Anneurysm is called the resulting blood vessel wall vessel, provoked by it with stretching or thinning due to any acquired or hereditary pathologies. The danger of such a problem largely depends on the site of localization of the vascular defect and the caliber of arteries or veins.

Aorta aneurysm rightly entered the list hazardous stateswhich can lead to almost instant death. The cunning of this disease lies in the fact that the patient for a long time may not even suspect of its presence, and the aorta is the largest vessel of the human body, and when a large aneurysm, formed on it, in a patient in a matter of minutes, may appear death or serious condition caused by massive bleeding.

AORT SPRESS

Aorta is the most large-caliber and long artery of the human body, which is the main vessel. big Circle blood circulation. It is divided into three parts: ascending, aortic arc and descending. The descending part of the aorta, in turn, is divided into the chest and abdominal department. The length of this large vessel takes distance from the sternum to the lumbar spine. Such dimensions of the artery say that when pumping blood in it, it creates the highest pressure, and that is why it can often be formed by the exposure areas (aneurysms).

Mechanisms and reasons for the development of aneurysm

Also, in connection with its anatomical features, Aorta is the most susceptible to infections, atherosclerotic changes, injury and dying of the medium shell of the vessel. All of these predisposing factors contribute to the development of aneurysm, bundle, atherosclerosis or inflammation of the aorta (aortita). Stretching or thinning of the walls of this largest artery is caused by either age-related changes or various injuries or diseases (syphilis, atherosclerosis, diabetes and etc.).

According to statistics, precisely atherosclerotic plaques in most cases are the root cause of this ailment. Also, not so long ago, scientists had suggested that the aortic aneurysm development could contribute to the herpes virus. At the moment, these data are not yet confirmed, and scientific research is under development.

At the initial stages of the aortic aneurysm disease, they do not show themselves and can be discovered absolutely by chance during the survey of the patient about other diseases (for example, when performing the ultrasound of vessels, organs abdominal cavity or hearts). In the future, in the middle wall of this artery, the elastic fibers atrophy occurs. They are replaced with fibrous cloth, and this leads to an increase in the aortic diameter and an increase in the voltage in its wall. With the progression of such pathological processes, the risk of rupture increases significantly.

Views aneurysm

Aortic aneurysms can be different in their structure and form.

In their pathological features of aneurysta, it happens:

• true - is the protrusion of the wall of the vessel, which is formed from all vascular layers of aorta;
• false (or pseudo-oscale) - is the protrusion of the wall of the vessel, which is formed from pulsating hematomas, the vessel walls consist of para-ortal connective tissue and sublayer deposits of blood clots.

By its form of aortic aneurysm can be:

• basching - the cavity of the pathological protrusion of the aorta is reported to its lumen through the shameless channel;
• spine-like - It is most often found, its cavity is similar to the form of spindle and reported with aortic lumen through a wide hole;
• resracted - the cavity is formed due to the bundle of the aorta walls and is filled with blood, such aneurysta is reported to the aortic lumen through the stratum wall.

For clinical manifestations, cardiologists identify such types of aneurysms:

Symptoms

The severity and nature of the signs of aortic aneurysm is predetermined by the place of its localization and development stage. They are nonspecific, diverse and, especially with insufficient severity or rapid progression, are attributed to other illnesses. The sequence of their appearance is always determined by such pathological processes:

• during the donor, the intima aorta in the patient appears pain and blood pressure decreases dramatically;
• in the process of bundling the wall of the aorta in the patient, there is a sharp pain of a migratory nature, repeated episodes of reduction arterial pressure and organ symptoms (they are determined by the location of the aneurysm, the observation of sex and hemorrhage);
• during the complete rupture of the walls of the aorta, the patient develops signs of internal bleeding (sharp pallor, cold sweat, decrease in blood pressure, etc.) and hemorrhagic shock develops.

Depending on the combination of all of the above factors, the patient may be observed:

• the pain of zhugochi, goded or fading character, localizing or irradiating in hand, chest, blades, neck, lower back, or legs;
• cyanosis of the faithful part of the body in the development of hemopericard;
• fainting, developing during damage and irritation of vessels departing to the brain or with a sharp anemization of the patient due to massive bleeding;
• pronounced bradycardia at the beginning of the intima donor, replacing the tachycardia subsequently.

In most patients aortic aneurysm, especially in the first stages of its development, proceeds asymptomatic. Especially relevant for the disease at the location of the pathological protrusion of the vessel wall in the thoracic group of aorta. In such cases, signs of pathology are either detected by chance with a tool survey about other diseases, or make themselves more pronounced if aneurysta is localized in the field of bending aorta in the arc. In some cases, when irritating the vessels, the bundle of the aorta in the field of coronary vessels and squeezing the coronary arteries, the clinical picture of the aortic aneurysms is combined with the symptoms of myocardial infarction or angina. When the pathological protrusion is located in the abdominal department, the symptoms of the disease are clearly pronounced.

With an ECG examination of a patient with aortic aneurysm, a variable picture may be observed. In 1/3 cases, it does not detect any deviations, and in others there are signs of focal lesions of myocardium and coronary failure. When the aortic bundle, these signs are persistent and detected on several re-removed ECG.

In the general blood test, leukocytosis and signs of anemia are detected in the patient. If the aortic aneurysm is bundled, the reduction of hemoglobin and erythrocyte levels is constantly progressing and combined with leukocytosis.

Also in patients with this disease, some neurological symptoms are possible:

• convulsions;
• disorders when urination and defecation;
• hemiplegia;
• faint;
• paraplegia.

In engaging in the pathological process of femoral and iliac arteries, there are signs of a violation of the blood supply to the lower extremities. The patient may appear: pain in the legs, swelling, pale or cyanosis of the skin and others.

In case of separation of the anneurysm of the abdominal aorta in the area of \u200b\u200bthe abdomen, the tumor pulsating and increasing in size is formed, and when blood is prolonged into the pleural cavity, pericardium or mediance when performing heart boundaries, their displacement, expansion and disorders are observed. heart Rhythm Up to the stop of the heart.

Symptoms with aortic aneurysm

In most cases, the aortic aortic aneurysm is not accompanied by any specific symptoms. Initially, the patient may appear discomfort and non-intensive pain, and at the beginning of bleeding to the clinical picture, signs of hemorrhagic shock are joined.

In the case of massive and fast hemorrhage, fainting and intensive pains in different parts of the body may occur (if the bundle or the aortic break occurs in close contact with the nervous beam). Further forecast of such significant blood loss depends on the total volume of lost blood.

