Bicuspid aortic valve:
Previous heart surgery, including aortic valve replacement surgery:
Connective tissue disorders:
Aortopathy:
Aging:
Blunt trauma:
Infectious or inflammatory conditions:
Cocaine:
Atherosclerosis:
Cocaine affects the connective tissue and has the ability to produce abrupt and severe hypertension. The differential of “cocaine chest pain” should always include aortic dissection.
Prior surgical interventions on the aorta weaken the blood vessel wall in some cases, resulting in an abnormal dilatation of the aorta with the risk of dissection.
As noted earlier, certain diseases, such as Marfan, and Ehlers- Danlos, affect the media of the aorta and make it prone to dissection. Pulsatile flow and high blood pressure contribute to the propagation of the dissection.
In one study, the probability of type A dissection increased gradually at a sinus diameter of 5.0 cm (from 4.1% to 13% at 7.2 cm) and then increased steeply at an ascending aortic diameter of 5.3 cm (from 3.8% to 35% at 8.4 cm). [1] Thus, early prophylactic ascending aortic replacement is recommended in patients with bicuspid aortic valve with aortas larger than approximately 5.0 cm.
Aortopathy can be present in heritable diseases such as Marfan, Ehlers-Danlos, anuloaortic ectasia, familial aortic dissections, adult polycystic kidney disease, Turner syndrome, Noonan syndrome, osteogenesis imperfecta, bicuspid aortic valve, and coarctation of the aorta. It is also seen in metabolic disorders such as homocystinuria and familial hypercholesterolemia.
Infectious conditions can lead to a vasculitis that affects the vaso vasorum or the small arteries that supply blood to the layers of the aortic wall.
Approximately 75% of dissections occur in those aged 40-70 years, with a peak age of 50-65 years.
The proximal descending aorta is the area most commonly involved in blunt trauma, due to its relative mobility over the fixed abdominal aorta, which is held in place by the ligamentum arteriosum.
The formation of atherosclerotic lesions can weaken and cause tears within the intima layer, serving as a risk factor for aortic dissection.
