Definition

Aortic dissection is the separation of layers in the aorta. The aorta is the main artery leading from the heart. Arterial walls have 3 layers. A tear in an inner layer can admit blood under pressure that works its way between layers, causing the layers to dissect apart or separate. This process can squeeze off the main channel so that blood cannot get through the main aorta or any of its branches.

This is a life-threatening event since it can cause stroke, sudden cardiac arrest, or death due to impaired blood flow to a number of vital organs. The enlarging mass of misdirected blood can also compromise nearby structures, such as the airways, lungs, or heart. It may also rupture with catastrophic bleeding.

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Causes

Aortic dissection is usually caused by elevated high blood pressure or a diseased aorta. This usually is the result of atherosclerosis.

Risk Factors

Factors that may increase your chances of aortic dissection:

• High blood pressure
• Atherosclerosis
• Chest injury or surgical mishap
• Hereditary connective tissue disorders, such as Ehlers-Danlos syndrome or Marfan syndrome
• Late pregnancy
• Smoking
• High cholesterol
• Untreated, late stage syphilis

Symptoms

Aortic dissection may cause:

• Sudden, ripping pain in the chest and or back
• Stroke
• Fainting
• Shortness of breath
• Sudden weakness

Diagnosis

Aortic dissection is usually a sudden, catastrophic event that results in a medical emergency. At the hospital, the doctor will ask about your symptoms and medical history. A physical exam will be done. Imaging tests evaluate 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 through a surgically placed catheter

Treatment

Treatment depends on where in the aorta the dissection occurs. Once stabilized, you will be further evaluated for the type of treatment needed. One type of aortic dissection requires immediate major surgery. Another type can often be managed without surgery (if no blood vessels are obstructed).

Treatment options may include:

Prevention

To help reduce your chances of aortic dissection:

• Keep high blood pressure and cholesterol under control through diet and/or medications
• Talk to your doctor about any risk factors you may have for aortic dissection