Treatment

For the treatment of aortic aneurysm, the patient needs to contact a vascular surgeon or cardiac surgeon. The definition of its tactics depends on the growth rate, the location of the localization and the size of the aneurysm, which are determined during the dynamic observation and permanent radiographic control. If necessary, to reduce the risk of developing possible complications or the preparation of a patient for surgical treatment, anticoagulant, anti-aggregative, hypotensive and anticholesterolemic drug therapy is carried out.

Decision on the execution of the planned surgical treatment Accepted in such clinical cases:

• the aneurysm of the abdominal department of the aorta with a diameter of more than 4 cm;
• aneurysta chest aorta with a diameter of more than 5.5-6 cm;
• a constant increase in the size of a small aneurysm by 0.5 cm and more in six months.

Emergency surgery is carried out as soon as possible, because with massive or long-term bleeding, the patient dies in a short time. Such terminal situations may become indications:

• embolization of peripheral arteries;
• builtrate or gap aorta.

Operations are carried out to eliminate the aneurysm, the purpose of which is directed to excision and stitching or replacing the prosthesis of the damaged area of \u200b\u200bthe aorta. In the presence of aortic insufficiency, during resection of the chest vessel, the aortic valve is replaced.

One of the minimally invasive variants of surgical treatment may become endovascular prosthetics with the subsequent installation of the stent or vascular prosthesis. If it is impossible to perform such operations, traditional interventions with open access to the location of resection is carried out:

• the aneurysm of the abdominal department;
• the aneurysms of the thoracic departure at the left side bypass;
• the aneurysms of the inflation with artificial blood circulation;
• aortic arc aneurysms with artificial blood circulation;
• aortic aneurysms of the abdominal department;
• aortic aneurysms of the abdominal department with artificial blood circulation;
• the aneurysms of the subsoil department of the aorta.

After the completion of chiurugic treatment, the patient is translated into the cardioreanimation separation, and in the restoration of all vital functions - to a vascular department or a cardiological center. In the postoperative period, analgesic therapy and symptomatic treatment is prescribed to the patient.

The forecast for aortic aneurysm will be determined by its dimensions, the rate of progression and the accompanying pathologies of cardiovascular and other organism systems. In the absence of treatment, the outcome of the disease is extremely unfavorable, since, due to the rupture of the aneurysm or the development of thromboembolism, the patient comes a fatal outcome. According to statistics, about 95% of patients dies during the first three years. This is explained by the frequent hidden course of the disease and the high risk of rupture aneurysm, the diameter of which reaches 6 cm. According to statistics, about 50% of patients per year dies with such aortic pathologies.

In case of early detection and planned surgical treatment, the aortic aneurysms postoperative forecast becomes more favorable, and death is no more than 5%. That is why for the prevention and timely detection of this disease, it is recommended to constantly monitor the level of blood pressure, to lead a healthy lifestyle, to undergo regular planned preventive inspections and all the appointments of the doctor for drug therapy of concomitant diseases.

Medical animation on the theme of the aortic aneurysm:

Aneurysm Breast Aorta

Aorta is a leading arterial blood vessel, it connects all parts of the body and internal organs with our heart. The aneurysm of the chest aorta is an indicator of exhalation, the production of vessel tissues, which in many cases leads to a sudden breaking of the wall and ends, as a rule, with a fatal outcome.

Causes of occurrence

Natural causes of the disease are many factors, it is the complex component that plays a decisive role. A person who is not thinking about his health is always at risk. The main reasons predisposing to the appearance of the aneurysm of the chest aorta:

• one-third obesity from normal weight;
• smoking;
• genetic tendency to aneurysm;
• infections;
• congenital disorders of the connective tissue, marfana syndrome;
• age older than sixty years;
• inflammatory processes of the walls of vessels, previously transferred bundle of aorta;
• atherosclerosis;
• breast injuries;
• cardiology of the heart valve;
• high rates HELL.

It is noted that the representatives of the White race suffer from the aortic aortic aneurysm disease more often than representatives of others. Also, the predisposition of men is higher than women.

Symptoms of the disease

Usually, the aneurysm of the chest aorta grows slowly and at first does not show anything in any way. This is the difficulty of diagnosing a disease on early stages. Slow-growing aneurysms do not always lead to a breakdown of vessel tissues, adding up to 1 cm in diameter for a year, they do not pose a danger. Only aggressive growths of the affected areas are life-ingrading, the risk of breaking in this case is fatally great. The rapid growth of the aneurysms contributes to the appearance of sudden pain in the stomach and chest, giving back. Beast and abdominal aorta is susceptible to aneurysm, less often it meets between the sternum and the abdominal area.

The main signs of the disease:

• the appearance of shortness of breath;
• highlighting voice;
• cough to hoarseness;
• horn syndrome;
• dysphagia, difficulty swallowing;
• permanent unpleasant, painful feelings in the chest.

The manifestation of many of the listed symptoms contributes to the squeezing of the arrangement of the surrounding tissues and organs. The released walls of the arterial vessel "stretch" under blood pressure vessel increases, presses the trachea, causing cough. If the aorta puts on the esophagus, the process of swallowing becomes difficult, pressing the nerves of the larynx contributes to the masking of the voice.

Another serious manifestation of the disease is considered to be a horner syndrome. It combines signs arising from the transmission of nerve endings in vegetative nervous systemthat are inside the sternum.

Characteristic signs Syndrome:

1. Narrow pupil.
2. Semi-finished eyelids.
3. Increase sweating.
4. Feeling of inner pulsation in the chest area.

If the aneurysm of the chest aorta is broken, then the fatal outcome is predetermined, even with rapid surgical care. However, if the following symptoms of the aneurysm of the chest aorta appear, the following symptoms of the beaches of the neurizm of the chest aorta appear - sharp chest pain spreading on all parts of the body, arterial hypotension, internal bleeding, bouts of vomiting with blood, similar symptoms are observed with myocardial infarction.

Treatment

The presence of the above symptoms, hereditary predisposition is a mandatory reason to come to the doctor on the reception. An ordinary procedure in this case will be an ultrasound examination for the identification of aneurysm.

Aortic aneurysm diagnostics methods:

1. X-ray, it shows the presence or absence of aneurysm.
2. Ultrasound or echocardiography, a simple and safe way to detect a deviation in the structure of aortic and hearts.
3. Computed tomography, provides a layer-by-layer body structure, harmful by ionizing radiation, but unmistakable.
4. MRI, magnetic resonance angiography, allows to obtain an accurate layer-by-layer structure of organs and tissues, including vessels using electromagnetic radiation.

Patients subject to risk of the formation of aneurysm on the leading arterial vessel are obliged to pass the ultrasound regularly. This is the fastest and most affordable method of diagnosing pathologies of blood vessels and other organs.

The main techniques of treatment of aneurysm

Naturally, the main task of a doctor and a patient with a given disease is the prevention of aortic breaking at the exaggeration site. Treatment is divided into two stages:

1. observation;
2. surgical intervention.

