How is aortic dissection diagnosed?
Your doctor will
ask you questions about your symptoms, medical history, lifestyle, and family
medical history and do a physical exam. He or she may ask if you
have been hit hard in the chest or been in an automobile accident. Several
specialists may see you.
Your doctor will listen to your heart sounds
with a stethoscope, take your pulse and evaluate your circulation, and evaluate
your neurological status (nerve and brain function). As the symptoms of aortic
dissection mimic many other conditions, you may need several tests.
If you have an aortic
dissection, you may need:
- Blood tests. These tests can give your doctor
clues about what is causing your symptoms.
- An angiogram. This test can help your doctor know what the size of your
dissection is and if you have blood clots or other blood vessel
- Computed tomography scanning (CT) and
magnetic resonance imaging (MRI) to help your doctor
know if your dissection is growing.
- A transthoracic
echocardiography and transesophageal echocardiography
(TEE) to let your doctor look at blood vessels inside your
- An intravascular
ultrasound to get a better look at your blood
How is aortic dissection treated?
The treatment of
aortic dissection depends in part on where the dissection is located:
- Dissections involving the aorta where it goes
up from the heart (with or without the arch) are known as type A dissections
and are typically treated with surgery.
- Dissections involving the
rest of the aorta are known as type B dissections. If there are no
complications, type B dissections are typically treated with
Initial emergency treatment
Treatment for aortic dissection should
be started immediately following the diagnosis. The goal of initial emergency
treatment is to relieve pain and to reduce the blood pressure on the dissection
(reduction of the pulsatile load). This helps prevent additional bleeding and
reduces the risk of a rupture.
Typically, you are put immediately
in an intensive care unit (ICU) or taken to the operating room. Your doctor
will continuously monitor and control your blood pressure, pulse, and heart
Treating type A dissections
Typically, the first line of treatment for type A dissections
(dissection of the aorta involving the ascending aorta) is surgery.
The goal of the operation is to prevent death due to bleeding and to
reestablish blood flow into the extremities and inner organs (if branches of
the aorta are involved in the dissection process).
open-heart procedure, your chest is opened and the surgeon removes the part of
the aorta where the tear is found. The portion of the aorta removed can be
replaced with a man-made graft. Another approach
uses a similar graft that is placed inside the aorta. In this approach the
ascending aorta is not replaced but internally reinforced.