Definition

Aortic dissection is when a layer tears in the aorta. The aorta is the main blood vessel leading from the heart.

This condition can impair blood flow to vital organs. It can lead to stroke, cardiac arrest, or death. It may also rupture and lead to serious bleeding. It needs to be treated right away.

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Causes

The aorta has three layers. Aortic dissection happens when pressure causes a tear in an inner layer of the aorta. Blood then gets between layers. This causes the layers to separate. It also squeezes off the main channel of blood.

Risk Factors

This condition is more common in men over 60 years old and women over age 67. Other things that raise the risk are:

• High blood pressure
• High cholesterol and atherosclerosis
• Chest injury or injury from surgery
• Some inherited problems, such as Ehlers-Danlos syndrome or Marfan syndrome
• Medicines that lower the immune system
• Late pregnancy
• Smoking or using cocaine or stimulants
• Infections of the aortic wall

Symptoms

Aortic dissection may cause:

• Sudden, ripping pain in the chest and or back
• Stroke
• Fainting
• Problems breathing
• Sudden weakness

Diagnosis

Aortic dissection is often a sudden event. It is a medical emergency. At the hospital, the doctor will ask about symptoms and health history. A physical exam will be done. Imaging tests will check the aorta and surrounding structures. These may include:

• Chest x-ray
• CT scan of chest and abdomen
• MRI scan of chest and abdomen
• Echocardiogram
• Aortography—x-rays taken after dye is injected into the aorta (less common)

Diagnosis is based on imaging test results.

Treatment

The first goal is emergency care. Once the person is stabilized, treatment is determined. Treatment depends on where in the aorta the tear has happened. One type of aortic dissection needs surgery right away. Another type can often be managed without surgery (if no blood vessels are blocked).

Treatment options may be:

• Surgery—The chest is opened and the aorta is repaired.
• Medicines to:
  • Reduce heart rate
  • Reduce blood pressure
  • Ease pain

The goal of long-term treatment is to reduce stress on the aorta. This may include managing blood pressure, cholesterol, and other conditions.

Prevention

The risk of this condition may be lowered by:

• Managing high blood pressure, cholesterol, and other conditions
• Not using tobacco or stimulant drugs