Aortic dissection

Definition

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.

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 two 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.

Symptoms

In most cases, the symptoms begin suddenly, and include severe chest pain. The pain may feel like a heart attack and it:

Symptoms are caused by a decrease of blood flowing to the rest of the body, and can include:

Other symptoms may include:

Exams and Tests

The health care provider will take your family history and listen to your heart, lungs, and abdomen with a stethoscope. The exam may find:

Aortic dissection or aortic aneurysm may be seen on:

Blood work to rule out a heart attack is needed.

Treatment

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.

Outlook (Prognosis)

Aortic dissection is life threatening. The condition can be managed with surgery if it is done before the aorta ruptures. Less than 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:

When to Contact a Medical Professional

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.

Prevention

Many cases of aortic dissection cannot be prevented.

Things you can do to reduce your risk include:


Review Date: 5/27/2014
Reviewed By: Deepak Sudheendra, MD, Assistant Professor of Interventional Radiology & Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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