In medicine, the term aortic dissection is used to describe the splitting of the wall layers of the aorta. This splitting is most frequently caused by tears in the inner wall of the vessel, which lead to bleeding into the individual wall layers of the aorta. In most cases, this causes severe, sudden onset of pain and can lead to a life-threatening situation with circulatory problems and massive internal blood loss if the aorta ruptures.
Symptoms of aortic dissection
The following signs are typical leading symptoms of an aortic dissection: sudden onset of severe pain – usually tearing or stabbing shortness of breath chest pain pain in the arms or legs (depending on the location of the dissection) abdominal pain blood pressure drop loss of consciousness dizziness pulse acceleration difficulty swallowing
- Main symptom: sudden onset of severe pain – usually tearing or stabbing
- Shortness of breath
- Chest pain
- Pain in the arms or legs (depending on the location of the dissection)
- Abdominal pain
- Blood pressure drop
- Loss of consciousness
- Pulse Acceleration
- Swallowing difficulties
Pain in the chest or abdominal area is the leading symptom of an aortic dissection. As a rule, it sets in suddenly and has a stabbing pain character. Most patients experience the pain in maximum intensity, “never experienced pain”, often with accompanying anxiety symptoms, curvature with pain, up to unconsciousness.
Often a migration of the pain from the chest area downwards into abdominal, flank and leg pain is described. In addition to chest pain, depending on the location of the aortic dissection, pain in the back or between the shoulder blades may also set in. A silent aortic dissection is also possible, this is accompanied by no pain or other symptoms and is usually only noticeable during routine examinations. In addition to sudden, stabbing pain in the chest or back, shortness of breath is one of the most common symptoms associated with aortic dissection. In combination with the pain, most patients experience this as very constricting and often leads to a strong feeling of anxiety and panic attacks.
Complications of aortic dissection
Acute renal failure is also a not uncommon complication of aortic dissection, since the vessels supplying the kidneys come directly from the aorta. If the aorta ruptures at this level or above, the arterial supply is no longer sufficient for adequate blood flow to the kidney. The result is a functional restriction with reduced or even non-existent urine excretion (you can no longer urinate in the toilet), which leads to an accumulation of excretion-obligatory, sometimes toxic substances in the body’s circulatory system.
The term shock is understood in medicine as a life-threatening clinical picture based on a circulatory disorder. In the course of aortic dissection, a so-called volume deficiency shock can occur, which is caused by the large loss of blood. There is an imbalance between the volume ejected by the heart per minute and the required blood flow to the organs.
Signs of a shock are puffiness, cold sweat, loss of blood pressure, rapid and shallow breathing and even collapse. A dreaded complication of aortic dissection is a stroke due to shearing of the arteries supplying the head, such as the arteria carotis communis (carotid artery). How the stroke manifests itself is determined by the individual and by the location of the dissection.
The symptoms can progress slowly, but usually occur suddenly. The severity of the symptoms is determined by the area of the brain that was not supplied with enough oxygen. The most common signs of a stroke are listed below: sudden, very severe headaches sudden problems with speech, slurred speech, choppy speech, up to and including loss of speech sudden loss of consciousness up to and including unconsciousness sudden unilateral paralysis, which is manifested by immobility of an arm, leg or by a drooping eyelid or corner of the mouth unilateral numbness Tingling sensation in one half of the body Difficulty and uncertainty when walking due to dizziness or swaying, danger of falling suddenly occurring visual disturbances, eye flickering, double vision up to blindness The symptoms of a stroke are very typical and can be provisionally recorded with the FAST test.
This makes it possible to detect the stroke early, which in turn is an important prognostic factor. The “FAST” stands for F-Face, A- Arms, S-Speech, T-Time. One asks the affected person to smile and pays attention to the two corners of the mouth.
In the case of a stroke, the corner of the mouth hangs down due to hemiplegia of the face. When examining the arms, the person is asked to raise both arms to the same height, paying attention to possible paralysis. To check the language, the person is asked to repeat sentences.
The time factor is the most important aspect. Even if there is a slight suspicion of a stroke, the doctor should be alerted as soon as possible. – sudden, very severe headaches
- Sudden problems with speech, unclear speech, jumpy speech, even loss of speech
- Sudden loss of consciousness up to unconsciousness
- Sudden unilateral paralysis that is manifested by immobility of an arm or leg or by a drooping eyelid or corner of the mouth
- Unilateral numbness, tingling sensation in one half of the body
- Difficulty and uncertainty when walking due to dizziness or swaying, danger of falling
- Suddenly occurring visual disturbances, flickering eyes, double vision and even blindness
Paraplegia is a rather rare but severe complication of aortic dissection.
Due to bleeding into the tear of the aortic wall or the abdominal cavity, the spinal cord and motor nerves may be undersupplied, resulting in paralysis. If the therapy is carried out quickly and the blood flow is ensured, the paralysis symptoms can be reversed. Again, time is the decisive factor.