Patient repos sharp shooting retrosternal pain progressing downward initially between scapulae and later to epigastric region. On examination he has feeble lower limb pulse compared to upper limbs. This is highly suggestive of-
Aoic dissection (AD) occurs when an injury to the innermost layer of the aoa allows blood to flow between the layers of the aoic wall, forcing the layers apa.In most cases, this is associated with a sudden onset of severe chest or back pain, often described as "tearing" in character. Also, vomiting, sweating, and lightheadedness may occurOther symptoms may result from decreased blood supply to other organs, such as stroke or mesenteric ischemia Aoic dissection can quickly lead to death from not enough blood flow to the hea or complete rupture of the aoa AD is more common in those with a history of high blood pressure, a number of connective tissue diseases that affect blood vessel wall strength including Marfan syndrome and Ehlers Danlos syndrome, a bicuspid aoic valve, and previous hea surgery. Major trauma, smoking, cocaine use, pregnancy, a thoracic aoic aneurysm, inflammation of aeries, and abnormal lipid levels are also associated with an increased risk.The diagnosis is suspected based on symptoms with medical imaging, such as computed tomography, magnetic resonance imaging, or ultrasound used to confirm and fuher evaluate the dissection.The two main types are Stanford type A, which involves the first pa of the aoa, and type B, which does not. Ref Davidson 23rd edition pg 431
Coarctation of aoa
Dissecting aneurysm of aoa
Peripheral vascular disease
Aooaeritis
C.V.S