Aortic dissection risk factors: Difference between revisions
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== Risk Factors == | == Risk Factors == | ||
* [[Aging]] | * [[Aging]]. The highest incidence of aortic dissection is in individuals who are 50 to 70 years old. | ||
* [[Atherosclerosis]] and its associated risk factors like [[diabetes]] | * [[Atherosclerosis]] and its associated risk factors like [[diabetes]] | ||
* [[Bicuspid aortic valve]] is present in approximately 7%-14% of patients. These individuals are prone to dissection in the [[ascending aorta]]. The risk of dissection in individuals with bicuspid aortic valve is not associated with the degree of [[aortic stenosis|stenosis]] of the valve. | * [[Bicuspid aortic valve]] is present in approximately 7%-14% of patients. These individuals are prone to dissection in the [[ascending aorta]]. The risk of dissection in individuals with bicuspid aortic valve is not associated with the degree of [[aortic stenosis|stenosis]] of the valve. | ||
* [[Chest trauma]]. Chest trauma leading to aortic dissection can be divided into two groups based on etiology: blunt chest trauma (commonly seen in car accidents) and [[iatrogenic]]. Iatrogenic causes include trauma during [[cardiac catheterization]] or due to an [[intra-aortic balloon pump]]. | |||
* [[Cocaine abuse]] | * [[Cocaine abuse]] | ||
* [[Coarctation of the aorta]] | * [[Coarctation of the aorta]] | ||
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* [[Giant cell arteritis]] | * [[Giant cell arteritis]] | ||
* [[Heart surgery]] particularly [[aortic valve replacement]]; 18% of individuals who present with an acute aortic dissection have a history of open heart surgery. Individuals who have undergone [[aortic valve replacement]] for [[aortic insufficiency]] are at particularly high risk. This is because [[aortic insufficiency]] causes increased blood flow in the [[ascending aorta]]. This can cause dilatation and weakening of the walls of the [[ascending aorta]]. | * [[Heart surgery]] particularly [[aortic valve replacement]]; 18% of individuals who present with an acute aortic dissection have a history of open heart surgery. Individuals who have undergone [[aortic valve replacement]] for [[aortic insufficiency]] are at particularly high risk. This is because [[aortic insufficiency]] causes increased blood flow in the [[ascending aorta]]. This can cause dilatation and weakening of the walls of the [[ascending aorta]]. | ||
* [[Hypertension]] is seen in 71-86% of patients | * [[Hypertension]] is seen in 71-86% of patients. It occurs most frequently in those with type III dissection. | ||
* [[Marfan’s syndrome]] is present in | * [[Marfan’s syndrome]] is present in 5%-9% of patients. In this subset, there is an increased incidence in young individuals. Individuals with Marfan syndrome patients are more prone to proximal dissections of the aorta. | ||
* [[Pseudoxanthoma elasticum]] | * [[Pseudoxanthoma elasticum]] | ||
* [[Turner's syndrome]] | * [[Turner's syndrome]] | ||
* [[Tertiary syphilis]] | * [[Tertiary syphilis]] | ||
* [[Third trimester of pregnancy]] | * [[Third trimester of pregnancy]]. Half of dissections in females before age 40 occur during [[pregnancy]] (typically in the 3rd trimester or early [[postpartum]] period). | ||
* [[Vasculitis]] ([[inflammation]] of an artery) is rarely associated with aortic dissection. | |||
==Age== | |||
The highest incidence of aortic dissection is in individuals who are 50 to 70 years old. Half of dissections in females before age 40 occur during [[pregnancy]] (typically in the 3rd trimester or early [[postpartum]] period). | |||
==Gender== | |||
The incidence is twice as high in males as in females (male-to-female ratio is 2:1). | |||
[[ | [[Turner syndrome]] also increases the risk of aortic dissection, by aortic root dilatation<ref>[http://www.ncbi.nlm.nih.gov/sites/entrez?Db=PubMed&Cmd=ShowDetailView&TermToSearch=17055808&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum Increased maternal cardiovascular mortality associated with pregnancy in women with Turner syndrome.]</ref>. | ||
== References == | == References == | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 17:56, 19 August 2012
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Aortic dissection Microchapters |
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Diagnosis |
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Treatment |
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Special Scenarios |
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Case Studies |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Aging, atherosclerosis, diabetes, hypertension and trauma are common risk factors for aortic dissection. Uncommon risk factors include Bicuspid aortic valve, cocaine, Coarctation of the aorta, Cystic medial necrosis, Ehlers-Danlos syndrome, Giant cell arteritis, Heart surgery, Marfan’s syndrome, Pseudoxanthoma elasticum, Turner's syndrome, Tertiary syphilis and the third trimester of pregnancy.
Risk Factors
- Aging. The highest incidence of aortic dissection is in individuals who are 50 to 70 years old.
- Atherosclerosis and its associated risk factors like diabetes
- Bicuspid aortic valve is present in approximately 7%-14% of patients. These individuals are prone to dissection in the ascending aorta. The risk of dissection in individuals with bicuspid aortic valve is not associated with the degree of stenosis of the valve.
- Chest trauma. Chest trauma leading to aortic dissection can be divided into two groups based on etiology: blunt chest trauma (commonly seen in car accidents) and iatrogenic. Iatrogenic causes include trauma during cardiac catheterization or due to an intra-aortic balloon pump.
- Cocaine abuse
- Coarctation of the aorta
- Cystic medial necrosis
- Deceleration trauma most commonly causes aortic rupture, not dissection
- Ehlers-Danlos syndrome
- Giant cell arteritis
- Heart surgery particularly aortic valve replacement; 18% of individuals who present with an acute aortic dissection have a history of open heart surgery. Individuals who have undergone aortic valve replacement for aortic insufficiency are at particularly high risk. This is because aortic insufficiency causes increased blood flow in the ascending aorta. This can cause dilatation and weakening of the walls of the ascending aorta.
- Hypertension is seen in 71-86% of patients. It occurs most frequently in those with type III dissection.
- Marfan’s syndrome is present in 5%-9% of patients. In this subset, there is an increased incidence in young individuals. Individuals with Marfan syndrome patients are more prone to proximal dissections of the aorta.
- Pseudoxanthoma elasticum
- Turner's syndrome
- Tertiary syphilis
- Third trimester of pregnancy. Half of dissections in females before age 40 occur during pregnancy (typically in the 3rd trimester or early postpartum period).
- Vasculitis (inflammation of an artery) is rarely associated with aortic dissection.
Age
The highest incidence of aortic dissection is in individuals who are 50 to 70 years old. Half of dissections in females before age 40 occur during pregnancy (typically in the 3rd trimester or early postpartum period).
Gender
The incidence is twice as high in males as in females (male-to-female ratio is 2:1).
Turner syndrome also increases the risk of aortic dissection, by aortic root dilatation[1].