Aortic Dissection

An aortic dissection is a life-threatening medical emergency in which a tear develops in the inner layer of the aorta, the body's largest artery. Blood enters the tear and separates ("dissects") the layers of the aortic wall, which can reduce blood flow to vital organs or cause the aorta to rupture.

Symptoms

The most common symptom is:

• Sudden, severe chest or upper back pain, often described as tearing, ripping, or sharp.

Other symptoms can include:

• Pain that moves from the chest to the back, abdomen, or neck
• Shortness of breath
• Fainting
• Weakness or numbness on one side of the body (similar to a stroke)
• Difficulty speaking
• Weak or absent pulse in one arm or leg
• Sweating, dizziness, or confusion

Risk factors

People are at higher risk if they have:

• Long-standing high blood pressure
• An enlarged aorta (aneurysm)
• Certain inherited connective tissue disorders, such as Marfan syndrome or Loeys–Dietz syndrome
• A bicuspid aortic valve
• A history of heart or aortic surgery
• Trauma to the chest
• Increasing age (especially for some types)

Diagnosis

Doctors typically use:

• CT angiography (most common in emergency settings)
• Transesophageal echocardiography (TEE)
• MRI (in selected cases)
• Blood pressure measurements in both arms and a physical examination

Treatment

Treatment depends on where the dissection occurs:

• Type A dissection (involving the ascending aorta): This usually requires emergency surgery because it carries a very high risk of death if untreated.
• Type B dissection (limited to the descending aorta): This is often treated initially with medications to lower blood pressure and heart rate. Some patients also need an endovascular stent procedure or surgery if complications develop.

Common medications include:

• Beta blockers to reduce heart rate and blood pressure
• Additional blood pressure medications if needed
• Strong pain medication

Prognosis

Prompt treatment greatly improves survival. Without treatment, especially for Type A dissections, the risk of death increases rapidly over the first hours and days.

When to seek emergency care

If you or someone else has sudden, severe chest, back, or abdominal pain, especially if it feels tearing or ripping, or if it occurs with fainting, weakness, or difficulty speaking, call your local emergency services immediately. Do not try to drive yourself to the hospital.

Important Factors

• Your age and sex
• Where the pain is located
• When it started
• Whether it's sudden or gradual
• Any associated symptoms (shortness of breath, fainting, weakness, numbness, etc.)

 Suspected aortic dissection always requires immediate emergency evaluation.

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