Heart Disease and Diabetes in 3D

Aortic Dissection

What Is an Aortic Dissection?

An aortic dissection is an emergency with your aorta, which is the largest blood vessel in your body and the main artery that takes blood from your heart to the rest of your body.

In an aortic dissection, the inner layer of the aorta tears, letting blood in where it usually doesn’t go. This causes the inner and middle layers to separate, or dissect. If blood bursts through the outer wall of your aorta, it’s life threatening and needs immediate repair.

Types of Aortic Dissection

There are two kinds of aortic dissections. The difference is where the dissection is located.

Type A. This is the more common of the two, and more dangerous. The tear happens in your upper aorta, which is also called the ascending aorta. It can extend into your abdomen (your belly) or in the area where the aorta leaves your heart.

Type B. This is a tear in your lower, or descending, aorta. It, too, may reach into your abdomen.

Aortic Dissection Symptoms

The signs of aortic dissection can be similar to those of other diseases. Or you could feel like you’re having a heart attack. But some people don’t have any pain.

The most common symptoms are:

  • Shortness of breath
  • Loss of consciousness
  • A weaker pulse in one arm than the other
  • Fever
  • Fainting or dizziness
  • Pale skin
  • Nausea
  • Heavy sweating
  • Sense of doom
  • Sudden, severe upper back or chest pain (often described as a “tearing” sensation from the neck down the back)
  • Sudden, severe belly pain
  • Leg pain
  • Mild neck, jaw, or chest pain
  • Sudden trouble speaking
  • Loss of vision
  • Paralysis or weakness on one side of the body, much like a stroke
  • Tingling, numbness, or pain in the toes or fingers
  • Trouble walking

When to call 911: If you, or someone you love, has any of these symptoms, call 911 right away. An aortic dissection can lead to internal bleeding and organ and heart damage.

Stay as calm as possible. Sometimes these symptoms don’t mean there’s a serious medical problem. They can happen for other reasons. But you need to find out right away, so make the call.

Aortic Dissection Causes and Risk Factors

Aortic dissections happen in places where your aortic wall is weak. Over time, high blood pressure can weaken your aortic tissue.

Sometimes the weakness is from a condition you’re born with that affects the strength or size of your aorta. Marfan syndrome is one example.

In rare cases it results from a traumatic injury to the chest, like you’d get in a car accident.

Who’s at risk: Aortic dissections most often affect men between the ages of 60 and 80. Men are twice as likely to have an aortic dissection as women. Other things that make an aortic dissection more likely include:

  • Hardening of the arteries, or atherosclerosis
  • High blood pressure, or hypertension, that isn’t under control
  • A pre-existing bulging or weakened artery
  • A bicuspid aortic valve (a valve with two leaflets)
  • An aorta that’s narrowed at birth, a condition called aortic coarctation
  • Smoking

Certain genetic diseases also seem to increase your odds of having an aortic dissection, including:

  • Turner’s syndrome. Caused by a lack of one X chromosome, this condition only affects women. Among other things, it can cause high blood pressure and heart problems.
  • Connective tissue disorders like Marfan syndrome, Ehlers-Danlos syndrome, and Loeys-Dietz syndrome. They can lead to weakened blood vessels.
  • Some inflammatory conditions, such as giant cell arteritis and syphilis, which can also affect your blood vessels.

Using cocaine, being pregnant, and even high-intensity weightlifting can raise your chances of having an aortic dissection. It’s mostly likely if you already have a history of blood pressure or blood vessel problems.

Aortic Dissection Diagnosis

If your doctor spots an aortic dissection early, you have a greater chance of being able to be treated. Most of the time this life-threatening condition happens suddenly (doctors will call it acute) and you get diagnosed in the emergency room.

Exams and tests

The doctor will ask about your medical history and check for abnormal heart sounds. They’re listening for a swishing sound, or murmur, which signals a leaky aortic valve. They’ll also check the blood pressure in your arms to see if one is different from the other. If it is, that means the aortic dissection has cut off blood flow to one of your arms.

