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Aortic Dissection

Last updated May 2, 2018

Approved by: Krish Tangella MD, MBA, FCAP

The aorta is the largest and most vital (oxygenated) blood supplying artery, originating from the heart. If due to any reason there occurs a tear on the arterial wall, it leads to a serious medical condition called Aortic Dissection.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Aortendissektion
  • Aortic Aneurysm - Dissecting
  • Aortic Aneurysm and Dissection

What is Aortic Dissection? (Definition/Background Information)

  • The aorta is the largest and most vital (oxygenated) blood supplying artery, originating from the heart. If due to any reason there occurs a tear on the arterial wall, it leads to a serious medical condition called Aortic Dissection
  • Due to pressure of the blood being pumped from the heart, a small rupture can become large and cause the blood to flow along the walls or in between the layers of the arterial walls, or even cause a bulge (like a balloon, called an aneurysm)
  • Aortic Dissections are classified as acute and chronic. The mortality rate due to this condition is high. Any incidence of Aortic Dissection require immediate and urgent medical attention, with/without surgery

Who gets Aortic Dissection? (Age and Sex Distribution)

  • Aortic Dissection is commonly seen in the age group 40-70 years
  • The number of males being affected, outnumber the females, by a ratio ranging between 3:1 to 2:1
  • Based on race: Asians seem to be the least affected, followed by Caucasians and then by the Afro-Americans

What are the Risk Factors for Aortic Dissection? (Predisposing Factors)

Some of the predisposing factors for Aortic Dissection include:

  • Advancing age that reduces the aorta’s strength and elastic properties
  • Congenital conditions that involve, or cause problems to the aorta, such as Marfan syndrome, Ehlers-Danlos syndrome, Turner syndrome, polycystic kidney disease (adult), bicuspid aortic valve, connective tissue disorders, osteogenesis imperfecta, etc.
  • Chest trauma, such as caused by the impact of any direct force, like during an accident
  • Hypertension (elevated blood pressure)
  • Coronary artery disease
  • High cholesterol levels in blood
  • A condition called atherosclerosis, where the artery walls thicken, due to fat deposits or other related reasons
  • Sometimes pregnancy is a risk factor - more so if the individual suffers from Marfan syndrome
  • Use of cocaine
  • Being affected by a kind of syphilitic infection, where the arterial walls become inflamed and tender, termed as syphilitic aortitis
  • Having had a heart surgery, like for a valve replacement, a bypass, etc.
  • If the individual already has an aortic aneurysm (bulge in the artery due to a localized wall weakness)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Aortic Dissection? (Etiology)

The aortic walls are made of several layers that are fine, strong, and elastic. When a separation of these layers take place due to blood infiltration, the layers tear or split, leading to a condition termed as Aortic Dissection. In some cases a balloon-like bulge may appear on the walls, called an aneurysm, filled with blood.

The causes for the split in the aortic walls include:

  • An advancing age considerably reduces the resilience and elasticity of the aorta. If this is combined with factors, such as high blood pressure, connective tissue disorders, valvular conditions, and a family history of dissection; then, there may be a serious risk
  • Congenital problems of the heart, and/or the heart valves, or the aorta
  • Accidental injury to the chest or abdomen
  • Syphilitic aortitis
  • Pregnancy (mainly in women suffering from underlying conditions, like Marfan syndrome)
  • Sometimes, while performing certain cardiologic (surgical) procedures, it may result in an Aortic Dissection

What are the Signs and Symptoms of Aortic Dissection?

Individuals suffering from an Aortic Dissection typically may have mild to severe chest pain (such that it is normally mistaken for a heart attack). Sometimes no pain is felt, even though an Aortic Dissection has occurred.

The location of the chest pain indicates the origin of the dissection:

  • If the pain is felt on the front side of the chest, then the aortic wall tear/split is near the origin of the aorta itself, or at the aortic arch
  • If the pain extends to the neck and jaw area, then the aortic arch maybe involved
  • Severe tearing pain at the shoulder, extending down to the armpits, and the back may indicate that a dissection may have occurred at the descending aorta
  • Pain may be felt at other locations, such as the thoracic or abdominal region, if the tear or rupture is in that area

Despite the above specifics, the maximum number of dissection occurs within the first few inches of the ascending aorta.

The other accompanying signs and symptoms of the rupture/disorder are:

  • Difficulty swallowing, due to pressure on the esophagus
  • Nausea and vomiting
  • Stress and anxiety - fearing a heart attack due to chest pain, or having heart-attack like symptoms (heavy sweating, pale skin, breathing trouble when lying on bed)
  • Reduced or increased pulse rate; feeling faint and dizzy
  • Fever

How is Aortic Dissection Diagnosed?

The two most distinguishing factors of an Aortic Dissection are the severe intensity of pain at commencement, and the sudden abruptness with which it occurs. These two indicators together help identify the condition, significantly differentiating it from a heart attack.

