Not long after 2021 began a new chapter in the medical profession, several young doctors were tragically and suddenly killed.
Most of the causes of sudden death are cardiogenic, with aortic dissection among them.
What the hell is this disease that doctors can’t cure themselves?
But there is a particular type of aortic dissection, known in the medical community as a “suicide bomber,” known as the “king of bombs” : sudden death aortic dissection.
What is sudden death aortic dissection
As the thickest blood vessel in the human body, the wall of the aorta is mainly composed of three layers: the intima, the media and the adventitia.
Aortic dissection refers to a tear in the inner wall of the aorta, through which blood enters and separates the inner wall, media and adventitia of the aorta. Blood is retained between the three layers and gradually expands along the long axis of the aorta, forming a separation state of the true and false cavities of the aorta wall, which is called aortic dissection.
When the lesion is further aggravated, the blood accumulates more and more between the three layers of membrane, and finally breaks through to the outer membrane, and the blood flows out instantly. The person will die within a few minutes, because the disease has a high mortality rate, so it is called “human bomb”.
Not all aortic dissections cause sudden death, and some aortic dissections can enter a relatively stable chronic phase after prompt treatment.
Figure 1. Schematic diagram of aortic dissection
When the first opening of aortic dissection (i.e. the entrance) is much greater than the exit, or when there is no exit for the dissection, the flow velocity through the entrance into the false lumen is much greater than the flow velocity through the exit back to the true lumen of the aorta.
This causes a sudden increase in pressure in the false cavity and a break in the outer membrane, leading to sudden death.
There are also parts of ascending aorta dissection, even if the rupture is not large, but the pericardial blood, leading to tamponade, can also occur sudden death.
Who is at risk for sudden death aortic dissection
Aortic dissection is caused by two factors: high blood pressure and poor blood vessel quality.
High and poorly controlled blood pressure, fluctuating blood pressure, prone to aortic dissection.
The quality of blood vessels is poor, there are congenital Marfan syndrome, congenital vascular dysplasia, will make the blood vessels easy to rupture.
Aortic dissection is also prone to epigenetic factors such as arterial plaque or atherosclerosis.
The increased incidence of aortic dissection is associated with poor lifestyle, which includes the following four aspects.
(1) unhealthy diet
High – salt diet, excessive intake of sodium salt, taste overweight, is the diet of Chinese common disease.
High fat diet, high sugar diet, low dietary fiber diet, insufficient intake of fresh fruit, these unhealthy diets lead to hypertension, hyperlipidemia, diabetes, obesity, hyperuricemia, etc., which become the catalyst for the occurrence of cardiovascular diseases.
(2) Staying up late
With the fierce competition in modern society, working overtime and staying up late is almost the norm for many people.
Young people like nightlife, stay up late to surf the Internet, games and so on, day and night life is reversed, but also aggravate the circulation system burden of bad factors.
(3) Smoking and drinking
It is well known that smoking hurts the lungs, but smoking is sad but not understood by many people.
In fact, in addition to the harmful substances in the respiratory tract, but also on the circulatory system, cause vascular endothelial proliferation, resulting in vascular plaque instability, thereby inducing the occurrence of cardiovascular events.
Alcohol is also one of the harmful factors that induce the occurrence of cardiovascular events.
(4) Hypertension does not take medicine in a standard way
The incidence of adult hypertension in China is as high as 20%, and many hypertension patients have some misunderstandings in understanding: no symptoms can not take medicine;
Hypertensive drugs to eat more drug resistance;
Take medicine for high blood pressure. There is no need to monitor blood pressure.
It is not good to take hypertensive drugs too much, usually think of eating, forget even.
It is precisely because of these misconceptions about taking medication for hypertension that hypertension complications such as aortic dissection occur.
Although medical staff understand these, due to the particularity of their profession and the relative shortage of medical staff in China, it is normal for medical staff to work overtime and stay up late, and work pressure is heavy, which makes them prone to such fatal cardiovascular diseases.
CT imaging changes of sudden death aortic dissection
When CT or CTA imaging changes in patients with aortic dissection have the following, attention should be paid to timely treatment to avoid sudden death and other catastrophic consequences.
(1) Ascending aortic dissection with diameter greater than 6 cm Figure 2 Ascending aortic dissection with diameter greater than 7 cm combined with large laceration (red asterisk)
(2) Massive pericardial effusion Figure 3 Dissection of descending aorta involving the distal aortic arch with massive pericardial effusion (red asterisk)
(3) Enlarged pseudoslumen of descending aorta and/or combined with massive pleural effusion Fig. 4 Enlarged pseudoslumen of descending aorta dissection (red asterisk) Fig. 5 Enlarged pseudoslumen of descending aorta dissection and blood flow from the pseudoslumen ruptured into the right thoracic cavity (red arrow)
It is accompanied by a large pleural effusion on the right (red asterisk)
Fig. 6 Blood flow from the true lumen of descending aorta dissection enters the false lumen through the rupture (shown by red arrow)
At the same time, blood flow from the false lumen again passed through the incision into the third lumen (black arrow). Fig. 7 Dissection of the descending aorta, except for the true lumen (red arrow)
The remaining three are false lumens (indicated by the red asterisk).
Figure 8 Descending aortic dissection (red arrow) with periaortic hematoma (red asterisk)
In this case summary
- Aortic dissection is an acute cardiovascular disease, so timely diagnosis and early treatment are critical.
- Special Types of Sudden Death in Aortic Dissection Aortic dissection is prone to sudden death in patients, and early identification of related signs is important.
Expert Profile Zheng Zhi
Zheng Zhi, Associate Chief Physician, Department of Cardiac and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, MD, Frankfurt University, Germany.
American College of Cardiology (ACC) International Affiliate Member;
Member of Thoracic Aorta Committee, China Branch, International Union of Vessels (IUA);
Member, Asian Society of Cardiovascular and Thoracic Surgery (ASCVTS);
Member of World Association of Chinese Physicians (WACD);
Member, Vascular Medicine Committee, Chinese Association of Research Hospitals;
Member of Chest Pain Committee of China Medical Education Association;
He proposed the concept of minimally invasive endovascular treatment of type A aortic dissection and individualized treatment of aortic dissection “guided by medical humanistic care”, and advocated “medical innovation, humanistic innovation and popular science innovation” in the treatment of acute cardiovascular critical diseases. He has published more than 30 medical papers in international journals (SCI) and domestic journals.