Conservative ways, as it were, "delayed" the development of the defeat on the aorta plot, it is impossible to fully care from the aneurysm. With an aggressive course of the disease, surgery is shown.

How is the observation of aneurysm

Hypertensions and patients suffering atherosclerosis, cardiologists prescribe reduced beta-blockers, angiotensin II inhibitors, also reduced cholesterol drugs. Patients are recommended to abandon smoking.

Thus, a visit to the doctor takes every six months to clarify the dynamics of the development of the disease, examination and adjustment of the course of preventive treatment to prevent the aortic aneurysm rupture.

Operation on Aorte

The gap of the aorta of the chest department at the aneurysm site is a catastrophic situation, without the help of a surgeon, a fatal outcome, with an operation survival costs up to 65%. Therefore, the operation is advisable to hold a planning, if there are serious testimony. The main of which are the foci of blood accumulation, which began the process of separating the aorta.

The heavy stage of the disease is characterized by the presence of "burning" pain, like infarction, develops collapse of all systems. The sign is becoming the impossibility of the patient to move upper limbs (Hands).

There is many years of experience in observing the symptoms of the aneurysm, but the diagnosis is sometimes clear only after the catastrophic break. It opens a strong bleeding, the pleural cavity is filled with blood, as well as trachea and esophagus. The patient has signs of hemorrhagic shock - a sharp drop in blood pressure, the pallor of the skin, tachycardia, loss of consciousness, the absence of the right perception of surrounding reality. The lack of medical care leads to a fatal outcome. The complications of the disease are also deficiency of cardiac activity, clogging of vessels with blood clots.

Surgery in this case goes in two ways:

1. endovascular treatment method;
2. open operation.

The endovascular method is carried out using a puncture in the femoral part of the artery, through which the compressed transplant, stent is carried out in place of the extended part of the artery. It is implanted into the vessel wall, representing a synthetic inner frame, while the blood current pressure on the artery wall ceases, which gives it the opportunity for recovery, warns its gap. Reception This miniinvasive, i.e., the defeat of the body is not enough. The patient a few days after the operation is ready for discharge. However, the method does not allow one hundred percent warranty and is not yet sufficiently studied.

The purpose of the surgical operation of the open type is the prosthetics of the damaged aorta. The surgeon cuts the chest and implants the prosthesis of the blood vessel. Part of the artery is removed and replaced by artificial implant. The heart valve is usually adjusted, as well as surgical revasculation of suffering ischemia. The recovery period after the operation to remove the aortic aneurysm lasts up to one month and depends on the overall condition of the body.

The indication to the operation is the large size of the aneurysm, 5-6 cm in diameter, and its rapid growth.

Also necessarily operate the aneurysms:

• after injuries of the chest;
• with pronounced manifestations;
• after syphilis.

Without treatment in patients with large sites, the aortic defeat arises a predisposition to the formation of thromboms. The disease for five years "eats up" three of the four people and did not decide on the operation.

Prevention measures Aorta aneurysm

The very first step is to refuse smoking. A person with aneurysm is required to constantly monitor its arterial pressure, the frequency of cardiac rhythm. It is especially necessary to be attentive hypertensive with experience, men after 60 years.

If some pathological conditions are noticed, deviations in the work of the heart, resistant high blood pressure rates need to urgently consult a doctor-specialist, cardiologist. Prescribed drugs need to be taken regularly without deviating from the scheme. The seriousness of the disease, such as the aortic aortic aortic aorta should not scare, modern treatment of treatment give encouraging results, the main thing to follow their health.

Diet to improve the condition of blood vessels

Some products need to be removed from everyday diet forever. These include:

• hydrogenated fats, such as margarine and products based on it - cookies, cupcakes, cakes, semi-finished products in the form of a layer test, Pies:
• egg whites, souffle, marshmallows;
• fatty fried meat.

Excellent replacement of the above-mentioned products - ocean fish, lean vegetable oils, vegetables and greens. Cheeses, cottage cheese, and sour cream need to be chosen with a reduced fatness percentage. Useful energy - whole grain porridge, black bread. Under reasonable limits, it is necessary to consume garlic, onions, ginger and other spices, they contain useful for blood vessels and microelements.

Increase physical activity

Raise exercise The body needs smoothly, step by step, under the control of the doctor. It is required to achieve a lung training effect of the whole organism, and in particular the work of the heart and the blood system. It is advisable to maintain the usual rhythm of life with a light deviation towards activity. For example, the daily evening walks in the store can be increased by 15-30 minutes, go later on. The most important thing is that any action should be regular.

Self-control questions with additional physical exertion:

• pulse 120-140 beats per minute;
• immediately reduce the intensity when weakness, pain, shortness of breath appears, increased sweating.

Gradually, you need to teach yourself to 3-4 km walks, at a speed of 120 steps per minute, 3-5 times a week. Good luck and health!

Aneurysm chest aorta

Aorta is one of the major arteries in the human body, which connects the organs and parts of the body with the main body, on which our life depends - with a heart. But each second person is diagnosed various diseases Vessels, which represents a serious threat to human health and life.

One of the common pathologies of the aorta is aneurysm. The aneurysm of the chest aorta is an anomaly of the main artery of the human body, which is characterized by the pathological expansion of the lumen of the aorta in the chest. Such an abnormal expansion provokes a violation of the normal functioning of the valve, which is located between the heart and the aorta. And it is accompanied by a phenomenon in which the blood flow returns back to the heart, but the valve is closed. The aneurysm of the chest aorta causes an increased probability of random break and bleeding, which leads to death.

Overview of the disease

The aorta is the largest vessel that begins in the left ventricle, rises a little up and falls down in the form of an arc. Part of this vessel, passing in the chest area, is called a chest aorta, and during the transition to the abdominal cavity it acquires the name of the abdominal aorta. For aneurysm, the aorta is defeated in the rising vessel department. Also, the aneurysm of the chest aorta is combined with the aneurysm of the abdominal department of the artery.

The normal diameter of the aortic lumen is 2 cm, and if aneurysm is developing, the diameter can increase to incredible sizes that threaten human life. This leads to the development of such complications as the bundle of vascular walls and their gap. Anomaly arises in a weakened section of the wall of the aorta, and the high pressure convened at the same time, contributes to its further expansion.
If the aneurysm does not reveal on time and not to begin to treat, then it is possible to break it, which will open dead bleeding. Mortality equals almost 70%, so it is important to notice signs of the disease and consult a doctor.

Causes of the aneurysm of the chest aorta

There are many reasons for the development of the disease, but pathology arises as a result of the impact of factors:

• existence of excess weight and obesity on the third part of normal weight;
• harmful habits: smoking, alcohol;
• age factor: people over 60 years old;
• marfan syndrome;
• cholesterol deposition and atherosclerosis;
• sedentary lifestyle;
• breast injuries;
• infectious diseases accompanied by vessel lesions: tuberculosis, syphilis;
• inflammation of the walls of the vessel;
• yatrogenation;
• cardiology of the heart valve;
• hypertension.

