It is a tear of the innermost lining of the aorta, a rare disease, which affects only three or four people per 100,000
This week we learned that Depeche Mode keyboardist Andrew “Fletch” Fletcher died last May due to an aortic dissection. Aortic dissections are relatively rare compared to other cardiovascular diseases, such as heart attacks, but their consequences are often very negative.
The aorta is the main artery of the body. It carries oxygen- and nutrient-rich blood from the heart to the rest of the body, providing our tissues with everything they need to function properly. An aortic dissection is a tear in the innermost lining of the aorta. The inner lining is a single layer of highly specialized cells called endothelial cells, which ensure that blood remains in its liquid form as it flows through the body’s blood vessels.
When damage occurs to the endothelial layer, high-pressure blood passes through the intimal layer and into the next layer, the medial layer, literally dissecting a path to the outer layers of the aorta.
If left undiagnosed and untreated, this can lead to complete failure of the aortic wall and leakage of blood from the vessel into neighboring structures and tissues. This stretches the aorta and changes its biomechanical function, which may further contribute to the disease process.
The diversion of blood towards the tear can hinder the flow of the organs located below, in some cases preventing the supply to some of them. The tear also changes blood flow through the vessel, which can cause further damage to specialized cells in the endothelial lining.
rare disease
Aortic dissections affect about three to four people out of 100,000. And they are twice as common in the ascending part of the aorta as compared to the descending part.
It is important to know where an aortic dissection occurs, as this can influence how a person is affected, the treatment of the disease, and their chance of survival. Dissections involving the ascending aorta are known as type A, while those involving the descending aorta are type B.
A person’s gender also influences the type of aortic dissection they may develop, as well as the likelihood of developing it. In the case of men, aortic dissection usually occurs around the age of 60, while in women it usually occurs later, around the age of 65. Type A dissections are twice as likely in men as in women.
Aortic dissections are mainly linked to two factors: genetic conditions and lifestyle, which affect the heart and blood vessels. For example, poor diet and smoking can lead to hypertension (high blood pressure), which increases the chance that specialized cells lining the blood vessels will be damaged. This makes it much more likely that a person will develop an aortic dissection.
Another important lifestyle factor that makes a person more likely to develop aortic dissection is cocaine use. This increases your heart rate and blood pressure, while decreasing the amount of blood that passes through the arteries that supply your heart.
Cocaine use not only makes a person more likely to develop an aortic dissection later in life, but it can also trigger an aortic dissection.
There are a number of genetic diseases that are also associated with an increased risk of aortic dissection. The most common is a disease called Marfan syndrome, which affects about one in 5,000 people. This disease prevents people from producing enough of a key protein that helps give blood vessel walls their structure and elasticity.
Without a sufficient amount of this protein, the walls of the blood vessels weaken and are at greater risk of dissection or rupture. People with Marfan syndrome are also more likely to develop aortic dissection at a younger age, usually around 38 years of age.
Trauma can also lead to dissection, with traffic accidents being one of the main causes. They can cause the beginning of a dissection, or a spontaneous rupture of the aorta.
Possible treatments
Symptoms of aortic dissection include pain, often described as a tear in the chest, abdomen, or back. In cases where people are known to have predisposing conditions, they are medically monitored or managed, usually with drugs such as beta-blockers and antihypertensives, which lower blood pressure and reduce the risk of damage to the endothelial lining. This type of treatment is only really appropriate for type B dissections. Type A almost always requires immediate surgical intervention.
In people with suspected aortic dissection, or who already know about it, it is essential to detect it early. A CT scan is usually used to diagnose the disease, and the final phase of treatment is surgical repair or replacement of the defective portion of the aorta. But the results of this procedure are mixed, since the survival of surgery for a type A dissection is usually around 52-94% at one year after the operation and 45-88% at five years. For type B, there is similar variation in survival, at 1 year (about 56-92%) and at 5 years (48-82%).
In type B dissections, antihypertensive medications can sometimes be used to stabilize the patient before surgery, but this is not always possible. A dissection is a serious disease and does not repair itself.
Due to the seriousness and potential poor outcomes of aortic dissection, it is important to modify any lifestyle factors that may contribute to increased risk, including exercise, a healthy balanced diet, and smoking cessation. It’s also important to make sure any underlying health conditions that may pose a higher risk (such as high blood pressure) are medically monitored.
This article has been published in ‘The Conversation‘.
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