The first recorded aortic dissection was found in a dead king in 1760
When George II of Great Britain died in 1760, his post-mortem revealed the first described case of aortic dissection: a tear that lets blood force apart the layers of the body's main artery. It still kills fast; untreated, about half of the most dangerous type die within three days.
The aorta wall has layers. If the innermost one is damaged, blood can push into the wall itself and peel the layers apart. Almost everyone affected, about 96 percent, feels sudden severe pain in the chest, back or abdomen, often described as tearing or stabbing, and in roughly 17 percent it travels as the split extends. Pain at the front of the chest points to the ascending aorta; pain between the shoulder blades suggests the descending part. Vomiting, sweating and light-headedness can accompany it, and starved blood supply may cause strokes or damage to the gut, legs or kidneys.
It can be mistaken for a heart attack, but usually lacks the typical heart-failure signs and ECG changes. The deadliest complication is bleeding into the sac around the heart, which squeezes it; fainting is caused this way about half the time, and very low blood pressure on arrival is a grim sign. Doctors confirm a suspected dissection with CT, MRI or ultrasound.
Clinicians sort cases into two Stanford types. Type A involves the first stretch of the aorta beside the heart and usually needs surgery, either through the open chest or from inside the vessel. Type B spares that section and is often treated with drugs that bring down blood pressure and heart rate, unless leaks or blocked branch arteries force an operation. Untreated, around 10 percent of type B patients die within a month. Michael DeBakey pioneered surgical repair in the 1950s.
The condition is uncommon, at roughly three cases per 100,000 people a year, more often in men, with a typical diagnosis age of 63 and about one case in ten before 40. Risk rises with high blood pressure, connective tissue disorders such as Marfan and Ehlers-Danlos syndromes, a bicuspid aortic valve, previous heart surgery, smoking, cocaine and pregnancy. Controlling blood pressure and not smoking are the preventive measures the source names.
Source: Aortic dissection