The aneurysm of the chest aorta is observed in men at the age of more than 60 years, especially among representatives of the White race. And if the pathology was discovered in a young man, then the cause of its occurrence is innate or hereditary.

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Symptoms of the aneurysm of the chest aorta

The clinical picture of pathology is diverse and arises from the impact of certain factors. Symptoms depend on the location of the localization and size of the anomaly, the degree of bundle of the walls and the influence of the damaged artery on the body.

The aneurysm of the thoracic aorta grows slowly, but slow the growth rates of the aneurysm provoke the gap of the aorta tissues and do not represent a serious threat, because they increase in diameter no more than 1 cm per year. The threat to the life of the aortic aneurysm becomes in the event that the aggressive growth of the deformed areas occurs, since the probability of tissue break is very large. If pathology grows very quickly, there are sudden pain in the abdomen and chest, which can give in the back.

The aneurysm of the chest aorta is developing without manifestation of symptoms, and if the signs of the disease appear, their specificity is poorly expressed, which assume the development of the disease, as aneurysm, is difficult. Pathology is manifested by the following symptomatics:

• pain of various intensity in the area of \u200b\u200bthe chest, which are given to the lower back. Painful sensations may occur in the neck or lower jaw;
• frequent shortness of breath;
• voting or hoarseness;
• difficult breathing;
• bouts of dry cough with chrys in the throat;
• headaches, dizziness;
• reduced blood pressure;
• heart palpitations;
• difficult breathing, dysfagia.

The appearance of symptoms contributes to the compression of an expanded artery of organs and tissues that are nearby. The walls of the vessel become thinner, which is why they are quickly stretched and blood pressure leads to an increase in the vessel, which in the end begins to put on the trachea, causing cough. And if the aorta begins to put pressure on the esophagus, then the difficult swallowing is noted, and with pressure on the larynx - the voices or hoarseness.

Another serious sign of the aneurysm of the chest aorta is the horner syndrome. This syndrome consists of symptoms resulting from the transmission of the nerve endings of the vegetative nervous system in the chest. Gorner syndrome is manifested by a clinical picture:

• narrowed pupil;
• increased sweating;
• eyelids are in a harassed state;
• the feeling of pulsation in the chest.

Symptoms of the ripper aneurysm

• sharp continuous chest pain or abdomen;
• sharp, pulsating headache in the back of the head;
• severe weakness;
• frequent attacks of nausea and vomiting with blood;
• shock state;
• low pressure;
• increasing body temperature;
• disturbed consciousness;
• internal bleeding.

Such symptoms may also mean myocardial infarction or pathological state Blood supply heart muscle. Therefore, it is necessary to consult a doctor at once, as soon as the slightest suspicions of a serious illness arise, so that the specialist can diagnose pathology as soon as possible and begin immediate treatment, thereby reducing the risk of fatal complications.

Complications of aortic aneurysms and forecast

Aortic aortic aortic can cause the following dangerous complications:

• gap aorta. This phenomenon represents a threat to the patient's life. And the larger aneurysm, the greater the likelihood of its rupture;
• formation of thromboms;
• bundle of the wall of the vessel;
• cardiac and pulmonary failure.

Given the statistics, the complications of the aortal aneurysm lead to death in 40% of cases after 3 years of diagnosis, and 60% of cases - 5 years after the detection of the disease. The forecast for the aneurysm of the chest aorta mainly depends on the size of the anomaly, the rate of progression and the presence of concomitant diseases.

Surgical medicine does not stand still, so patients with such a diagnosis can be saved. The main cause of death with aortic aneurysme is its gap, as well as the ischemic heart disease and strokes can lead to a fatal outcome. The probability of the aneurysm rupture depends on the size of the pathology. An increase in the diameter of the vessel is more than 5 cm, represents a threat to the patient's life. The bundle of the wall of the aorta has an unfavorable forecast if surgical treatment has not been started in the first days.

Diagnosis of the aneurysm of the chest aorta

• passing generally clinical analyzes;
• radiography. It allows you to detect the presence of aneurysm;
• Ultrasound of the heart;
• cT scan;
• aORTOGRAPHY;
• angiography.

Patients who have revealed the risk of anneurysm of the chest aorta must regularly pass an ultrasound, as it is an affordable and inexpensive way to diagnose vascular pathologies. After all surveys were passed, it is necessary to turn to the attending physician with the results of research, each of which is capable of providing important information that will make it possible to choose the best treatment.

If suspicion of the aorta rupture arose, then it is necessary to provide an obligatory passage of ultrasound echocardiological research through the esophagus, as well as tomography. In some cases, the doctor can send tests for the presence of syphilis, as it is a frequent cause of aortic aneurysm. It is also possible to check for bacterial and fungal blood cultures.

Any operation during the aneurysm of the chest aorta is to replace the damaged area of \u200b\u200bthe aorta to a special prosthesis that prevents the risk of breaking and the occurrence of dangerous bleeding. After any operation on the chest aorta, constant observation of the doctor for a long time.

The aortic aneurysm is often gives the clinical picture similar to that with myocardial infarction. The bundle of the walls of the aortic usually appears on the background of the inflammatory process of various etiology (including syphilitic mesoutitis), as well as pronounced atherosclerosis. Long and pronounced hypertension can often contribute to the bundle of the aortic walls, less often - injuries of the chest.

Clinical picture and diagnosis of aortic aneurysm

The most important feature of the agricultural aortic aneurysm is sharply pronounced pains arising in most cases in an interitant in the chest. The beginning of the pain does not always coincide with the full bundle of the aorta. Sometimes the appearance of pain points only at the beginning of the process, the aorta observer. At the time of complete bundle and the formation of aneurysm, there is often a significant drop in the blood pressure, accompanied by a fainting condition and even a collapse.

Especially strong pain occurs at the moment when the aorta wall is rupture. Then they weaken, but further, when the aneurysm applies below along the aorta, pain can periodically increase. When progressing, the aneurysm of pain is growing, irradiated in the back, spine, lower back, crescent, sometimes in the inguinal areas, both legs. Similar localization and the migrating character of pain are not typical for myocardial infarction.

The activity of "cardiac enzymes" (KFK, LDH, ACT, ALT) with a separating aneurysis can remain normal or slightly increased, the level of myoglobin does not change significantly. Signs of subendocardial ischemia (decrease in ST segment) can be detected on the ECG, as well as the violation of the repolarization phase in the myocardium of the ventricles (change in the shape of the teeth T).

