Aortic dissection
Aortic aneurysm - dissecting; Chest pain - aortic dissection; Thoracic aortic aneurysm - dissectionAortic dissection is a serious condition in which there is a tear in the wall of the major artery carrying blood out of the heart (aorta). As the tear extends along the wall of the aorta, blood can flow in between the layers of the blood vessel wall (dissection). This can lead to aortic rupture or decreased blood flow (ischemia) to organs.
Causes
When it leaves the heart, the aorta first moves up through the chest towards the head (the ascending aorta). It then bends or arches, and finally moves down through the chest and abdomen (the descending aorta).
Aortic dissection most often happens because of a tear or damage to the inner wall of the aorta. This very often occurs in the chest (thoracic) part of the artery, but it may also occur in the abdominal aorta.
When a tear occurs, it creates 2 channels:
- One in which blood continues to travel
- Another where blood stays still
If the channel with non-traveling blood gets bigger, it can push on other branches of the aorta. This can narrow the other branches and reduce blood flow through them.
An aortic dissection may also cause abnormal widening or ballooning of the aorta (aneurysm).
Aneurysm
An aneurysm is an abnormal widening or ballooning of a part of an artery due to weakness in the wall of the blood vessel.
Read Article Now Book Mark ArticleThe exact cause is unknown, but more common risks include:
- Aging
- Atherosclerosis
Atherosclerosis
Atherosclerosis, sometimes called "hardening of the arteries," occurs when fat, cholesterol, and other substances build up in the walls of arteries. ...
Read Article Now Book Mark Article - Blunt trauma to the chest, such as hitting the steering wheel of a car during an accident
- High blood pressure
High blood pressure
Blood pressure is a measurement of the force exerted against the walls of your arteries as your heart pumps blood to your body. Hypertension is the ...
Read Article Now Book Mark Article
Other risk factors and conditions linked to aortic dissection include:
- Bicuspid aortic valve
- Coarctation (narrowing) of the aorta
Coarctation (narrowing) of the aorta
The aorta is a larger artery that carries blood from the heart to the vessels that supply the rest of the body with blood. If part of the aorta is n...
Read Article Now Book Mark Article - Connective tissue disorders (such as Marfan syndrome and Ehlers-Danlos syndrome) and rare genetic disorders
Marfan syndrome
Marfan syndrome is a disorder of connective tissue. This is the tissue that strengthens the body's structures. Disorders of connective tissue affect...
Read Article Now Book Mark Article - Heart surgery or procedures
- Pregnancy
- Swelling of the blood vessels due to conditions such as arteritis and syphilis
Aortic dissection occurs in about 2 out of every 10,000 people. It can affect anyone, but is most often seen in men ages 40 to 70.
Symptoms
In most cases, the symptoms begin suddenly, and include severe chest pain. The pain may feel like a heart attack.
Chest pain
Chest pain is discomfort or pain that you feel anywhere along the front of your body between your neck and upper abdomen.
Read Article Now Book Mark Article- Pain can be described as sharp, stabbing, tearing, or ripping.
- It is felt below the breast bone, and then moves under the shoulder blades or to the back.
- Pain can move to the shoulder, neck, arm, jaw, abdomen, or hips.
- The pain changes position, often moving to the arms and legs as the aortic dissection gets worse.
Symptoms are caused by a decrease of blood flowing to the rest of the body, and can include:
- Anxiety and a feeling of doom
- Fainting or dizziness
Fainting
Fainting is a brief loss of consciousness due to a drop in blood flow to the brain. The episode most often lasts less than a couple of minutes and y...
Read Article Now Book Mark ArticleDizziness
Dizziness is a term that is often used to describe 2 different symptoms: lightheadedness and vertigo. Lightheadedness is a feeling that you might fai...
Read Article Now Book Mark Article - Heavy sweating (clammy skin)
Heavy sweating
Sweating is the release of liquid from the body's sweat glands. This liquid contains salt. This process is also called perspiration. Sweating helps...
Read Article Now Book Mark Article - Nausea and vomiting
Nausea and vomiting
Nausea is feeling an urge to vomit. It is often called "being sick to your stomach. "Vomiting or throwing-up forces the contents of the stomach up t...
Read Article Now Book Mark Article - Pale skin (pallor)
Pallor
Paleness is an abnormal loss of color from normal skin or mucous membranes.
Read Article Now Book Mark Article - Rapid, weak pulse
- Shortness of breath and trouble breathing when lying flat (orthopnea)
Orthopnea
Breathing difficulty while lying down is an abnormal condition in which a person has a problem breathing normally when lying flat. The head must be ...
Read Article Now Book Mark Article
Other symptoms may include:
- Pain in the abdomen
- Stroke symptoms
- Swallowing difficulties from pressure on the esophagus
Exams and Tests
The health care provider will take your medical and family medical history and listen to your heart, lungs, and abdomen with a stethoscope. The exam may find:
- A "blowing" murmur over the aorta, heart murmur, or other abnormal sound
- A difference in blood pressure between the right and left arms, or between the arms and legs
- Low blood pressure
- Signs resembling a heart attack
- Signs of shock, but with normal blood pressure
Shock
Shock is a life-threatening condition that occurs when the body is not getting enough blood flow. Lack of blood flow means the cells and organs do n...
Read Article Now Book Mark Article
Aortic dissection or aortic aneurysm may be seen on:
- Aortic angiography
Aortic angiography
Aortic angiography is a procedure that uses a special dye and x-rays to see how blood flows through the aorta. The aorta is the major artery. It ca...
