Acute Type B Aortic Dissection - Risk Factors, Symptoms, and Prevention

Introduction:

Aortic dissection is a serious condition that can test the inner layer of the body's main artery, the aorta, and result in blood rushing through the tear. This leads the aorta to split inner and middle layers. As a result, the blood rushes through the outside aortic wall. This condition is relatively uncommon and often deadly. It mainly affects men between the ages of 60s and 70s. The symptoms of aortic disease mimic those of other heart conditions.

What Is Acute Aortic Dissection Type B?

Aortic dissection is a fatal condition and can lead to life-threatening consequences if not treated at the time. In this condition, the wall of the aorta develops a tear. This condition involves the descending aorta with an entry tear beyond the origin of the subclavian artery, sparing the ascending and arch segment and presenting within fourteen days of symptom onset. The wall has three layers, allowing blood to flow from the inner and middle layers. Type B aortic dissections involve a tear in the descending part of the aorta and may extend into the abdomen. Another type is present, type A, which develops in the ascending part of the aorta and other branches of the heart. Type B aortic dissection prognosis remains unclear. The main cause is greater stress against the aortic wall. Survival rates are between 56 % and 92 % in the span of a year and 48 to 82 % in the span of five years. Type A is the most common type and is more likely to be acute than chronic, type B can cause the aorta to rupture leading to a potentially fatal heart condition.

What Are the Risk Factors of Type B Acute Aortic Dissection?

The major risk factors of type B acute aortic dissection are:

• Men at the age between 60s and 70s.

• An important risk factor is increased blood pressure, which leads to more stress against the aortic wall.

Other factors are:

• Smoking.

• Preexisting aneurysm (an unusual ballooning or bulging in the blood vessel wall).

• Aortic valve defects (this type of heart valve disease are conditions that occur between the lower left heart and the main artery of the body that fails to work properly).

• Atherosclerosis (the gradual hardening and constriction of the arteries caused by cholesterol plaques that form on the arterial lining).

• Previous surgery on the aorta.

• Genetic disorders like Marfan’s syndrome, Turner's syndrome, and other connective tissue disorders.

• Traumatic chest injury is a potential cause of aortic dissection.

• Other risk factors are cocaine use, pregnancy, and high-intensity weightlifting.

What Are the Symptoms of Acute Aortic Dissection Type B?

The symptoms are those that are experienced during a heart attack. Early diagnosis and investigation are critical to distinguish between other conditions. The symptoms of acute aortic dissection type B are:

• Severe chest pain and upper back pain.

• Ripping and tearing sensation (separated forcibly).

• Loss of consciousness (fainting losing consciousness for a shorter duration).

• Sudden severe stomach pain.

• Difficulty walking.

• Leg pain.

• Vision problems, weakness, and loss of movement.

• Shortness of breath (dyspnea).

What Are the Complications of Acute Aortic Dissection Type B?

The complications can be really serious, and this results due to a rupture of the aorta. The causes of internal bleeding often lead to death. The buildup of blood in the aorta wall can disrupt normal blood flow in the abdomen and thorax. Blood supply to organs like the intestines and kidneys may be compromised. Stroke is one of the main complications of aortic dissection type B.

Complicated aortic dissection type B leads to mal perfusion syndrome that involves spinal, limb, and abdominal ischemia (restricted blood supply).

What Are Early and Late Mortality Predictors of Acute Aortic Dissection of Type B?

Early and late predictors of acute aortic dissection of type B are:

• Hypertension (uncontrolled high blood pressure): Hypertension is a condition when blood pressure is too high. Blood pressure is usually measured between two numbers, systolic and diastolic; if the systolic blood pressure reading is more than 140 mmHg and diastolic more than 90 mmHg, it is high blood pressure.

• Weakened and bulging artery (aortic aneurysm): It is a condition where balloon-like bulging in the aorta is present. Aorta is the largest artery that carries blood from the heart through the torso and chest. These can increase pressure in the aorta and lead to more complications. A ruptured abdominal aortic aneurysm can lead to life-threatening bleeding.

• Hardening of the arteries (atherosclerosis): Building of fats, cholesterol, and other substances deposited on artery walls. This buildup leads to plaque. This plaque can lead to arteries narrowing and blocking blood flow. These plaques can also burst and lead to blood clots.

What Are the Preventive Measures to Prevent Acute Aortic Dissection Type B?

Aortic dissection is prevented by preventing chest injury, and the steps to keep the heart healthy are:

• Quit smoking: Quitting smoking and measures to stop smoking.

• Wearing a seat belt: Reduces risk of chest injury in accidents.

• Maintaining an ideal weight: Low sodium diet with fiber intake, along with vegetables, fruits, and whole grains, helps maintain an ideal weight. Regular exercise is important.

• Controlling blood pressure: Maintaining high blood pressure but changing food habits and monitoring regularly is important.

• Talk with the healthcare provider: A detailed family history and information regarding other medical conditions are important to manage, along with normal blood pressure.

Conclusion:

Around 20% of individuals with aortic dissection die before reaching the hospital. When the treatment is not provided, the mortality (death) rate is 1 to 3% in the first 24 hours, 3% in the first week, 80% in the second week, and 90% in one year. A piece of detailed knowledge regarding key risk factors may help with a better choice of treatment and reduction in mortality in acute aortic dissection type B individuals. Individuals treated medically with complicated acute aortic dissection often have hypotension shock, acute renal failure, limb ischemia, and mesenteric ischemia. Therefore, the mortality rate is high. The independent predictors of early mortality in individuals with acute aortic dissection type B are uncontrolled hypertension and dissecting aorta diameter. Uncontrolled hypertension and pathologic difference in arterial blood pressure are independent predictors of late mortality and relapsing pain.