Nevertheless, diagnosing an Aortic Dissection is complicated and difficult. A clinical examination is performed by the physician, suspecting the condition based on the presentations. The individual’s family medical history details are also collected and analyzed.

The physical evaluation includes:

  • Using a stethoscope to listen to any abnormal sounds from the heart, lungs or abdomen; a heart murmur may be heard
  • Noting the blood pressure difference between the two arms or legs; noting high or low blood pressures
  • Indications or presence of signs, similar to a heart attack
  • Observing for any signs of shock, even though the blood pressure may be normal

Imaging studies are also used regularly to aid in diagnosing an Aortic Dissection, and they include:

  • MRI scan of chest
  • CT scan of chest
  • X-ray of the chest: Sometimes, this is performed using special dyes and the procedure is called aortic angiography
  • ECG test
  • Transesophageal echocardiogram
  • Using a doppler ultrasound to check the blood flow pattern in the body
  • A lab blood test, called troponin test

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Aortic Dissection?

Complications due to Aortic Dissection are dependent upon the location of the tear and the period for which it remains untreated. Some of the significant injuries that might occur include:

  • Shock and reduced blood pressure, due to aortic aneurysm rupture, leading to fatal conditions
  • Aortic insufficiency or regurgitation (where backward flow of blood into the heart occurs)
  • Cardiac tamponade (pressure build-up on the heart muscles due to fluid accumulation)
  • Myocardial ischemia (reduced blood flow to the heart)
  • Pulmonary edema (fluid in the lungs, causing breathing difficulties)

Another accompanying complication that arises is due to the loss of blood flow to some of the major organs (and parts of the body), like the brain, liver, kidneys, and to the heart itself, and the damage this causes. These can manifest in numerous life-threatening ways and is contingent upon the part affected (and the duration for which it occurs).

How is Aortic Dissection Treated?

Quick, early diagnosis and appropriate, urgent treatment is the key to averting life-threatening consequences from an Aortic (Aneurysm and) Dissection. The treatment mode is determined considering the location of the tear. If the ascending aorta is involved, then a surgery is usually required. However, if the descending aorta is involved, (in most cases) the condition can be managed with proper medications.

Surgical procedures employ two types of techniques:

  • Open surgery: This is the most standard form of surgery, where the condition is managed by surgically operating on the chest/abdomen
  • Endovascular aortic repair (EVAR): It is mainly used to treat a dissection of the abdominal or thoracic region, using a minimal surgical incision
  • However, if the coronary arteries are involved, then a bypass surgery is performed. And if the aortic valve is affected, they may be replaced

Management using drugs that may be given intravenously, usually follow a two-step process: One is to control the blood pressure and prevent further damage to the artery, and the second is to control the intense pain and provide a measure of comfort to the patient. The medications used are:

  • Beta-blockers to reduce high blood pressures and stress, or the drugs are administered to lower blood pressure
  • Intense pain is controlled using pain-killers (usually morphine)

How can Aortic Dissection be Prevented?

Aortic Dissection is a serious condition; nevertheless, it can be prevented. It is important to be aware of the risk factors and initiate certain steps to reduce them, especially if you are predisposed to the condition. The steps include:

  • Maintaining a healthy lifestyle and optimum body weight, which includes ‘no smoking’ (or consumption of other tobacco-based products), keeping blood pressure under check, staying physically fit, with reduced stress, etc.
  • Be careful while driving (always wear a seat belt), while performing any ‘physical’ tasks/job-related activities, or while exercising with weights; factors that put you at risk for a potential traumatic chest injury
  • Have regular consultations with your family physician, more so, if there is a family history of an aortic aneurysm or such a heart-related problem

What is the Prognosis of Aortic Dissection? (Outcomes/Resolutions)

  • Aortic Dissection is a critical heart condition requiring emergency medical treatment, possibly involving surgical intervention. The requirement of emergency aid is even more imminent, if a rupture of the aorta occurs
  • Chronic conditions have a better outcome, while acute cases of Aortic Dissection have higher mortalities
  • With timely, aggressive, and active treatment administration, the aortic defect can be effectively managed and controlled
  • Mortality rates are significantly high - if the health condition of the patient is not encouraging, if there are other complications, or if the condition remains unnoticed
  • Survivors of Aortic Dissection, require lifelong medication to keep their blood pressure under control, regular medical checkups with diagnostic testing to periodically monitor functioning of the heart and blood circulatory systems

Additional and Relevant Useful Information for Aortic Dissection:

  • Though many technological and medical advancements are available, the mortality rates with Aortic Dissection, still remain high
  • Patient education and periodic screening/checkups for heart conditions are encouraged, particularly for those individuals, who have crossed the age of 40 years

What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Dec. 10, 2013
Last updated: May 2, 2018