Aortic dissection
- starts with a tear in the intima of the aortic lining. The tear allows a column of blood under pressure to enter the aortic wall, forming a haematoma which separates the intima from the adventitia and creates a false lumen.

Signs and symptoms

The typical patient is a man in his 60s with hypertension and sudden onset of chest pain.
The majority of patients with aortic dissection, present with a sudden severe pain of the chest or back, classically described as 'ripping'.
However, some may describe mild pain in the chest, back or groin, and it is easy to dismiss such cases as musculoskeletal.

In aortic dissection, pain is abrupt in onset and maximal at the time of onset. In contrast, the pain associated with acute myocardial infarction starts slowly and gains in intensity with time. It is usually more oppressive and dull.
The pain migrates as the dissection progresses. This is also very important.
In proximal dissections, the pain is usually retrosternal, but with distal dissections the location is between the scapulae and in the back. Hypertension is typically associated with distal aortic dissection.
Although tearing is the classical description, the pain is described as sharp more often than tearing, ripping, or stabbing.
Angina due to involvement of the coronary arteries.
Paraplegia due to involvement of the spinal arteries.
Limb ischaemia due to distal aortic involvement.
Neurological deficit due to carotid artery involvement.
Pulse deficit may be present initially, may develop, or may occur transiently.
There is a difference in blood pressure in limbs on the right and left side of the body.

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Notiz am Aneurysm & Dissections, erstellt von bessimajamal am 10/06/2014.