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Hypertension
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
The left ventricle slowly hypertrophies due to increased afterload, and diastolic dysfunction develops. Eventually, the ventricle dilates, resulting in dilated cardiomyopathy and heart failure from systolic dysfunction. This is often made worse by arteriosclerotic CAD. Hypertension often causes thoracic aortic dissection. Nearly all patients with abdominal aortic aneurysms have hypertension.
Cardiac Emergencies in Obstetrics
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Sanjeewa Rajapakse
Aortic dissection in pregnancy occurs most commonly in the third trimester and also in the early postpartum period due to the hyperdynamic circulation and hormonal effects on the vasculature. Oestrogen suppresses the synthesis of collagen and elastin, leading to a weakening of vascular walls. Systolic hypertension is a key factor in the causation of aortic dissection. This emphasises the importance of monitoring for and treatment of hypertension in pregnancy. The ascending aorta is the commonest site affected accounting for 65% of cases, followed by the descending aorta, aortic arch and abdominal aorta.
Cardiac conditions
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Aortic dissection is usually diagnosed by CT. A transoesophogeal ECHO or MRI may also be used. A rise in systolic BP, and/or with different blood pressures in each arm may be present3. Medical treatment to lower the blood pressure may be appropriate54, or repair by surgery may be necessary and a Caesarean section can be carried out at the same time2.
Prevalence and development of aortic dilation and dissection in women with Turner syndrome: a systematic review and meta-analysis
Published in Expert Review of Cardiovascular Therapy, 2023
F. Meccanici, J.W.C. de Bruijn, J.S. Dommisse, J.J.M. Takkenberg, A.E. van den Bosch, J. W. Roos-Hesselink
Regarding aortic dissection, we found a pooled incidence of 164 per 100.000 patient-years (95% CI 95–284) in TS women, markedly higher than the incidence in the general population ranging from 4.6 to 7.2 cases per 100.000 patient-years [51–53]. Our hypothesis was that in earlier published studies the incidence of aortic dissection might have been overestimated, due to selection of a more severe phenotype in previous time cohorts and increased awareness in later time cohorts. However, this was not confirmed by our sensitivity analysis excluding studies published before 2010. Even though most TS women are carefully monitored by multidisciplinary expert centers, aortic dissection remains associated with mortality in women with TS, greatly affecting their life-expectancy [52]. Interestingly, in the study by Yetman et al., a lack of surveillance by a cardiologist was associated with a higher incidence of vascular dissection in TS women [44]. This highlights the importance of regular follow-up by specialized health-care providers.
Exercise parameters for the chronic type B aortic dissection patient: a literature review and case report
Published in Postgraduate Medicine, 2021
Donald C. DeFabio, Christopher J. DeFabio
The patient’s report of onset of symptoms is consistent with aortic dissection. He recalls experiencing a sharp and sudden pain between his shoulders while paddling. The intensity of pain, as the patient states, was ‘like I never had before.’ The patient was rushed to an emergency department shortly after, where an initial diagnosis of an uncomplicated TBD, from just distal of the subclavian artery for approximately 6 cm with a closed lumen, was provided. After 2 weeks in cardiac intensive care (CIC) the patient was transitioned from intravenous anti-hypertensive therapy to oral medication. Soon after, a spontaneous elevation of his blood pressure caused the dissection to expand to the common iliac arteries bilaterally with a now patent lumen, as confirmed by computed tomography (CT) scan. After an additional two weeks in CIC his blood pressure was considered under control with oral medication and he was released from the hospital to home.
Numerical simulation of two-phase non-Newtonian blood flow with fluid-structure interaction in aortic dissection
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
Yonghui Qiao, Yujie Zeng, Ying Ding, Jianren Fan, Kun Luo, Ting Zhu
Aortic dissection is a serious hazardous cardiovascular disease in which blood enters the middle layer of the aortic wall through an entrance tear. This causes the layer to split, forming a “true lumen” (TL) and a “false lumen” (FL) (Wan Ab Naim et al. 2014). Currently, there is a lack of sufficient understanding of the pathogenesis and pathophysiological changes involved in aortic dissection. Detailed knowledge of flow-related variables such as wall pressure and wall shear stress (WSS) can provide better insight into the progression of aortic dissection, aid clinicians in tailoring treatment to individual patients, and optimize management of the disease. In the last several decades, many researchers have applied numerical approaches to obtain the hemodynamic parameters of aortic dissection (Sun & Chaichana 2016). Khanafer and Berguer (2009) found that the highest shear stress occurs in the medial layer, and this may contribute to the dissection. Tse et al. (2011) investigated blood flow in a pre-aneurismal aorta model and inferred that elevated TAWSS would extend the tear. Ab Naim et al. (2016) reported vortical structure in the FL and its interaction with WSS to predict thrombus formation.