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The stratified aortic aneurysm
June 26, 2012
The stratifying aortic aneurysm is a morbid condition at which the aorta wall in the place of its aneurysmal expansion and existence of damage is stratified.
The biggest artery in a human body is the aorta. Through it there is a blood stream from heart to all fabrics and bodies of our organism. The aorta leaves heart, and through its chest department there is a blood stream to bodies which are located in this zone. Then the aorta passes through a diaphragm, forming belly department of an aorta. Below the aorta is divided into two ileal arteries which provide supply with blood of legs, a bottom of a stomach, generative organs.
The aortic aneurysm is an expansion of a wall of an aorta, meshotchaty type which arises because of gradually thinning of a wall of an aorta. According to medical statistics approximately in a quarter of cases of an aneurysm appears in chest department. If the wall of an aorta is weakened, and at the same time there is rather strong pressure of blood, then as a result the wall site ballonoobrazno extends. If the aorta stays in a normality, then its diameter equals to two centimeters. But if the patient has an aortic aneurysm, then diameter extends to the sizes threatening health and human life. Aneurism which develops in any of departments of an aorta can be stratified and even to become torn owing to what there is severe bleeding inside and a lethal outcome.
The reasons of the stratifying aortic aneurysm
The stratifying aortic aneurysm is a special form of aneurism which arises at the person owing to frequent increases of a blood pressure. Distribution of stratification through all aorta is possible that becomes the reason of blocking of a blood-groove to kidneys, extremities, a brain, and also to other bodies. Stratification is very dangerous state, life-threatening the person.
In most cases this disease develops at people who already were 50 years old. The illness is more often diagnosed for males.
Long arterial hypertension is a basic reason of emergence in the patient of the stratifying aortic aneurysm. One more factor provoking stratification of an aorta is hereditary pathology of connecting fabric. Also the people who are suffering from defects of cardiovascular system or having an open arteriovenous channel risk to get sick with this illness.
Damage of an aorta atherosclerosis also is the contributing factor to emergence and stratification of aneurism. The illness can be shown at syphilis, less often the illness develops at Morfan's syndrome.
In more exceptional cases process of stratification of a wall of an aorta happens owing to introduction of a catheter in the course of some diagnostic testings or at aorta and heart operations.
The mechanism of the stratifying aortic aneurysm
Initially at the patient the arterial pressure then there is an increase of pressure in an aorta increases. Pressure influences an aorta wall owing to what it stretches. The inside layer of an aorta is as a result damaged and blood gets under the influence of pressure to the center. Thus, layers are divided, and between them there is a hematoma consisting of the accumulated blood. If pressure increases further, then the rupture of thirds of a cover of an aorta is possible owing to what the lethal outcome is inevitable.
Sometimes stratifying happens in the distantny direction, in more exceptional cases in the proximal direction. It as a result provokes a hemopericardium, a lead of the aortal valve, occlusion of coronary arteries, heavy aortal insufficiency. Also owing to stratifying there can be a repeated break of an internal cover of an aorta. Such break arises below from that place where there was an initial stratifying.
As the stratifying aortic aneurysm is shown
In medicine three stages of development of the stratifying aortic aneurysm are allocated. At an acute stage of a disease process of stratification happens over two days, at the same time most often the death of the person occurs the first several minutes or hours after stratification began.
Duration of a subacute stage of a disease proceeds from two to four weeks. At a chronic stage of the stratifying aortic aneurysm process of stratification continues for months, sometimes even several years. In this case the most favorable development of a disease from the point of view of a possibility of rendering the surgical help takes place. At an acute stage of an illness doctors do not manage to perform necessary operations for treatment of the patient. At the same time after attenuation of acute symptoms of an illness it is possible to do a surgery.
Symptoms of the stratifying aortic aneurysm
The most indicative symptom of the stratifying aortic aneurysm is sharp manifestation of pain in a breast. The person suffers from arching pain which is shown in a thorax and gives to the area of a back. This pain has constant character and over time accrues if stratification of an aorta continues. Pain can also mainly be felt in heart, give to the left hand. Arterial pressure, as a rule, suddenly goes down, and in more exceptional cases pressure increases.
At the patient pulse on extremities can not be probed and if in the course of a rupture of an aorta there is a hit of blood in lungs and bronchial tubes, the expectoration of blood is possible. If blood gets into a gullet, then at the patient the hematemesis can be observed.
At stratification of an aorta an asthma, signs of aortal insufficiency also takes place. At the same time on an ECG changes are not observed. If during progressing of this state to make a X-ray, then it is possible to find expansion of a shadow of an aorta which is observed for several days.
At such diagnosis most of people perish at once or within several days while the illness progresses. A basic reason of death – internal bleeding.
Complications of the stratifying aortic aneurysm
The stroke, myocardial infarction can become complications of a similar state. Perhaps also disturbances of functions of legs in view of changes of a blood flow on podvozdoshny arteries. If blood supply of a spinal cord is broken and walls of vertebral arteries are damaged, then disturbance of functions of a spinal cord is possible. Besides, at such illness arise to an abdominal pain and a waist if the blood flow in other vessels is blocked.
