BMJ  2003;326:1135-1136 (24 May), doi:10.1136/bmj.326.7399.1135

Commentary

Cardiovascular management

Irene Lang, consultant cardiologist1

1 University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria irene.lang@univie.ac.at

The first 150 words of the full text of this article appear below.

In the United States each year, aortic dissection causes two deaths per 100 000 men and 0.8 deaths per 100 000 women.1 Predisposing factors include Marfan's, Ehlers-Danlos, and Turner's syndrome and mutation in the gene for type III collagen. The third trimester of pregnancy, bicuspid aortic valve (91% of dissected aortic aneurysms show bicuspid aortic valves2), coarctation of the aorta, arteritis, systemic lupus erythematosus, juvenile nephropathic nephrocalcinosis, Cushing's syndrome, and cocaine misuse are additional predisposing factors. Arterial hypertension, another common risk factor for aortic dissection, was mentioned by many respondents to the case.

The characteristic histological change in aortic dissection is cystic medial necrosis.2 Apoptosis of medial smooth muscle cells leads to microscopic gunshot-like holes in the medial layer. The most widely used classification of aortic dissection is that of Stanford, with type A being proximal aortic dissection and type B aortic dissection distal to the left subclavian artery. . . . [Full text of this article]


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