Definition

Aortic dissection occurs when the layers of the aorta separate. The aorta is the main artery leading from the heart. Arterial walls have three layers. A tear in an inner layer can admit blood under pressure that works its way between layers, causing the layers to dissect apart or separate. This process can squeeze off the main channel so that blood cannot get through the main aorta or any of its branches.

This is a life-threatening event since it can cause stroke , sudden cardiac arrest , or death to impaired blood flow to a number of vital organs. The enlarging mass of misdirected blood can also compromise nearby structures, such as the airways, lungs, or heart. It may also rupture with catastrophic bleeding.

Heart and Main Vessels
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Causes

Elevated blood pressure and a diseased aorta are the principal causes, usually due to atherosclerosis . Other congenital and acquired afflictions of the aorta also increase the chances of dissection.

Risk Factors

Factors that may increase your chance of aortic dissection include:

  • Hypertension
  • Atherosclerosis
  • A major chest injury, such as an auto accident
  • A hereditary connective tissue disorder
  • Nearing the end of a pregnancy
  • Untreated syphilis

Symptoms

If you experience any of the symptoms below, see your physician. They may reflect aortic dissection or many other serious and not-so-serious conditions. These are the most common, but there are many other possible symptoms since the aorta supplies blood to every organ in the body except the lungs.

  • Sudden, ripping pain in the chest and or back
  • Stroke
  • Fainting
  • Shortness of breath
  • Sudden weakness

Diagnosis

The usual case of aortic dissection appears in the emergency department as a sudden catastrophic event. Your emergency physician will ask about your symptoms and medical history. A physical exam will be done. Imaging tests evaluate the aorta and surrounding structures. These may include:

  • Chest x-ray
  • CT scan of chest and abdomen
  • MRI scan of chest and abdomen
  • Echocardiogram
  • Aortography—x-rays taken after dye is injected into the aorta through a surgically placed catheter

Treatment

You will most likely be admitted to the intensive care unit (ICU) for stabilization and further evaluation. Blood pressure will be controlled, and you will be carefully observed.

One type of aortic dissection requires immediate major surgery. Another type can often be managed without surgery (if no blood vessels are obstructed). It depends on where in the aorta the dissection occurs. Sixty percent of people treated for aortic dissection are alive 10 years later. Treatment options include the following:

Surgery

The chest is opened, and the aorta is repaired. A length of Dacron (called a stent) may be used to replace the damaged segment of aorta.

Medical Treatment

Your blood pressure will be reduced to minimize stress on the aorta. You may undergo repeat imaging studies every 6-12 months to detect further dissection.

Prevention

To help reduce your chance of aortic dissection:

  • Follow and control blood pressure
  • Ask your doctor to check you over if you have any of the risk factors for aortic dissection
  • Keep high cholesterol under control through diet and/or medications

Revision Information

  • American Heart Association

    http://www.heart.org

  • Family Doctor—American Academy of Family Physicians

    http://familydoctor.org

  • Health Canada

    http://www.hc-sc.gc.ca

  • The College of Family Physicians of Canada

    http://www.cfpc.ca

  • Aortic dissection. The Merck Manual Professional Edition website. Available at: http://www.merckmanuals.com/professional/cardiovascular%5Fdisorders/diseases%5Fof%5Fthe%5Faorta%5Fand%5Fits%5Fbranches/aortic%5Fdissection.html. Updated May 2014. Accessed August 20, 2014.

  • Isselbacher K, et al. Harrison's Principles of Internal Medicine. 14th ed. New York: McGraw-Hill; 1998.

  • Mukherjee D, Eagle KA. Aortic dissection–an update. Curr Probl Cardiol. 2005 Jun;30(6):287-325.

  • Thoracic aortic aneurysm and dissection. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 11, 2014. Accessed August 20, 2014.

  • 8/20/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Jacobs JE, Latson LA, et al. American College of Radiology (ACR) Appropriateness Criteria for acute chest pain: suggested aortic dissection. Available at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/AcuteChestPainSuspectedAorticDissection.pdf. Updated 2014. Accessed August 20, 2014.