Aortic dissection is a serious condition in which there is a separation of the aorta walls. The small tear can come larger. It can lead to bleeding into and along the wall of the aorta, the major artery carrying blood out of the heart.
Aortic aneurysm - dissecting
When it leaves the heart, the aorta first moves up through the chest toward the head (the ascending aorta). It then bends or arches, and finally moves down through the chest and abdomen (the descending aorta).
Aortic dissection most often happens because of a tear or damage to the inner wall of the aorta. This usually occurs in the chest (thoracic) part of the artery, but it may also occur in the abdominal part.
When a tear occurs, it creates two channels:
If the channel with nontraveling blood gets bigger, it can push on other branches of the aorta. This can narrow the other branches and reduce blood flow through them.
An aortic dissection may also cause abnormal widening or ballooning of the aorta (aneurysm).
The exact cause is unknown, but more common risks include:
Other risk factors and conditions associated with the development of aortic dissection include:
Aortic dissection occurs in about 2 out of every 10,000 people. It can affect anyone, but is most often seen in men ages 40 to 70.
The symptoms usually begin suddenly, and include severe chest pain. The pain may feel like a heart attack, and can:
Symptoms are caused by a decrease of blood flowing to the rest of the body, and can include:
Other symptoms may include:
The health care provider will take your family history and listen to your heart, lungs, and abdomen with a stethoscope. The examinatinon may find:
Aortic dissection or aortic aneurysm may be seen on:
Blood work to rule out a heart attack is needed.
Aortic dissection is a life-threatening condition and needs to be treated right away.
Two different techniques may be used for surgery:
Drugs that lower blood pressure may be prescribed. These drugs may be given through a vein (intravenously). Beta-blockers are the first drugs of choice. Strong pain relievers are usually needed.
If the aortic valve is damaged, valve replacement is needed. If the heart arteries are involved, a coronary bypass is also performed.
Aortic dissection is life threatening. The condition can be managed with surgery if it is done before the aorta ruptures. Less than half of patients with a ruptured aorta survive.
Those who survive will need lifelong, aggressive treatment of high blood pressure. They will need to be followed up with CT scans every few months to monitor the aorta.
Aortic dissection may decrease or stop the blood flow to many different parts of the body. This may result in short-term or long-term problems, or damage to the:
If you have symptoms of aortic dissection or severe chest pain, call 911 or your local emergency number, or go to the emergency room as quickly as possible.
Proper treatment and control of hardening of the arteries (atherosclerosis) and high blood pressure may reduce your risk of aortic dissection. It is very important for patients at risk for dissection to tightly control their blood pressure.
Take safety precautions to prevent injuries, which can cause dissections.
Many cases of aortic dissection cannot be prevented.
If you have been diagnosed with Marfan or Ehler syndrome, make sure you regularly follow-up with your doctor.
Isselbacher EM. Diseases of the aorta. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 78.
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