acute renal failure, or visceral ischemia
- Claudication due to an extension of the dissection into the iliac arteries
- Redissection and aortic diameter enlargement
- Aneurysmal dilatation and saccular aneurysm
Neurologic findings include:
- Ischemic cerebrovascular accident (CVA)
- Hemiplegia
- Hemianesthesia
Compressive symptoms include:
- Superior vena cava syndrome
- Horner syndrome (involves superior cervical ganglia)
- Dysphagia (involves the esophagus)
- Airway compromise
- Hemoptysis (involves the compression of the bronchus)
- Vocal cord paralysis and hoarseness
Prognosis
The mortality rate is in large part determined by the patient's age and comorbidities.
- 30% in hospital mortality
- 60% 10-year survival rate among treated patients
Type A aortic dissection
- Surgical treatment-30% mortality rate
- Medical treatment-60% mortality rate
Type B aortic dissection
- Surgical treatment-10% mortality rate
- Medical treatment- 30% mortality rate