There are cases of compression of a sparking aneurysm of the mouth of the coronary artery with the development of myocardial infarction. Almost always, the coronary blood circulation to a certain extent suffers from the fall of blood pressure in the aorta. Therefore, the ECG is more often registered by the above changes.

The lethal exodus with an extensive aneurysm of the aorta usually comes suddenly, but sometimes, with a slowly progressive process and increasing clinical symptoms, - after 1 to 2 weeks and later. If death does not occur immediately, moderate anemia appears on the 2-3rd day, which is not typical for myocardial infarction.

Occasionally the condition of patients with stratifying aneurysm gradually stabilizes, the bundle is terminated, chronic aneurysm of the aorta is formed. Of great importance in the diagnosis of aortic aortic aneurysm, including chronic, has X-ray-contrast and echocardiographic research.

Treatment of aging aneurysm aorta

Surgical intervention in specialized hospitals is performed. In the prevention of the disease, the correction of blood pressure, treatment and prevention of atherosclerosis, as well as other aortic diseases play.

B.B.gopbachev

"Signs of aging aortic aneurysm" and other articles from the section

Aortic aneurysm is an expansion of a part of the aorta, which appeared due to pathological changes in the connecting structures.

The aortic aurated aneurysm is an unforeseen deformation of the inner envelopes of an extended artery, which is accompanied by the appearance of internal hematoma and a false opening.

Basically the process occurs when high pressureWhen blood begins to spread between the layers of the artery wall, gradually dissection.

According to statistical data, the risk of a disease in men is 2 times more than in women. At the same time, the age of 60% of the diseased is 55-65 years. The stratification of the aortic aneurysms is one of the most serious diseases that can lead to death, so it is important to recognize it at the initial stages.

Classification of aging aortic aneurysm

There are several classifications of the disease. They are based on the location of the illness, the features of the course of the disease.

American Cardiac Corridge Michael Debaraki created a classification according to the localization of the disease:

1. I type. The internal shell turns in the ascending artery area, and the bundle gradually affects the abdominal and thoracic departments. There are 2 outcome of this type: the formation of a blind bag or a distal gap of aorta,
2. II type. The observation is localized exclusively in the field of ascending artery, which leads to the formation of a blind bag in the shoulder trunk,
3. III type. The internal layer pumping occurs in the descending area of \u200b\u200bthe artery. The pathological process has several outcomes: the blind bag can be formed above the diaphragm or in the distal sections of the abdominal aorta, the separation is distributed on the arc and the ascending part of the aorta.

By the course of the disease distinguish chronic form (proceeds for several months), the shape of the form (the process can last up to 3-4 weeks) and is a sharp form (the death occurs after several hours of exacerbation). According to the standford classification, distinguish 2 types. Type A is characterized by the settlement of the ascending artery (regardless of the localization of the oversight of the inner layer), the type B is characterized by the distal bundle of an arc and a downward aorta. The development of complications in most cases leads type A.

The causes of the occurrence of illness

In 85% of cases, the development of the disease is associated with arterial hypertension, which remained a long period of time. This condition is significantly injured by the artery that entails her gap.

There are also a number of factors provoking the aortic aneurysm stratification:

1. genetic predisposition,
2. deviations from the endocrine system (obesity),
3. tobacco product abuse
4. the presence of serious diseases (atherosclerosis of aorta, polycystic disease of the kidneys),
5. postoperative period (surgical interventions),
6. high blood pressure (hypertension).

Important! The risk group includes people who have chronic infectious diseases (syphilis, tuberculosis).

Symptom of aging aortic aneurysm

Aortic aneurysms that appeared due to hereditary pathology, which have no connection with the bundle of the vessel wall, do not appear in any way. In other cases, the aortic aneurysm has pronounced symptoms. At the same time, some clinical signs of the disease may be similar to other diseases.

Most often, with an acute attack, the following symptoms arise:

1. sharp pain in the chest or lower back (depending on the place of damage),
2. a significant increase in blood pressure in the first 60 minutes, then a sharp decrease,
3. the appearance of shortness of breath and hoarseness,
4. deviations from the neurological system, for example, anxiety and violation of consciousness (fainting),
5. frequent sensations of lack of oxygen,
6. pain in the inter-opacculent region (characteristic of type II disease),
7. nausea and vomiting (in exceptional situations),
8. disorders and disorders of digestive
9. the asymmetry of the pulse both on the upper and on the lower limbs.

Diagnosis of the disease

When detecting characteristic symptoms It is recommended to seek help from a specialist. On the primary inspection, the doctor carries out auscultation (there is a diastolic or systolic noise in the heart), after which it appoints a further diagnostic study. Recognize a disease can only with the help of instrumental diagnostic methods.

These include:

1. Radiography. In case of a radiograph of the radiograph, the doctor will detect the characteristic features of the aorta bundle: a significant expansion of the artery, deformation of the shadow of the artery outline. According to this study, you can control the dynamics of disease progression.
2. Echocardiography. With this study, doctors are able to exclude ischemic heart disease, which has similar signs (pain in the chest area).
3. Magnetic resonance tomography. It helps to detect the location of the intima gap, to evaluate the involvement of the main branches of the aorta.
4. AORTOGRAPHY. With this study, you can see the accurate localization of the initial oversight in real time.

Despite the fact that all instrumental methods are similar to among themselves, many experts believe that in most cases one study is not enough for reliable diagnosis. In addition to the surveys listed, the patient measures the pulse and pressure (sharp jumps will be fixed when detaching the aorta). Differential diagnosis is important to distinguish the disease from other ailments (for example, from the aorta thromboembolism or acute occlusion of mesenterial vessels). From laboratory studies are prescribed a general analysis of blood and urine, this is necessary to eliminate suspicion of inflammation of the pancreas and renal colic.

First aid with aortic aneurysm

With an acute deterioration of the state, immediate assistance must immediately cause emergency assistance. First of all, the patient will be stopped pain syndromeFor this, intravenously introduced morphine and an analgesic mixture (a dose establishes a doctor based on the physical condition of the patient).

Through the gas framework, there is inhalation using a mixture of nitrogen zaksi. If a person is sick with hypertension, it is introduced to drugs to maintain normal pressure. Hospitalization is an integral stage in the treatment of the disease, a patient needs a strict bed regime.

Treatment of aging aneurysm aorta

When diagnosing the aneurysm of the abdominal or thoracic aorta, conservative treatment is prescribed. It lies in the reception drug addictswho are needed to eliminate the causes of the development of the disease and the relief of symptoms. Also, drug therapy is necessary in order not to cause further bundle of the aorta. These drugs include beta-adrenoblays and ACE inhibitors.