Read Article Now Book Mark Article - Chest x-ray
Chest x-ray
A chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm.
Read Article Now Book Mark Article - Chest MRI
Chest MRI
A chest MRI (magnetic resonance imaging) scan is an imaging test that uses powerful magnetic fields and radio waves to create pictures of the chest (...
Read Article Now Book Mark Article - CT scan of chest with dye
CT scan of chest
A chest CT (computed tomography) scan is an imaging method that uses x-rays to create cross-sectional pictures of the chest and upper abdomen....
Read Article Now Book Mark Article - Duplex Doppler ultrasonography (occasionally performed)
Duplex Doppler ultrasonography
This test uses ultrasound to look at the blood flow in the large arteries and veins in the arms or legs.
Read Article Now Book Mark Article - Echocardiogram
Echocardiogram
An echocardiogram is a test that uses sound waves to create pictures of the heart. The picture and information it produces is more detailed than a s...
Read Article Now Book Mark Article - Transesophageal echocardiogram (TEE)
Blood work to rule out a heart attack is needed.
Blood work to rule out a heart attack
A troponin test measures the levels of troponin T or troponin I proteins in the blood. These proteins are released when the heart muscle has been da...
Read Article Now Book Mark ArticleTreatment
Aortic dissection is a life-threatening condition and needs to be treated right away.
- Dissections that occur in the part of the aorta that is leaving the heart (ascending) are treated with surgery.
- Dissections that occur in other parts of the aorta (descending) may be managed with surgery or medicines.
Two techniques may be used for surgery:
- Standard, open surgery. This requires a surgical incision that is made in the chest or abdomen.
- Endovascular aortic repair. This surgery is done without any major surgical incisions.
Medicines that lower blood pressure may be prescribed. These medicines may be given through a vein (intravenously). Beta-blockers are the medicines of first choice. Strong pain relievers are very often needed.
If the aortic valve is damaged, valve replacement is needed. If the heart arteries are involved, a coronary bypass is also performed.
Outlook (Prognosis)
Aortic dissection is life threatening. The condition can be managed with surgery if it is done before the aorta ruptures. Less than one half of people with a ruptured aorta survive.
Those who survive will need lifelong, aggressive treatment of high blood pressure. They will need to be followed up with CT scans every few months to monitor the aorta.
Possible Complications
Aortic dissection may decrease or stop the blood flow to many different parts of the body. This may result in short-term or long-term problems, or damage to the:
- Brain
- Heart
- Intestines or bowels
- Kidneys
- Legs
When to Contact a Medical Professional
If you have symptoms of an aortic dissection or severe chest pain, call 911 or the local emergency number, or go to the emergency room as quickly as possible.
Prevention
Many cases of aortic dissection cannot be prevented.
Things you can do to reduce your risk include:
- Treating and controlling hardening of the arteries (atherosclerosis)
- Keeping high blood pressure under control, especially if you are at risk for dissection
- Taking safety precautions to prevent injuries that can cause dissections
- If you have been diagnosed with Marfan or Ehlers-Danlos syndrome, making sure you regularly follow-up with your provider
References
Beckman JA. Diseases of the aorta. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 63.
Braverman AC, Schermerhorn M. Diseases of the aorta. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 43.
Conrad MF. Aortic dissection: epidemiology, pathophysiology, clinical presentation, and medical and surgical management. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 83.
Aortic rupture - chest X-ray - illustration
Aortic rupture (a tear in the aorta, which is the major artery coming from the heart) can be seen on a chest X-ray. In this case, it was caused by a traumatic perforation of the thoracic aorta. This is how the X-ray appears when the chest is full of blood (right-sided hemothorax) seen here as cloudiness on the left side of the picture.
Aortic rupture - chest X-ray
illustration
Aortic aneurysm - illustration
Abdominal aortic aneurysm involves a widening, stretching, or ballooning of the aorta. There are several causes of abdominal aortic aneurysm, but the most common results from atherosclerotic disease. As the aorta gets progressively larger over time there is increased chance of rupture.
Aortic aneurysm
illustration
Aortic dissection - illustration
Aortic dissection is a condition in which there is bleeding into and along the wall of the aorta (the major artery from the heart). This most often occurs because of a tear or damage to the inner wall of the artery. Although aortic dissection can affect anybody, it is most often seen in men 40 to 70 years old. Symptoms usually begin suddenly and require prompt medical attention.
Aortic dissection
illustration
Aortic rupture - chest X-ray - illustration
Aortic rupture (a tear in the aorta, which is the major artery coming from the heart) can be seen on a chest X-ray. In this case, it was caused by a traumatic perforation of the thoracic aorta. This is how the X-ray appears when the chest is full of blood (right-sided hemothorax) seen here as cloudiness on the left side of the picture.
Aortic rupture - chest X-ray
illustration
Aortic aneurysm - illustration
Abdominal aortic aneurysm involves a widening, stretching, or ballooning of the aorta. There are several causes of abdominal aortic aneurysm, but the most common results from atherosclerotic disease. As the aorta gets progressively larger over time there is increased chance of rupture.
Aortic aneurysm
illustration
Aortic dissection - illustration
Aortic dissection is a condition in which there is bleeding into and along the wall of the aorta (the major artery from the heart). This most often occurs because of a tear or damage to the inner wall of the artery. Although aortic dissection can affect anybody, it is most often seen in men 40 to 70 years old. Symptoms usually begin suddenly and require prompt medical attention.
Aortic dissection
illustration
Review Date: 5/10/2024
Reviewed By: Neil Grossman, MD, Saint Vincent Radiological Associates, Framingham, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.