Continued

You’ll need imaging tests to make sure you have an aortic dissection. The doctor may use one or more of these:

  • X-ray. It takes pictures of your heart, lungs, and aorta to see if your aorta is widening. This can be a sign of dissection.
  • CT scan. This test shows a cross-section of your chest and belly. Doctors use it to check the location and size of an aortic dissection.
  • Transesophageal echocardiogram. This test uses sound waves to create images of your heart.
  • Magnetic resonance imaging (MRI). It gives the doctor a cross-section view of your aorta.
  • Magnetic resonance angiogram (MRA). This will show the doctor how the blood is flowing in your aorta and blood vessels.

Your doctor may also do blood tests like a complete blood count (CBC). Results can show if your system is under stress or if the dissection is leaking or had ruptured.

Aortic Dissection Treatment

Depending on the part of the aorta involved, the doctor may treat aortic dissection in one of two ways:

Medications

These can include beta-blockers and sodium nitroprusside (Nitropress), which will help lower your blood pressure and heart rate.  Medication is the same whether you have type A or type B.

The doctor may also ask for follow-up scans to monitor your heart and prescribe medicine to relieve pain.

Surgery

The type of surgery depends on the type of aortic dissection:

Type A: The surgeon will remove as much of the dissected aorta as possible and rebuild it with a manmade tube called a graft. They’ll also repair any leaks in the aortic valve and place the valve in the new graft.

Type B: The surgeon will use the same graft procedure as in type A. But for a more complicated repair, they might add a stent. This is a sort of wire mesh support for the aorta.

Aortic Dissection Complications

Even after you repair an aortic dissection with surgery, you could still have problems such as:

  • Heart attack
  • Respiratory failure
  • Kidney failure
  • Stroke
  • Paralysis
  • Lung infections
  • Problems with anesthesia
  • Organ damage
  • Aortic valve damage
  • Severe internal bleeding
  • Death

Your doctor will keep a close eye on you after surgery to make sure no new problems arise.

Aortic Dissection Prevention

The best way to lower your odds of having an aortic dissection is to schedule an annual visit with your doctor so they can check your heart. You can also:

  • Talk to your doctor. Discuss any genetic conditions you have. If they raise your chances of aortic dissection, the doctor may suggest you take blood pressure medications to help prevent it.
  • Control your blood pressure. If you have high blood pressure, keep up with your medicine, diet, and exercise to manage it. You may also want to buy a portable blood pressure measuring device or check your pressure at grocery stores or pharmacies that have machines.
  • Don’t smoke. If you do, plan to quit. Many people try several times before they kick the habit for good. That’s OK -- keep trying! Tell your doctor, who can look into methods that will help you quit.
  • Practice heart-heathy habits. Eat whole grains, fruits, and vegetables and exercise regularly. Limit how much salt you get -- check food labels.
  • Wear a seat belt. It can lower your odds of a traumatic chest injury in case of an accident.

WebMD Medical Reference Reviewed by Arefa Cassoobhoy, MD, MPH on June 30, 2020

Sources

SOURCES:

Mayo Clinic: “Aortic Dissection.”

Medscape: “Aortic Dissection.”

The Marfan Foundation: “Aortic Dissection: Red Flags For Emergency Triage Staff.”

Cleveland Clinic: “Aortic Dissection.”

Cedars Sinai: “Aortic Dissection.”

Mayo Clinic:  “Ehlers-Danlos syndrome,” “Marfan syndrome,” “Turner syndrome,”

The Marfan Foundation: “Loeys-Dietz Syndrome.”

Johns Hopkins Vasculitis Center: “Giant Cell Arteritis.”

CDC: “Syphilis - CDC Fact Sheet (Detailed).”

Circulation: “Cocaine-Related Aortic Dissection in Perspective.”

The Western Journal of Emergency Medicine: “Acute Aortic Dissection in Third Trimester Pregnancy without Risk Factors.”

Cases Journal: “Aortic dissection type I in a weightlifter with hypertension: A case report.”

NYU Langone Health: “Diagnosing Aortic Dissection.”

Medscape: “Aortic Dissection Workup,” “What are postoperative complications of aortic dissection?”

Johns Hopkins Medicine: “Aortic Dissection Repair.”

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