In the absence of an effect from conservative therapy, they resort to surgical intervention. The surgeon performs resection of the damaged area of \u200b\u200bthe aorta with a supervision, eliminates the false clearance and with prosthetics restores a damaged artery fragment. Sometimes operations are carried out using artificial blood circulation. For the first few days after surgery, the patient is in hospital under the supervision of doctors.

Important! In the absence of timely treatment, the risk of death is high: during the first 2 months is more than 80%.

Prevention of the disease

The degree of aorta is a serious illness that often ends with a breakdown of the vessel. For a favorable outcome, it is important to recognize in the initial stages. Since in most cases the disease is manifested by blood pressure jumps, it is necessary to regularly change it. It is important to observe the course of any cardiovascular diseases, passing the surveillance from the cardiologist. With a significant deterioration in the state, the appearance of symptoms characteristic of illness, it is impossible to tighten the trip to the doctor, the timely appeal to the specialist will reduce the risk of fatal outcome.

The article is told about such a disease as aortic aneurysm. The reasons for the development of pathology, main manifestations, the degree of danger to life are indicated.

Aortic aneurysm is an extended section of the vessel with a thinned wall. The clinical picture is determined by the dimensions of the pathologically changed area. The disease carries a direct threat to life, since the thin vascular wall can break and it leads to massive bleeding.

Aortity aneurysm Hearts - what is it?

This is so called the pathological condition, characterized by the expansion of any part of the aorta and the thinning of its wall. In this case, the diameter of the vessel in this area is significantly increased. Figuratively speaking, aneurysm is a bag in the vascular wall.

This protrusion of the vascular wall leads to a blood flow violation. If there is damage to the inner layer of the vessel, the blood begins to fall in the rink and aneurysm increases. So it is formed separating aneurysm. Wrong blood flow leads to the formation of blood clots on the aortic wall.

Aorta may be affected all over. Depending on the shape of the aneurysm distinguish:

• spindle-shaped - when the extension is formed throughout the vessel circumference;
• borrowed - Expansion only on the one hand.

Different sections of the vessel suffer from this pathology with different frequencies. Consider this on the example of the diagram.

Classification Aortic aortic aortic refers to stratifying aneurysms and takes into account localization pathological process. In total, there are three variants of the aorta bundle.

1. Type I.. Begins at the exit of the vessel from the heart, ends at the place of the yield of the shoulder arteries.
2. Type II.. It begins at the exit of the vessel from the heart, limited to the upward department.
3. Type III. It begins in the descending part of the aorta, ends in the field of leaving the left connector artery.

Separately, combined aneurysms, exciting both vessel departments - thoracic and abdominal.

According to the nature of the structure, true and false aneurysms are distinguished. With true, the protrusion of all layers of the vascular wall is observed. False is characterized by a protrusion of only the outer, connective tissue shell.

Causes

The aneurysm of the heart aorta may arise for several reasons:

1. Atherosclerosis. As a result of the sealing of the vascular wall and the destruction of atherosclerotic plaques, protrusion is formed. More often has a bagproof character and is localized in the abdominal part of the vessel.
2. Hereditary. It develops with such diseases such as Marfan or Ellers-Danlo syndrome. These pathologies are characterized by a violation of the development of connective tissue.
3. Syphilis. The tertiary period of syphilis causes the destruction of the connective tissue, in particular, in the aorta. The upward department is stronger.
4. Injury. This is a false aneuryism formed due to hematoma in the vascular wall after its injury.

Also, pathology can be caused by some system infections. For the causes of the disease include hypertensive disease, Nicotine abuse, burdened heredity.

Most often, the aneurysm of the abdominal aorta is observed. A typical patient for this pathology is a middle-aged man, overweight.

Clinical picture

Signs of aortic aneurysms depend primarily from its localization and size. The characteristics of the body have the value, the presence of concomitant pathology, lifestyle. Sometimes the disease proceeds asymptomatic and detected in medical examinations as a random find.

Table. Symptoms of aneurysm, depending on its location:

In such a state, as the aneurysm of the chest aorta, the symptoms are more pronounced than with the defeat of the abdominal department.

Stratifying

This is the most severe disease. It arises due to the defect of the inner shell of the vessel, the bundle causes blood pressure. A hematoma is formed in the thicker of the vascular wall. The initial part of the ascending department is usually affected.

If aortic aortic aneurysm occurred, symptoms are developing quickly. It is characterized by a state of sharply emerging and increasing chest pain. In the first hours there is an increase in blood pressure, then it decreases sharply. Pain sensations move as the stratification progressing.

Diagnostics

Diagnosis of pathology includes an objective examination of the patient and conducting instrumental diagnostics. Characteristic features are described in the Clinical Picture section.

ECG for aortic aneurysm looks like this:

• signs of expansion of the left ventricle;
• changing the shape of the ST segment;
• reducing the amplitude of all the keys of the cardiogram is a sign of the tamponads of the heart.

Such changes are observed not in all cases of the disease, and then, when there is an aneurysm of the thoracic part of the aorta torn.

Often, pathology is found randomly with an x-ray study of the chest or abdominal cavity. An aneurysmatic expansion of the ascending aorta looks like a protrusion along the vessel or a circular expansion.

Most accurately diagnose the disease allow computed tomography or aortography. The price of such studies is high enough, so they are carried out only to confirm the already intended diagnosis.

Treatment methods

How to treat aortic aneurysm? Tactics of treatment depends on the severity of the pathological process and the size of aneurysmatic expansion. With small formation, the absence of symptoms is carried out only dynamic observation, periodic consultations of the vascular surgeon and the ultrasound of the aorta.

Medical treatment is to appoint antihypertensive drugs, to reduce cholesterol. The main treatment is surgical intervention.

The operation is carried out according to the following testimony:

• the diameter of education is more than 4 cm;
• rapid growth of the aneurysm;
• progressive clinic pathology;
• breaking the vascular wall.

The last state is an indication of emergency surgical intervention. The operation lies in the embossing of the broken wall or excision of the affected area. If the aneurysm of the rising aorta is diagnosed, treatment is combined with the prosthetics of the aortic valve. A planned treatment consists in stenting the affected area.

Forecast

The disease is characterized by an unfavorable flow.

The high risk of death is associated with the development of severe complications:

• breaking the wall of the vessel;
• hemorrhagic shock;
• stroke;
• renal failure;
• grinding nervous plexuses.

Read more possible complications Tell a specialist in the video in this article. Preventive activities are regularly examined by the Cardiologist and Vascular Surgeon, it applies to people from risk groups.

Aortic aneurysm - severe pathology characterized by a high frequency of deaths. It meets infrequently - about 3% of all vascular pathologies. Reduce the frequency of adverse outcomes allows high-quality diagnosis and full treatment.

Questions to the doctor

Good day. Recently, I notice discomfort in the chest, frequent dizziness, increased fatigue. I know what happens in heart disease. I would like to more accurately find out what aortic aneurysm is and can my symptoms be signs of this disease?

