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Aortic Dissection - Topic Overview

What is an aortic dissection?

Aortic dissection occurs when a small tear develops in the wall of the aorta camera.gif. The tear forms a new channel between the inner and outer layers of the aortic wall. This causes bleeding into the channel and can enlarge the tear. Aortic dissection is a life-threatening condition.

Aortic dissection can be caused by atherosclerosis (hardening of the arteries) and high blood pressure, traumatic injury to the chest, such as being hit by the steering wheel of a car during an accident, and conditions that are present at birth, such as Marfan's syndrome or Ehlers-Danlos syndrome.

What causes aortic dissection, and how can it be prevented?

The key point in prevention of aortic dissection is managing high blood pressure. Minimizing this and other risk factors for atherosclerosis greatly reduces the risk of aortic dissection.

Any one or any combination of the following may cause aortic dissection:

  • High blood pressure. Most patients with an aortic dissection have had high blood pressure for many years. The high blood pressure accelerates the natural processes of tissue aging and damage to the tissue, promoting a weakness of the aortic wall and increasing the risk for a tear.
  • Chest injury. Severe chest injury, such as might occur in an automobile accident, may also cause aortic dissection.
  • Diseases of the connective tissue. Either Marfan's syndrome or Ehlers-Danlos syndrome can damage the connective tissue in the middle of the aortic wall. This damage can lead to aortic dissection.
  • Other diseases. Certain diseases increase the risk of an aortic dissection. These include lupus, polycystic kidney disease, Cushing's syndrome, giant cell arteritis.

A family history of aortic dissection is also a risk factor.

Pregnancy can also increase the risk of a dissection. This risk is caused by the combination of hormonal effect on the tissue structure (elastin fibers) and additional high blood pressure stress.

Illegal drugs that raise blood pressure, such as cocaine, increase the risk of a dissection.

What are the symptoms of aortic dissection?

Pain is the leading symptom of aortic dissection. A person typically has a sudden onset of pain at the moment of dissection. The pain is usually described as ripping or tearing and as the worst pain ever experienced. It is usually in between the shoulders on the back and might radiate to the arms or the neck. Less frequently, the pain can be felt as chest pain. The pain is very difficult to distinguish from that of angina or a heart attack.

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