Aortitis
The content of the article:
- Causes and risk factors
- Forms
- Symptoms
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
Aortitis is a disease in which the walls of the aorta become inflamed (aortitis, from the Greek aortē - "aorta" and Latin -itis - the ending indicating the presence of inflammation).
Both the inner, middle and outer layers of the aorta can be affected in isolation (we are talking about endaortitis, mesaortitis, periaortitis, respectively), and the entire thickness of the vascular wall (panaortitis). In addition to the aorta itself, the aortic valve, the orifices of the coronary arteries, and adjacent adipose tissue can be involved in the pathological process.
A characteristic pathological picture of the disease: the inner lining of the vessel is thickened, deformed, the walls are overstretched and sclerosed, the elastic component is replaced by connective tissue. Due to the death of elastic fibers, the vessel wall can transform into an aneurysmal sac, which in severe cases exfoliates or ruptures. The altered inner wall of the aorta is often covered with thrombotic masses.
The thoracic and abdominal aorta is equally likely to be involved in the inflammatory process.
Aortic dissection - a complication of aortitis
Causes and risk factors
Aortitis rarely occurs as an independent disease: more often it is a manifestation of systemic vascular pathology, connective tissue, or an infectious process.
The main diseases and conditions that cause aortitis:
- Takayasu's aortoarteritis (Takayasu's disease);
- giant cell arteritis;
- ankylosing spondylitis (ankylosing spondylitis);
- recurrent polychondritis (systemic chondromalacia);
- bacterial endocarditis;
- psoriatic arthritis;
- tuberculosis;
- Reiter's disease;
- syphilis;
- Rocky Mountain spotted fever (tick-borne rickettsiosis of America);
- deep mycoses;
- sepsis;
- medionecrosis of the aorta;
- Kogan's syndrome.
Forms
Depending on the cause, the following forms of aortitis are distinguished:
- infectious (syphilitic, non-specific infectious);
- allergic (autoimmune, infectious-allergic, toxic-allergic).
By the nature of the course, aortitis is:
- acute (purulent, necrotic);
- subacute (often develops with bacterial damage to the inner endothelial layer);
- chronic.
Symptoms
The main symptoms of aortitis, which are common to various provoking pathological conditions, are:
- impaired blood circulation in the branches of the aorta extending from the affected area, as a result - ischemia and hypoxia in the organs and tissues supplied by them;
- pain of varying intensity (from monotonous non-intense pressing to acute, unbearable nature), different localization, which depends on the level of damage to the aortic trunk (behind the sternum, in the abdominal cavity, in the lumbar region, with irradiation to the adjacent anatomical zones);
- systolic murmur over the affected area of the aorta;
- severe weakness, intolerance to the usual physical exertion, chills, cold extremities.
For some aortitis, in addition to general ones, a number of specific features are distinguished.
Localization of pain in aortitis depends on the level of damage to the aortic trunk
Syphilitic aortitis:
- occurs in the period from 5 to 25 years from the moment of infection (specific anamnesis);
- there are no complaints for a long time;
- clinical manifestations are associated with aortic valve insufficiency, ischemia of the heart's own tissues (ischemic heart disease, coronary artery disease);
- the main complication is aneurysm (the most common cause of death in such patients).
Nonspecific infectious aortitis:
- develops against the background of a previous acute illness;
- more often provoked by Staphylococcus aureus;
- there is a fever of unknown etiology;
- the course is fast, malignant.
Aortitis accompanying Takayasu's disease:
- slow progression;
- women suffer more often than men (ratio 8: 1);
- debut at the age of 15-30;
- hereditary predisposition;
- beginning with nonspecific general symptoms (fever, weakness, malaise, weight loss, arthralgia);
- weakening of the pulse in one or both radial arteries, up to its complete disappearance, accompanied by weakness and paresthesia of the upper limbs;
- more than half of the patients have a complication of arterial hypertension.
Tuberculous aortitis:
- there is a clear connection with tuberculosis in the anamnesis;
- there are signs of tuberculosis of organs adjacent to the aorta (lymph nodes of the mediastinum, lungs, spine);
- the walls of the aorta are affected by specific granulations with caseous (necrotic) foci;
- ulceration of the inner lining of the vessel, intramural calcium deposition are observed.
Diagnostics
Patients go to the doctor with complaints of a characteristic pain syndrome, a spontaneous rise in body temperature to high levels, general malaise, chills, weakness.
To establish a diagnosis, carry out:
- general blood test (a sharp unmotivated acceleration of ESR, an increase in the number of leukocytes is established);
- biochemical blood test (markers of inflammation, C-reactive protein are determined);
- serological examination for suspected syphilitic process;
- sowing arterial blood on a nutrient medium to exclude (confirm) an active bacterial process;
- Ultrasound examination of the aorta (changes in diameter, ulceration, the presence of foci of calcification in the wall, pathology of the aortic valve, reverse blood discharge are detected);
- Doppler scan (decreased blood flow);
- aortography;
- radiography.
Ultrasound of the aorta reveals foci of calcification, change in diameter, manifestation, pathology of the aortic valve in aortitis
Treatment
Treatment is aimed primarily at eliminating the cause of aortitis, relieving painful symptoms (pain, circulatory disorders) and consists in prescribing:
- antibiotics;
- immunosuppressants;
- anti-inflammatory drugs;
- analgesics.
With an aneurysm of the aorta, its dissection, damage to the mouths of the arteries departing from it, surgical treatment is indicated: resection of the affected segment with prosthetics. With nonspecific aortoarteritis, the operation is preferable to perform after the relief of acute inflammation.
Possible complications and consequences
The main complication of aortitis is the formation of an aortic aneurysm with its subsequent dissection or rupture.
In addition, the following complications are common:
- insufficiency of the aortic valve;
- stenosis of the coronary arteries, as a result - ischemic heart disease;
- acute, chronic heart failure;
- myocardial infarction;
- acute violation of cerebral circulation;
- acute, chronic renal failure;
- thromboembolism;
- sudden cardiac death.
Forecast
The prognosis depends on the timeliness of the diagnosis and initiation of therapy for the disease. In uncomplicated aortitis, the prognosis is generally favorable. If the process involves arteries that supply blood to the heart tissue, or aortic valve insufficiency develops, the prognosis worsens and depends on the severity of valve damage, the intensity of cardiosclerosis, and the type and stage of heart failure. The prognosis is especially unfavorable when an aortic aneurysm occurs, although in this case it is not the same in different patients, which is due to the nature, location and size of the aneurysm.
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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
