How dangerous is aortic dissection?

Medical news update July 19th: How dangerous is aortic dissection?

Aortic dissection is a rare but very dangerous condition (occurring in 5-30 cases per 1,000,000 people) (if left untreated, the mortality rate can reach 50% within the first 48 hours of onset).

When is aortic dissection necessary?

Mr. Ph., 40 years old, experienced severe back pain while driving. After numerous diagnostic tests, doctors discovered it was due to a rare condition called aortic dissection.

The risk of aortic dissection can be minimized by modifying risk factors such as lowering blood pressure to a target of 120/80 mmHg.

Previously, Mr. Ph. (residing in Hoc Mon District, Ho Chi Minh City) was taken to a nearby hospital complaining of pain between his shoulder blades, radiating to his chest between his sternum and both arms.

The pain gradually increased, accompanied by sweating and dizziness. He received emergency treatment for several hours but his condition did not improve, so he was transferred to another hospital.

According to Dr. Nguyen Thi Le Chi, from the Cardiology Department 1, Cardiovascular Center, Tam Anh General Hospital, Ho Chi Minh City, the patient's blood pressure upon admission was very high (219/103 mmHg), despite having no prior history of hypertension. He was given antihypertensive medication, which reduced his blood pressure to 180/100 mmHg, but he still experienced severe back pain.

Bedside echocardiography and aortic ultrasound showed good cardiac contractility, no valvular damage, and no pericardial effusion; the aorta was not dilated, but signs of dissection were difficult to assess due to the thickened chest wall.

An electrocardiogram and cardiac enzyme tests showed no signs of acute myocardial infarction. A chest X-ray revealed no pneumothorax, no cardiac enlargement, and mild aortic arch dilation. The emergency room physician suspected spinal pain and ordered an MRI of the spine, which revealed thoracic spinal degeneration.

Mr. Ph. was transferred to the Cardiology Department at the Cardiovascular Center due to a hypertensive crisis. The doctor prescribed painkillers for him.

Dr. Huynh Thanh Kieu, Head of Cardiology Department 1, Cardiovascular Center, Tam Anh General Hospital, Ho Chi Minh City, ordered cardiovascular tests. The results showed that the D-dimer index (which helps assess the presence of blood clots in blood vessels) was 13 times higher than normal, suggesting vascular pathology such as pulmonary embolism or aortic dissection.

Subsequent findings revealed a dissection of the aorta extending from the left subclavian artery down to the left common iliac artery, narrowing the blood vessels supplying the kidney. This was the reason the patient's blood pressure could not be lowered despite intensive treatment for many hours.

Transthoracic ultrasound imaging makes it difficult to accurately assess the aorta because it lies deep behind other structures in the chest cavity, and it is especially difficult to observe in patients with thick chest walls like Mr. Phan.

This can easily lead doctors to overlook pathologies related to aortic dissection. Without a very high D-dimer level and experience in diagnosing many similar cases, doctors would not suspect aortic dissection and would quickly proceed with a CT scan, failing to find an effective treatment plan for the patient.

Aortic dissection occurs suddenly when the endothelium tears, causing blood flow to be reduced in the true lumen and diverted into a false lumen, located between the endothelium and the media. At this point, blood flow to the body slows down or becomes blocked. Simultaneously, the aortic wall weakens and is at risk of rupture, leading to death.

Fortunately, Mr. Phan's aortic dissection has not caused any organ hypoperfusion complications, so stent graft placement is not yet indicated.

The patient received medical treatment with intravenous medication to control blood pressure and heart rate. After one day, his chest and back pain subsided, his blood pressure stabilized at 117/65 mmHg, and his heart rate was 70 beats/minute. He was closely monitored for vital signs and assessed for any potential damage to internal organs.

According to Doctor Kieu, aortic dissection is a rare condition (occurring in 5-30 cases per 1,000,000 people) but is very dangerous (if left untreated, the mortality rate can reach 50% within the first 48 hours of onset).

