What to know about aortic dissection
Aortic dissection is a medical emergency. The condition can quickly become fatal if the blood breaks through the aorta's outer lining.
Aortic dissection is not common. It affects between 5 and 30 people out of every 1 million each year, and it is most likely to affect older men.
In this article, we describe the two types of aortic dissection, their symptoms and treatment options, and the outlook for people with this condition.
Severe pain in the abdomen is a potential symptom of aortic dissection.
Due to its symptoms, aortic dissection can resemble other high-risk conditions that are more common, so it can be challenging to diagnose.
People with risk factors for aortic dissection, such as high blood pressure or a family history of aortic dissection, should have regular heart checkups with their doctor.
Aortic dissection symptoms usually appear quickly after the tear occurs. They often resemble the symptoms of other heart problems and may include:
- severe pain in the chest, back, or abdomen, which occurs in up to 90 percent of cases
- difficulty speaking
- difficulty walking
- a fast, weak pulse in one arm or leg
- leg pain
- loss of consciousness
- paralysis of one side of the body
- shortness of breath
Types of aortic dissection
- There are two types of aortic dissection:
- Type A is the most common and dangerous form of aortic dissection. It occurs when the upper aorta, called the ascending aorta, tears. The tear may spread to the abdomen.
- Type B refers to a tear in the lower aorta, called the descending aorta. This tear may also extend to the abdomen.
Medical professionals may classify aortic dissection in other ways, including the following:
- acute: the tear has been present for less than 14 days
- chronic: the tear has been present for 14 days or more
- complicated: the tear has caused other issues, such as poor blood supply to some organs
- uncomplicated: the tear has not led to any complications
Causes and risk factors
Aortic dissection affects the walls of the aortic valve.
Aortic dissection occurs when a weak section of the aorta wall rips or tears.
Factors that increase a person's risk of aortic dissection include:
Age and sex
Most cases occur in men between the ages of 50 and 65 years, but both men and women of any age can develop the condition.
High blood pressure
Long-term hypertension places greater pressure on the artery walls, making them more likely to tear.
Certain genetic disorders
People with specific genetic conditions have a higher risk of aortic dissection. These conditions include:
- Turner syndrome
- Marfan syndrome
- Ehlers-Danlos syndrome
An infectious or inflammatory condition
Other artery problems
Having a preexisting aortic issue may increase the risk of the artery separating. These issues include:
- hardening of the arteries, or atherosclerosis
- valve defects, such as a bicuspid aortic valve
- a narrow aorta, or aortic coarctation
- a weak and bulging artery, or an aortic aneurysm
Trauma to the chest
Less commonly, a severe chest injury may contribute to a tear in the aorta.
Aortic dissections can occur during pregnancy in rare cases.
Cocaine raises blood pressure, which increases a person's risk of aortic dissection.
Intense resistance training increases blood pressure, which may result in an aortic tear.
When to see a doctor
People who develop any of the symptoms of aortic dissection or experience another cardiac event should call 911 immediately. Aortic dissection can have severe consequences, including organ failure or death, especially if a person does not receive urgent treatment.
Diagnosing aortic dissection
To diagnose aortic dissection, a doctor will take a medical history and carry out a physical examination. The signs and symptoms that will help them make a diagnosis include:
- an abnormal heartbeat
- differences in blood pressure between the left and right arms
- sudden, intense pain in the chest, back, or abdomen
Doctors will typically also carry out imaging tests to confirm or rule out a diagnosis of aortic dissection. These include:
- Chest X-ray. A chest X-ray can reveal a widening of the aorta. However, the images may appear normal in an estimated 10 to 20 percent of people with aortic dissection so additional tests may be necessary.
- Transesophageal echocardiogram (TEE). A TEE involves placing a probe down the food pipe, close to the aorta. Sound waves produce an image of the heart, which the doctor can check for irregularities.
- Aortic angiogram. During this procedure, the doctor will inject a contrast liquid into the arteries. They will then take X-rays which may show up any abnormalities in the aorta.
- Magnetic resonance angiogram (MRA). This test uses a magnetic field and radio waves to examine the blood vessels.
Additional tests, such as blood tests, may help the doctor rule out the possibility of other conditions and events with similar symptoms, including heart attack.
Immediate medical treatment is necessary for aortic dissection to prevent complications or death. This treatment typically involves medications, surgery, or both.
A doctor may prescribe medication to treat aortic dissection.
A doctor may give people with a type B aortic dissection beta-blockers and nitroprusside to lower their heart rate and blood pressure and to prevent the tear from getting worse.
People with a type A aortic dissection might also take these medications to help stabilize their condition, but they typically require surgery as well to correct the tear.
Most people who have an aortic dissection will need to take medications to reduce blood pressure for the rest of their lives.
People with a type A aortic dissection will usually undergo surgery to remove the damaged section of the aorta and replace it with a tube. This procedure prevents blood from flowing into the aortic wall.
The surgeon will also replace the aortic valve if it is leaking.
People with type B aortic dissection may undergo a similar procedure, but their surgery may also include the use of stents, which are small mesh tubes, to repair the aorta.
In addition to taking hypertension medications for life, people may need to have regular imaging scans to allow the doctor to monitor their condition.
People who are at risk of developing aortic dissection, including those with a family history of the condition, can use lifestyle methods to reduce their risk. These include:
- going for regular heart checkups
- monitoring their blood pressure regularly and receiving treatment for hypertension
- eating a healthful diet that is high in whole grains, fruits, and vegetables and low in salt
- exercising regularly
- maintaining a healthy body weight
- avoiding smoking
- following a treatment plan for any existing medical conditions that increase the risk of aortic dissection
- wearing a seat belt in the car to reduce the risk of chest injuries
Outlook and survival
Aortic dissection has a high rate of mortality. According to some sources, approximately 40 percent of people die after getting to the emergency department, and 20 to 30 percent of people die after surgery.
The highest mortality rates occur within the first 10 days of aortic dissection.
The likelihood of fatality increases by 1 percent for every hour a person goes without treatment.
The condition can cause complications, such as:
- internal bleeding
- organ failure
For the best chance of recovery, individuals should call 911 or go directly to the emergency department if they experience any of the symptoms of an aortic dissection. Early treatment can be life-saving.