What is Aorta Dissection?

Long Term Care Columnist / Guide · Sep 12, 2003

Aortic dissection is something like having the aorta come "unzipped", which of course causes massive internal bleeding. Longstanding high blood pressure can cause it, as can traumatic injury. Some of the symptoms are severe, "tearing" pain in the chest, confusion, shortness of breath and loss of consciousness. Unfortunately, the mortality rate is high---as many as 50% of people with this condition die within 48 hours of onset. A patient's chances of survival vary with the location of the tear in the aorta---the closer to the heart, the worse the odds. In any case, they have to use grafts to repair the aorta, it's not like they can sew it up again and call it good.

Very sad about John Ritter.

renerian, BSN, RN · Sep 12, 2003

I know it is very sad. I will miss his smile and wit.

renerian

Surgical Hrt RN · Sep 13, 2003

An Aortic Dissection is a tear in the aorta. Usually it is related to the same things that cause heart disease, and it carries a VERY high mortality rate. There are 2 types of dissections, Type I and Type II also known as Type A and Type B. Type I is a dissection that occurs at the level above the diaphragm and usually the tear goes all the way into the aortic valve. Type II is below the diaphragm and usually requires more of an abdominal surgery then a heart surgery.

These dissections are usually undetectable and happen rather suddenly. One of the nurses that I work with is 54. He was at Bally's Gym and was swimming in the pool. He got and out and said he "felt funny", then passed out. They rushed him to the hospital that we work at and worked him up in the ER. He was diaphoretic, gray, aneuric and close to death. Our surgeons rushed him into the OR. He had torn all the way down to the renal arteries. Luckily, he survived. They had to replace his valve and almost his whole aorta. Just this past weekend he came back to work. He is a living, walking miracle.

passing thru · Sep 13, 2003

Thanks for the post and great replies. I love to learn on this BB. So easy, compared to a book . and doing one's own research.

So much better to hear it from experienced nurses in the trenches.

I'll miss John too.

I'm a 3's company rerun fan.

healingtouchRN · Oct 4, 2003

me & another co-worker were bathing a comatose pt when "three's company" came on & we both commented on how much we loved John Ritter & how funny he was on the show. I really loved him in "SlingBlade"! We heard 15 minutes later that he & Johnny Cash had crossed over........gave me chills. Two really talented men, passing out of our time. :rolleyes:

Gracious · Feb 7, 2004

Hi ,

Is there any care protocol out there for care of the pre-op patient with aortic dissection? Any experience or current standard of practice? Should pt have a dissection, would it make any difference if BP is taken from Right or Left arm?:)

Gracious

kevro1013 · Feb 9, 2004

Actually, Bilateral BPs are a good idea when assessing for a AAA, greater than 20mm hg difference can be a significant finding.

rshores95 · Feb 21, 2004

An Aortic Dissection is a tear in the aorta. Usually it is related to the same things that cause heart disease, and it carries a VERY high mortality rate. There are 2 types of dissections, Type I and Type II also known as Type A and Type B. Type I is a dissection that occurs at the level above the diaphragm and usually the tear goes all the way into the aortic valve. Type II is below the diaphragm and usually requires more of an abdominal surgery then a heart surgery.
These dissections are usually undetectable and happen rather suddenly. One of the nurses that I work with is 54. He was at Bally's Gym and was swimming in the pool. He got and out and said he "felt funny", then passed out. They rushed him to the hospital that we work at and worked him up in the ER. He was diaphoretic, gray, aneuric and close to death. Our surgeons rushed him into the OR. He had torn all the way down to the renal arteries. Luckily, he survived. They had to replace his valve and almost his whole aorta. Just this past weekend he came back to work. He is a living, walking miracle.

Interesting, I always thought, and I'm pretty sure I'm right on this, that you classify three types (or use the A,B system)

Type I-Includes part of the ascending and descending aorta. This is the most severe type. Often these start at the Aortic root and go all the way down to past the mesenteric. Sometimes they include the carotids!.

Type II-Ascending aorta only

Type III-Descending aorta only

Does anyone else have a different understanding?

Gracious · Feb 23, 2004

Hi there,

I think there are two different types of classifications. The Stanford classification differs from DeBakeys. It depends on which one you are familiar with. Ussually, De Bakey's is more popular (type 1,2,3) as compared to Standford(type A, B). You can actually look it up on the internet.

Type 1- involves asc and dec aorta

Tpye 2 - Asc aorta only

Type 3 - Dec aorta only

Thanks for sharing about taking BP on both arms. I guess it's difficult to have a standard nursing protocol and I'm not sure if any one has it for aortic dissection as it really depends on the site of dissection, right? Anyway, I was asked to sort of talk abt this subject and to propose a protocol.

What do you think abt taking pedal pulses or having a circulation chart for lower limbs?