Aortic dissection

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.

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.

Your doctor will ask about your symptoms, health, and family medical history, and will do a physical exam. You may be asked if you've been hit hard in the chest or been in a car crash.

You may have a CT scan, an MRI, or a transesophageal echocardiogram to diagnose an aortic dissection.

During a physical exam, your doctor will listen to your heart, check your pulse and blood flow, and see how your nerves and brain are working. Because aortic dissection can look like other health problems, you might need several tests. These may include a blood test, a chest X-ray, or an electrocardiogram (EKG).

Aortic dissection needs immediate treatment. Doctors will work to ease your pain and lower your heart rate. If your blood pressure is too high, you will get treatment to lower it. You will get medicine and fluids to support your blood pressure if it's too low.

The treatment depends in part on where the dissection is located. There are two types: type A and type B.

Type A means that the aorta has a dissection near the heart. This is usually treated with emergency open heart surgery. In surgery, the torn part of the aorta is replaced or repaired with a human-made graft.

Type B means that the dissection is somewhere else in the aorta. These are usually treated with medicines. If the aorta ruptured or there are other problems, a procedure or surgery may be done to repair or replace the aorta with a human-made graft.