Aortic 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.
Aortic aneurysm - dissecting; Chest pain - aortic dissection; Thoracic aortic aneurysm - dissection
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:
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).
The exact cause is unknown, but more common risks include:
Other risk factors and conditions linked to aortic dissection include:
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.
In most cases, the symptoms begin suddenly, and include severe chest pain. The pain may feel like a heart attack.
Symptoms are caused by a decrease of blood flowing to the rest of the body, and can include:
Other symptoms may include:
Aortic dissection is a life-threatening condition and needs to be treated right away.
Two techniques may be used for surgery:
Drugs that lower blood pressure may be prescribed. These drugs may be given through a vein (intravenously). Beta-blockers are the first drugs of 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.
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.
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:
If you have symptoms of an aortic dissection or severe chest pain, call 911 or your local emergency number, or go to the emergency room as quickly as possible.
Many cases of aortic dissection cannot be prevented.
Things you can do to reduce your risk include:
Braverman AC, Schermerhorn M. Diseases of the aorta. In: Zipes DP, Libby P, Bonow RO, Mann, DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 63.
Conrad MF, Cambria RP. Aortic dissection: epidemiology, pathophysiology, clinical presentation, and medical and surgical management. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 9th ed. Philadelphia, PA: Elsevier; 2019:chap 81.
Lederle FA. Diseases of the aorta. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 69.