Aortic dissection
Aortic dissection is defined as separation of the layers within the aortic wall. Tears in the intimal layer result in the propagation of dissection (proximally or distally) secondary to blood entering the intima-media space. Since many patients die even before reaching the emergency department or before a diagnosis is made, aortic dissection may be diagnosed ante-mortem or postmortem. It is more common in males than in females, with a male-to-female ratio of 2:1. Significant aetiological factors are hypertension, aortic aneurysm, iatrogenic (by cardiac surgery, including aortic and mitral valve replacements, CABG or PTCA), aortic atherosclerosis and Marfan syndrome. The immediate treatment of a dissection is conservative, i.e. reduction of blood pressure and heart rate. Surgery is mandatory. Prognosis without surgery is very poor.
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