Julia, 44 years old, Rostov

Good afternoon, Julia. Aneurysm is called the anticipation of the aorta wall, which leads to a violation of blood flow. The symptoms of this disease depends on the location of pathological education. Your complaints may be signs of both aneurysm and many other heart disease. Cardiologist will help you to establish the correct diagnosis.

It is possible in any section of the aorta, but more often at a distance of 5 cm from the aorta valve.

This emergency surgical or therapeutic pathology, mortality from which without treatment in the first year exceeds 90%. The bundle begins with the formation of intima break, the effect of blood flow dissets the middle shell in the longitudinal direction at different lengths. The predisposing factors are summarized in this section below.

Classification

There are three classifications of the disease - Debakes, Stepford and Descriptive. The aneurysms with the involvement of the ascending part and / or the aortic arc are believed exclusively to emergency surgical pathology, the bundle of the downward aorta is treated with therapeutic agents.

The cause of the aortic aneurysm

Atherosclerosis, marfan syndrome, heredity, ag, physical activity.

Pathogenesis. Initima gap, bundle of the aorta wall, the formation of a false move.

Classification. According to the classification of the debit, the aortic aneurysm is divided into three types.

Flow. Acute (85%) - hours, days; subacute - from several days to 2-4 weeks; Chronic - up to several months.

Symptoms and signs of aortic aneurysm

• Pain in the chest: Classically with a sudden start, very acute in character, the most often observed pain in the front of the chest with irradiation into the inter-opacker region. Typically, a pain of a tearing character appears, which, unlike them, is most pronounced at the very beginning. The pain that is most susceptible in the front of the chest is associated with the stratification of the ascending aorta, while pain in the inter-opumen area indicates the formation of aneurysm. Patients often describe this pain as "tearing", "tearing", "sharp", "piercing", "like a knife strike."
• Sudden death.
• Constant failure.
• Signs of occlusion. Examples include:

1. stroke or acute limb ischemia - due to compression or bundle;
2. paraplegia with sensitivity impaired - due to occlusion of the spinal artery;
3. Im - usually the right corverity artery;
4. renal failure and renovascular hypertension;
5. stomach ache.

• There is a non-worry education of the disease.
• It is purposefully collecting history about hypertension, former noise in the heart, diseases of the aortic valve, the previous radiographs of the chest for comparison are requested.

Intensive pain in the back, behind the sternum, in the inter-opacculent and the retper area.

Sudden death or shock, as a rule, due to acute aortic insufficiency or tamponade of the heart.

Constant heart failure due to acute aortic insufficiency and (or).

Signs of occlusion of one of the branches of the aorta: stroke, acute limb ischemia, it, the ventricle, kidneys.

The bundles of the aorta are divided into proximal (in the upstream) and distal. It is characterized by a sudden strong pain behind the sternum or in the heart area, irradiates along the aorta or its main branches in the back, the blades and along the spine.

Diagnostics of aortic aurated aneurysm

ECG often corresponds to the norm or there are nonspecific changes - the anomalies of the ST segment and the T. T.

Radiography of the chest may not differ from the norm. The rear projection can detect the expansion of the upper mediastinum, darkening or an increase in the aortic bulbs, an uneven contour of the aorta, separation (more than 5 mm) intima calcium from the outer outline of the aorta, the trachea shift to the left, expansion of the heart shade (pericardial effusion).

Echokg helps to identify the expansion of the aortic bulbs, reverse blood flow through aortic valve, pericardial effusion (tamponade).

Golden Standard in the diagnosis of aortic aortic aneurysm - MRI angiography. It provides accurate data on the entrance fields (exit) to the false move and on the disorder of the branches. However, the presence of metal valves, rhythm drivers refer to contraindications for MRI. Monitoring patients in an unstable state while in tomography is difficult and unsafe.

A new test using monoclonal antibodies to the heavy chains of myosin smooth muscle fibers allows you to accurately differentiate a sharp bundle from them.

Diagnostic criteria

1. A sharp sudden pain behind the sternum.
2. Sharp pallor of skin.
3. Expansion of the vascular beam (determined by percussion).
4. The presence of signs of atherosclerosis.
5. A history of arterial hypertension.

The differential diagnosis between the myocardial infarction and the aorta bundle is difficult due to the similarity of the clinical picture, the frequency of manifestations and the similarity of the contingent (the elderly with atherosclerosis and arterial hypertension).

The following is the differential diagnosis:

1. The pain in a heart attack is enhanced gradually, with aneurysm - a sudden attack of severe pain.
2. The irradiation of pain in a sparking aneurysis is more often in the back, along the course of the spine, which is not typical for the heart attack.
3. Aneurysm pain may be accompanied by anemia.
4. Characteristic signs of ECG and an increase in the activity of enzymes with myocardial infarction and their absence with aortic aneurysm.

It should be noted that with full breaking the aorta patients dying within a few minutes. In case of incomplete break, this period may increase.

Inspection

• Results may correspond to the norm.
• Most patients have hypertension. The hypotension is more characteristic for the bundle of the ascending aorta (20-25%) and develops due to bloodstures (which is sometimes accompanied by heart failure) or tamponada.
• Pseudo-hypotensia is observed when bleeding violating one or both plug-in arteries. During the examination, it is detected and documented by the component on the right and left hand of blood pressure, the presence of peripheral pulse. The absence of either a changing pulse indicates an increase in the exhaust aneurysm.
• With the help of auscultation, you can identify the lack of aortic valve and, at times, the noise of fridge friction. The alarming aneurysm of the downward aorta is sometimes breaking and expires to the left pleural cavity, the accumulation of the lung base is formed as a result.
• Neurological disorders arise due to stratification sleepy artery Or its compression (hemiplegia) or by occlusion of the spinal artery.

Research methods

General research methods

• Electrocardiographic features often comply with the norm or there are certain changes (left ventricular hypertrophy). It is purposefully differentiated with specific changes, characteristic of the acute it (the lower it is observed if the bundle affects the mouth of the right corvering artery).
• Radiography.
• Blood tests.

Diagnostic methods

• EchoCG: Trans-speaking study helps in determining the expansion of the bulbs of aorta, reverse blood flow through aortic valve and pericardia pay / tamponade. Catching School Echography - the method of choice, since it allows you to better assess the ascending and downward aorta, identify the location of the intima gap, the ratio of the farming of the crown arteries and the flap of the flap, and also provide information about the lack of aorta valve. The method is less acceptable to visualize the distal part of the rising aorta and the proximal arc.
• MRI angiography is considered the "gold standard".
• Spiral CT with contrast recreates a three-dimensional image of all the aortic segments and adjacent structures. The true and false clearance is recognized by various activists of the radiocontrase substance, observe the entry and exit sites under an intimal flap, as well as pleural and pericardial fluid. However, the method cannot demonstrate the discrepancy between the aortic valve flaps, which sometimes accompanies the bundle of the ascending part of the aorta.
• Angiography with the use of femoral or axillary access shows the changed blood flow in two lumens, the failure of the aortic valve, the involvement of the branches and the place of intima gap. The study relates to invasive, associated with an increased risk in a patient with its initially high probability of complications. The method is largely extruded by KT / MPT and perchive-vegetable echographs.

