An aortic dissection is a serious condition in which a tear develops in the inner layer of the aorta, the large blood vessel branching off the heart. Blood surges through this tear into the middle layer of the aorta, causing the inner and middle layers to separate (dissect). If the blood-filled channel ruptures through the outside aortic wall, aortic dissection is often fatal.
Aortic dissection, also called dissecting aneurysm, is relatively uncommon. Anyone can develop the condition, but it most frequently occurs in men between 60 and 70 years of age. Symptoms of aortic dissection may mimic those of other diseases, often leading to delays in diagnosis. However, when an aortic dissection is detected early and treated promptly, your chance of survival greatly improves.
Aortic dissection symptoms may be similar to those of other heart problems, such as a heart attack. Typical signs and symptoms include:
When to see a doctor
If you have signs or symptoms such as severe chest pain, fainting, sudden onset of shortness of breath, or symptoms of a stroke, call 911 or emergency medical assistance. While experiencing such symptoms doesn’t always mean that you have a serious problem, it’s best to get checked out quickly. Early detection and treatment may help save your life.
An aortic dissection occurs in a weakened area of the aortic wall. Chronic high blood pressure may stress the aortic tissue, making it more susceptible to tearing. You can also be born with a condition associated with a weakened and enlarged aorta, such as Marfan syndrome or bicuspid aortic valve. Rarely, aortic dissections may be caused by traumatic injury to the chest area, such as during motor vehicle accidents.
Aortic dissections are divided into two groups, depending on which part of the aorta is affected:
Risk factors for aortic dissection include:
People with certain genetic diseases are more likely to have an aortic dissection than are people in the general population. These include:
Other potential risk factors include:
An aortic dissection can lead to:
Detecting an aortic dissection can be tricky because the symptoms are similar to those of a variety of health problems. Doctors often suspect an aortic dissection if the following signs and symptoms are present:
Although these signs and symptoms suggest aortic dissection, more-sensitive imaging techniques are usually needed. The most frequently used imaging procedures include:
An aortic dissection is a medical emergency requiring immediate treatment. Therapy may include surgery or medications, depending on the area of the aorta involved.
Type A aortic dissection
Type A aortic dissections are the more common and dangerous type of aortic dissection. These dissections involve a tear in the ascending portion of the aorta just where it exits the heart or a tear extending from the ascending portion down to the descending portion of the aorta, which may extend into the abdomen. Surgery is the preferred treatment for type A aortic dissections.
During the surgical procedure, surgeons remove as much of the dissected aorta as possible, block the entry of blood into the aortic wall and reconstruct the aorta with a synthetic tube called a graft. Some people with type A aortic dissection will need to have their aortic valve replaced at the same time if there’s valve leakage related to the damaged aorta. If aortic valve replacement is required, the valve is placed within the graft that is used to reconstruct the aorta.
Type B aortic dissection
This type of aortic dissection involves a tear in the descending aorta only, which may also extend into the abdomen. People with type B aortic dissection can be treated medically or with surgery. Surgical options for type B aortic dissection are similar to the procedures used to correct a type A aortic dissection. Sometimes stents — small wire mesh tubes that act as a sort of scaffolding — may be placed in the aorta to repair type B aortic dissections.
Medications for aortic dissection
Aortic dissections may be treated with medications, such as beta blockers and sodium nitroprusside (Nitropress), to relieve the force of blood on the aortic wall by reducing the heart rate and lowering blood pressure. With reduced blood force, the aortic dissection is less likely to worsen. These medications may be used to prepare a person for surgery. Most people with type B dissections can be treated with medications alone.
After treatment many people with aortic dissections need to take blood pressure lowering medication for the rest of their lives. In addition, they’ll often need follow-up CT or MRI scans periodically to monitor their condition. How often you’ll need imaging tests depends on your underlying condition.
The most important way to help prevent an aortic dissection is to keep your blood pressure under control. Here are a few tips to reduce your risk:
If you have a genetic condition that increases your risk of aortic dissection, your doctor may recommend medications, even if your blood pressure is normal. Talk to your doctor about which method or combination of methods is best for you.