The most dangerous complication of stratification of a wall of an aorta is its gap and internal bleeding, life-threatening the patient.
Diagnosis of the stratifying aortic aneurysm
For establishment of the diagnosis the patient with the symptoms described above should ask for fast medical assistance immediately. To diagnose a rassloyka of an aorta, to the patient appoint the whole complex of versatile researches. To the patient the ECG is carried out. However it is necessary to consider that results of such research not always display severity of a condition of the person. Even at complaints to very severe pain on the cardiogram there can be no essential changes that becomes a signal for the specialist of possible development of the stratifying aortic aneurysm. However, often take place and cases of stratification of an aortic aneurysm when changes of a myocardium on an ECG are brightly expressed. In this case research will not allow to differentiate an acute myocardial infarction from the stratifying aortic aneurysm.
Carrying out a X-ray analysis of bodies of a thorax allows to define, the aorta is how expanded and to see whether its situation changed.
Also to the patient carry out ultrasonography of heart or an echocardiography that allows to learn in detail Bol about a condition of large vessels and hearts of the person and to find the place of damage of an aorta.
By means of a transesophageal electrocardiography it is possible to examine chest department of an aorta, and also to estimate degree of atherosclerosis and to learn about a condition of the aortal valve.
The computer tomography and magnetic and resonant tomography allows to define existence of the stratified aortic aneurysm. The last method is the most exact and can precisely define that place where there was a stratification.
It is possible to learn about existence of aortal insufficiency by carrying out the phonocardiography allowing to estimate noise in heart and vessels.
Besides, complex research can include ultrasonography doppler sonography of vessels, and also an angiography which is carried out by that to patients who are trained for carrying out operation. The angiography allows to learn, stratification, and what its extent is located where exactly.
In the course of diagnosis such state should be differentiated with a myocardial infarction. It is rather difficult process as symptoms and symptoms of these diseases are similar that is especially characteristic of initial stages of illnesses. To establish the correct diagnosis very important as at the stratifying aortic aneurysm it is impossible to carry out treatment with use of anticoagulants and trombolitik, and at a myocardial infarction these means are used in the course of complex therapy.
Treatment of the stratifying aortic aneurysm
Very important at once to hospitalize patients with suspicion on development of stratification of an aorta in a hospital where complete control all of them vital signs is carried out.
In the course of therapy of the stratifying aortic aneurysm it is important to appoint medicamentous drugs which reduce the frequency of heartbeat and promote lowering of arterial pressure. The speech in this case goes about beta adrenoblockers, antagonists of calcium, APF inhibitors, nitroglycerine drugs. It is important that indicators of arterial pressure did not exceed 100/60 mm of mercury. At the same time, the pressure is lower, the tension which appears on aorta walls will be smaller. However in this case it is necessary to watch that pressure did not go down so that oppression of functioning of other bodies will take place carefully. So, already at a "upper" indicator of pressure of 40 mm of mercury. irreversible changes in a number of bodies begin.
If the aorta was affected owing to syphilis, then to the patient the course of treatment antibiotics is appointed.
In the course of treatment of a rassloyka of an aorta it is extremely important to conduct constant and careful control of level of arterial pressure, heart rate, to monitor diuresis. To control process which happens in an aorta, it is necessary to spend each 12 hours a thorax X-ray. It is necessary to define sharpness of process as at an acute stage operation of the stratified aortic aneurysm bears big risk.
There is a number of indications for carrying out an urgent surgery to the patient of the stratifying aortic aneurysm. First of all, it is threat of a rupture of a wall of an aorta, stratification process which actively progresses emergence of a sacculate aortic aneurysm. It is impossible to do without surgical intervention and if drug treatment is inefficient, or pain is not taken off. The indication to an operative measure is — a hemopericardium (hit of blood in an outside cover of heart).
Operation is performed also at uncontrollable hypertensia – a state when lowering of arterial pressure and its deduction on the necessary indicators is impossible.
Carrying out a surgery at stratification of an aorta assumes aorta plastics a synthetic prosthesis or carrying out endovascular prosthetics and installation of a stent.
Operation continues from 3 to 6 hours. If process takes place successfully, then recovery of the patient in a hospital after operation continues about 10 days. In the course of recovery it is regularly necessary to accept drugs which interfere with increase of pressure and frequency of reductions of a cardiac muscle.
According to physicians, without operative measure of 75% of patients with stratification of an aorta die for 2 weeks.
Prevention of the stratifying aortic aneurysm
For the purpose of prevention of developing of this pathology it is extremely important to observe all measures for the prevention of cardiovascular illnesses. Daily activity, healthy food with the diet containing products, useful to heart and vessels, will help to prevent emergence of aneurism. It is not less important to trace cholesterol level in blood and to leave off smoking completely. The people subject to regular increase of arterial pressure have to watch its level and use drugs for decrease in the ABP which will be appointed by the attending physician.
Section: Diseases of vessels