What is aortic dissection?
Aortic dissection is an internal tear in the lining of your heart’s aorta. It occurs when the innermost layer of the aorta’s wall separates from the outer layer. The aorta is the body’s main artery, supplying blood from the heart to other arteries that go to your limbs and organs. When the inner lining tears, redirected blood can flow between the layers, trapping blood that can build up and rupture the outer wall. Aortic dissection is an extremely serious condition. If the dissection leads to a rupture, it may be fatal due to severe internal bleeding.
There are two types of aortic dissection, categorized by location. The more serious type of aortic dissection is type A, which is a tear where the aorta leaves the heart, in the upper area of the aorta. It is the more common and dangerous type of dissection. Type B dissection is a tear in the lower aorta, sometimes extending into the abdomen. Doctors treat both types of aortic tears with surgery and medication, but type A requires urgent medical attention.
Blood from an aortic tear can also push on other branches of the aorta, which can restrict blood flow to the rest of your body. It may also cause the aorta to balloon outward, which is called an aneurysm. If the aneurysm bursts, it can be fatal.
Aortic dissection can occur in anyone, but it’s most commonly seen in men between the ages of 40 to 70.
Aortic dissection happens suddenly. You may feel a tearing sensation in your chest, intense pain and other symptoms similar to a heart attack. If you feel any of these aortic dissection symptoms, call 911. Do not wait to see if the symptoms get better. Aortic dissection is a life-threatening medical emergency—seek care immediately.
What are the symptoms of aortic dissection?
The symptoms of aortic dissection are similar to those of a heart attack, including severe chest pain and shortness of breath. You may also feel a tearing sensation in your chest.
A tear in the aorta is life threatening. Seek immediate medical care (call 911) if you or someone you are with has any of the following symptoms of aortic dissection:
- A tearing or ripping sensation in the chest, accompanied by severe pain.
- Severe pain that begins in the chest and moves to other parts of the body, such as the shoulder blades, back, torso, neck, jaw, or hips and legs
- Sharp, severe chest pain
- Shortness of breath, especially when lying down
- Heavy sweating
- Nausea or vomiting
- Rapid, weak pulse
- Difficulty swallowing
What causes aortic dissection?
High blood pressure is the most common cause of aortic dissection. Left untreated, high blood pressure can narrow your arteries and cause blood to push harder against the lining of the vessels. The additional pressure can cause a dissection or rupture the aortic lining.
If you develop an aortic aneurysm—a bulge in your aorta—it can grow until it tears, causing an aortic dissection. Serious traumas, such as when a steering wheel hits your chest in a car accident, can cause aortic dissection.
There is some evidence that intense physical exertion, such as heavy weight lifting, may cause aortic dissection.
What are the risk factors for aortic dissection?
A number of factors increase the risk of developing an aortic dissection. Not all people with these risk factors will get an aortic dissection, which is rare. Risk factors for aortic dissection include:
- High blood pressure
- Connective tissue disorders such as Marfan syndrome, which can cause weak spots in your aorta
- Aortic aneurysm, which is a bulge in a weak spot in your aorta
- Syphilis or other conditions that make blood vessels swell
Reducing your risk of aortic dissection
Most cases of aortic dissection cannot be prevented, but you may be able to lower your risk by:
- Controlling your high blood pressure
- Not smoking
- Staying at a healthy weight
- Wearing your seat belt
If you have or are at risk for hereditary forms of aortic dissection, take these additional precautions:
- No heavy lifting
- No strenuous exercise
- Have annual or more frequent echocardiograms to evaluate your aorta
How is aortic dissection treated?
Doctors treat both type A and type B aortic dissections with surgery and medication, but type A requires urgent medical attention. Treatment includes:
- Surgery to repair the dissection if it is done before the aorta ruptures. During open heart surgery, a cardiothoracic surgeon (also known as cardiac surgeon) will remove the torn area and replace it with a graft. The surgeon may need to create a new heart valve to reconstruct the aorta. Vascular surgeons repair aortic dissections occurring in the abdomen.
- Medication before or after surgery. Your doctor may give you beta blockers and nitroprusside (Nitropress) to reduce your heart rate and lower your blood pressure, which reduces the likelihood of the aortic dissection getting worse.
After treatment, you may need to continue taking medicine to lower your blood pressure. Doctor use echocardiograms and may order scans—either CTs or MRIs—to monitor the condition. After you heal from surgery, your prognosis for a full life depends on your overall health and whether you experienced complications during or after surgery. Most people have a good prognosis of 5 to 10 years after surgery, according to a limited number of studies analyzing life expectancy.
What are the potential complications of aortic dissection?
Quick diagnosis and treatment can reduce the risk of complications, and after repairing the dissection, doctors can assess damage to other organs, which may be short or long term. The damage is from restricted blood flow to the rest of the body during the dissection, and can occur in the brain, heart, intestines or kidneys. However, many people live a full life span if they receive immediate medical attention for an aortic dissection.