The disease can lead to serious complications: death from massive internal bleeding; organ damage, such as kidney failure or life-threatening necrotizing enterocolitis; stroke; damage to the aortic valve (acute aortic regurgitation) or hemopericardium causing acute cardiac tamponade.

Treatment for aortic dissection depends on the location and type of tear. Methods include medical treatment, surgical replacement of the stent graft, endovascular stent graft placement, and a combination of surgery and stent graft placement. After intervention, patients need lifelong monitoring to detect complications early.

The risk of aortic dissection can be minimized by modifying risk factors such as lowering blood pressure to a target of 120/80 mmHg with medication, changing diet, exercising regularly, managing stress, avoiding overweight and obesity, not smoking, avoiding accidents that cause chest trauma, and having regular health checkups or when abnormal symptoms appear.

Reduce the rate of malnutrition among children under 5 years old.

During the first six months of 2024, interventions aimed at reducing the number of children under 5 years old were implemented by the health sector.

The Department of Health and the Department of Education and Training are implementing an intervention model to prevent and control overweight and obesity in several primary schools in Hanoi, from 2023 to 2025, initially at La Thanh Primary School (Dong Da District), Nguyen Du Primary School (Hoan Kiem District), and Le Loi Primary School (Ha Dong District).

Recently, the health sector conducted a survey on knowledge and practices regarding nutrition and exercise among students at the three aforementioned primary schools. The survey revealed that 1460 children were overweight or obese.

Based on reviews and statistics gathered through surveys, the health sector will coordinate with the education sector to develop intervention solutions to gradually reduce the rate of overweight and obese children.

The first phase of the vitamin A supplementation campaign and micronutrient day activities in the city, such as weighing and measuring to assess the nutritional status of children under 5 years old, were organized in early June. Throughout the city, there were 1665 distribution points, and 379,495 out of 379,904 children aged 6-35 months received high-dose vitamin A supplementation, achieving a rate of 99.89%.

Regarding the assessment of malnutrition rates among children, 591,211 children under 5 years old were weighed and measured, achieving a rate of 95.07%. The results showed that the rate of underweight malnutrition was 6.6%, and the rate of stunting was 9.8%, meeting the targets set by the city.

Intervention activities to reduce the rate of malnutrition among children under 5 years old will continue to be implemented by the health sector in the coming period, including investigating and assessing the nutritional status of children under 5 years old and mothers with children under 5 years old in 60 clusters across the city.

Conduct community outreach, outreach at factories, enterprises, and industrial zones on nutrition during the first 1000 days of life and nutrition for children aged 2-5 years; organize the second phase of the Vitamin A supplementation campaign in 2024…

It is known that being overweight or obese causes many negative consequences for children's health, affecting their physical and intellectual development and increasing the risk of non-communicable diseases in adulthood. Overweight and obese children not only suffer from low self-esteem and feelings of inferiority, but also create significant pressure on their parents and caregivers. Some children have become withdrawn and depressed due to being overweight or obese.

A survey of 5,028 students in 75 schools in Hanoi, Ho Chi Minh City, Thai Nguyen, Nghe An, and Soc Trang showed that the overall rate of overweight and obesity among primary school students in both rural and urban areas was 29%; the rate of overweight and obesity was higher in urban students than in rural students (41.9% and 17.8%).

In particular, a survey of 5th-grade students in several districts of Hanoi, conducted in 2023, indicated that the number of overweight and obese children in many schools in the inner city exceeded 45%. Some schools had very high rates, such as Le Loi Primary School (Ha Dong district) at 49.5%; Tran Nhat Duat Primary School (Hoan Kiem district) at 51.4%; and La Thanh Primary School (Dong Da district) at 55.7%…

Source: https://baodautu.vn/tin-moi-y-te-ngay-197-boc-tach-dong-mach-chu-nguy-hiem-the-nao-d220350.html