Choosing a diagnostic method

• The diagnosis must be confirmed or reject.
• Determine whether the bundle of a downward aorta is limited or affects the ascending part / arc.
• Set the length, place of entry and exit and the presence or absence of a thrombus.
• Reveal whether aortic insufficiency, the involvement of crown arteries or traffic pericardia.
• If possible, you first use perch-flow echography. The study is safe and provides all the information necessary for planning an operation.
• If the title method of ultrasound is unavailable or its results are inadequate, they perform a spiral CT with contrast.
• MRI is usually used for subsequent scanning.
• Angiography is rarely applied, but its results are valuable if other methods do not allow the diagnosis and / or additional information about the branched vessels is required.

States predisposing to the development of aortic aortic aneurysm

• Hypertension.
• Hereditary diseases of vessels.
• Inflammatory diseases of the vessels.
• Injury with a sharp stopping movement.
• Chest injury.
• Pregnancy.
• Yatrogenic reasons: catheterization, cardiac surgery.

Treatment of aging aneurysm aorta

When involving an upward aorta, emergency surgery and hypotensive therapy are shown. Patients with a downward aorta bundle first receive conservative therapy with strict control control. Encouraging results Shows endovascular stenting.

Stabilization of the patient's condition

• If the disease under consideration is suspected, the patient must be translated into a compartment in which the equipment for resuscitation activities is available in full.
• We establish venous access with the help of widespread catheters (for example, a gray Venflon brand catheter).
• Take blood for unfolded general analysis blood, the determination of urea and electrolytes and conducting cross-samples for compatibility.
• After confirming the diagnosis or the appearance of cardiovascular complications of the patient, the patient is transferred to the intensive care unit, they establish an intraarterial catheter (in the radial artery, if the plug-in arterry is not affected, in such cases, preference is given to femured access), the central venous catheter and the urinary catheter.
• To correct hell make immediate measures.
• Adequate anesthesia (intravenous diamphin 2.5-10 mg and metoclopramide 10 mg).

Plan of radical treatment

It depends on the type of bundle and its influence on the patient, but comes down to two basic principles:

1. Patients who are involved in rising aorta are subject to emergency surgery and hypotensive therapy.
2. Patients with a stratification, limited downward aorta, first receive conservative treatment with strict control of blood pressure. Nevertheless, these provisions may change in the near future thanks to the encouraging results of endovascular stenting.

Indications and principles of operations

1. The bundle of ascending aorta.
2. Outdoor gap (hemopericard, hemotorax., Effusion).
3. The involvement of exhaust arteries (limb ischemia, renal failure, stroke).
4. Contraindications K. conservative treatment (adverse reactions, lack of left ventricle).
5. Progression (continued pain, increase in hematoma in subsequent pictures, the disappearance of the pulse, the noise of fridge friction or aortic failure).

The goal of surgical treatment is the replacement of the ascending part of the aorta, which prevents the retrograde bundle and the tamponade of the heart (the main cause of death). Sometimes it is necessary to carry out reconstructive interference on the aortic valve, in the presence of structural anomalies (bikuspidal valve, marfan syndrome) perform prosthetics.

Indications and Principles of Conservative Tactics

Conservative treatment is the most preferred method of treatment in the case of:

• uncomplicated separation aneurysm type B;
• stable isolated aortic arc bundle;
• chronic (\u003e 2 weeks) stable bundle type V.

Treatment of all patients, with the exception of persons with hypotension, is primarily aimed at reducing systemic blood pressure and myocardial reductions. The main goal is to stop the spread of intramural hematoma and prevent the gap. Best criterion An adequate elimination of pain is considered. Strict bed regime in a quiet room is an indispensable condition.

Reduced blood pressure:

• Begin with the use of β-adrenoblockers (in the absence of contraindications) in order to reduce the heart rate to 60-70 per minute.
• After the pulse is reached, if the hell remains high, a vasodilator is added, such as sodium nitroprusside. Vasodilators in the absence of β-adrenobloclars sometimes increase myocardial reductions and increase rate (DP / DT). Theoretically named effect contributes to the spread of the bundle.
• For antihypertensive therapy, others use other traditional drugsRelated to blockers of slow calcium channels, α-adrenoblockers and ACE inhibitors.
• Patients with lack of aortic valve and stagnant heart failure is not recommended to assign funds that reduce the reduction of myocardium. To control the blood pressure, these patients use only vasodilators. Hypotension arises due to bleeding or tamponade of the heart.
• Hell is restored by fast intravenous infusion (ideally use of colloids or blood, but crystalloids can also be applied). The catheter for the pulmonary artery of Svaang-Ganz is used to monitor the pressure of the jamming and to control the volume of infusion therapy.
• If there are signs of aortic insufficiency or tamponads, it is necessary to conduct urgent echoch and consult with surgeons.

Emergency testimony and principles of endovascular interventions

Recently, more and more messages and descriptions of small series of cases appear, which indicate the favorable outcomes (prognostic and symptomatic) endovascular stenting in the treatment mainly of the bundles of the Aorta type B and to a lesser extent type A.

Based on modern data, endovascular stents should be considered as a way of insulation of the entrance to the false clearance and expanding the comprehensive lumen in the following situations:

• Unstable aurated aortic aortic aorta
• Syndrome of broken perfusion (proximal aortic stent and / or distal fencing / stenting of branched arteries).
• Planned treatment of stratification of type B (in the process of research). Heart Tamponade: If the patient's condition is relatively stable, pericardia puncture can cause a cardiovascular collapse, and therefore the procedure is not recommended. The patient must be accidentally delivered to the operating room for direct surgical recovery. Pericardiocentes is justified in the case of tamponades and electromechanical dissociation or pronounced hypotension.
• Long-term treatment: should include strict control over the level of blood pressure.

Forecast

• Mortality in the absence of treatment is approximately 20-30% in the first day and 65-75% for 2 weeks.
• If the bundle is limited to a downward aorta, short-term survival rate (up to 80%), but approximately 30-50% of patients, the bundle progresses, despite aggressive therapy, and indications appear to the operation.
• Operating mortality is about 10-25% and depends on the initial state before the start of intervention. Postoperative 5-year-old projected survival is up to 75%.