Showing papers in "Cardiovascular clinics in 1973"

Dissecting aneurysm of the aorta.

Abstract: IRST CLEARLY DESCRIBED more than 200 yr ago, ~ dissecting aneurysm may be defined as a deformity of the aorta resulting from an intramural hemorrhage. Its extension along the length of the aorta for variable distances is the characteristic which gives the lesion its name. Commonly, dissection extends into one or more of the primary branches of the aorta. Infrequently, isolated dissecting aneurysms arise outside of the aorta and have been observed in cerebral, 2 temporal, 3 coronary, 4 hepatic, 5 renal, 6 and other arteries. Currently, varying with the special interests of individual hospitals, dissecting aneurysms comprise as many as 23~o of aortic aneurysms, second only to the atherosclerotic variety. 7 According to Hirst and associates, 8 they are found in about one of every 10,000 general hospital admissions and once in every 363 autopsies. The peak incidence involves the years 40-69, although no age group is exempt. There is a two- to threefold prediliction for males but after the age of 80, the sex ratio is reversed. When allowance is made for differences in the prevalence of hypertension, no racial prediliction has been observed. Clinical Features In little more than a generation, the clinical recognition of dissecting aneurysm, once an untreatable rarity, has become commonplace and an urgent requirement of effective management. 8 Sudden onset of excruciating, sharp, tearing, persistent chest pain is most frequent. Subsequent axial or peripheral migration of pain is distinctive, especially if associated with pulse and/or pressure differences in the extremities and/or other evidences of transient or stable arterial obstruction. Hypertension is most commonly present. Should external rupture from the dissection channel supervene, signs and symptoms of massive hemorrhage, varying with the site, will be added to those already present and indeed may become predominant.