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Managing blood pressure crucial for those with aortic dissection

DEAR MAYO CLINIC: My nephew was admitted into the hospital with severe chest and back pain and elevated blood pressure. After a CT scan, it was determined that he had a tear in the aorta but did not require surgery. He was placed on several blood pressure medications. How serious is an aorta tear? Will he able be able to lead a normal life if he keeps his blood pressure down?

Your nephew’s condition, more commonly called aortic dissection, is serious. But with proper medical management, he most likely will live a normal life.

It’s serious because the aorta, the largest artery in the body, is the main conduit of oxygenated blood from the heart. It ascends out of the left ventricle of the heart, arches over and descends through the chest and abdomen. It then divides into arteries that pass into the legs. The arteries to the kidneys and vital organs come off of the aorta.

In aortic dissection, a tear in the inner layer of the aorta causes the inner and middle layers to separate, sometimes affecting the entire length of the aorta. To help visualize the effect, imagine what happens to the layers of plywood when left out in the rain.

Aortic dissection is the result of a weakness in the aortic wall. When this occurs, the usual symptoms are the ones that your nephew experienced, sudden severe chest or upper back pain. Other symptoms can include fainting or shortness of breath.

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The condition is uncommon, affecting just 3 in 100,000 people each year. It most frequently occurs in men ages 40 to 70. The most common risk factor is uncontrolled high blood pressure. Sometimes, aortic dissection runs in families. Other risk factors include:

• Atherosclerosis (hardening of the arteries)

• Constriction of the aorta

• Marfan’s syndrome, a genetic disease where connective tissues in the body are weak

• Bicuspid aortic valves, where this heart valve has two leaflets to prevent the backflow of blood instead of the normal three

• Cigarette smoking

A tear that begins in the ascending portion of the aorta is a medical emergency and is repaired with immediate surgery. When a tear occurs in the descending aorta, blood pressure management usually is the recommended treatment and works for about two-thirds of patients. The rest may require surgical repair. When possible, stabilizing the aorta with blood pressure management is preferred, because surgery is risky. With emergent surgical repair, the risk of death is about 30 percent. With medical therapy, the risk of death is reduced to 10 percent.

Managing blood pressure reduces the stress and tension on the aortic wall, which allows the aorta to heal and strengthen. In addition to medication, lifestyle changes can help with blood pressure control. They include:

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• Maintaining an ideal weight

• Exercising regularly

• Following a low-salt diet

• Treating cholesterol levels

• Avoiding tobacco use

Not managing blood pressure can have serious consequences. The aorta will tend to expand, increasing the risk of an aneurysm, a balloon-like bulge in the artery that can rupture with deadly consequences. — Thoralf Sundt, M.D., Cardiovascular Surgery, Mayo Clinic, Rochester.

E-mail a question to medicaledge@mayo.edu or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207.

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