What is aortic dissection?

Pain is the leading symptom of aortic dissection. A person typically has a sudden onset of pain at the moment of dissection. The pain is usually described as ripping or tearing and as the worst pain ever experienced. It is usually in between the shoulders on the back and might radiate to the arms or the neck. Less frequently, the pain can be felt as chest pain. The pain is very difficult to distinguish from that of angina or a heart attack.

Other symptoms may include:

• Numbness and the inability to move the legs.
• Sweating.
• Nausea.
• Fainting.
• Pale skin.

Emergency treatment includes medicines to relieve pain, lower your heart rate, and get your blood pressure back to normal. Further treatment depends partly on location. Dissections near the heart are usually treated with emergency surgery. Dissections elsewhere in the aorta are treated with medicines or a procedure or surgery to repair the aorta.

You may help prevent an aortic dissection by managing risk factors for atherosclerosis, such as high blood pressure.

Your doctor will ask you questions about your symptoms, medical history, lifestyle, and family medical history and do a physical exam. You may also be asked if you have been hit hard in the chest or been in an automobile accident. Several specialists may see you.

Physical exam

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.

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.
• A chest X-ray.
• Computed tomography scanning (CT) or magnetic resonance imaging (MRI) to help your doctor see the dissection.
• A transthoracic echocardiography or transesophageal echocardiography (TEE) to let your doctor look at blood vessels inside your chest.
• An intravascular ultrasound to get a better look at your blood vessels.

Aortic dissection occurs when a small tear develops in the wall of the aorta. The tear forms a new channel between the inner and outer layers of the aortic wall. This causes bleeding into the channel and can enlarge the tear. Aortic dissection is a life-threatening condition.

Aortic dissection can be caused by atherosclerosis (hardening of the arteries) and high blood pressure, traumatic injury to the chest, such as being hit by the steering wheel of a car during an accident, and conditions that are present at birth, such as Marfan syndrome or Ehlers-Danlos syndrome.

Any one or any combination of the following may cause aortic dissection:

High blood pressure.

Most patients with an aortic dissection have had high blood pressure for many years. The high blood pressure accelerates the natural processes of tissue aging and damage to the tissue, promoting a weakness of the aortic wall and increasing the risk for a tear.

Chest injury.

Severe chest injury, such as might occur in an automobile accident, may also cause aortic dissection.

Diseases of the connective tissue.

Either Marfan syndrome or Ehlers-Danlos syndrome can damage the connective tissue in the middle of the aortic wall. This damage can lead to aortic dissection.

Other diseases.

Certain diseases increase the risk of an aortic dissection. These include lupus, polycystic kidney disease, Cushing's syndrome, giant cell arteritis

A family history of aortic dissection is also a risk factor.

Pregnancy can also increase the risk of a dissection. This risk is caused by the combination of hormonal effect on the tissue structure (elastin fibers) and additional high blood pressure stress.

Illegal drugs that raise blood pressure, such as cocaine, increase the risk of a dissection.