Aortic Dissection

What is an aortic dissection?

An aortic dissection is a condition in which a tear or split occurs in the aorta. This is often a medical emergency. The aorta is the main blood vessel coming from the heart and supplying blood and oxygen to the entire body. This condition is most common between the ages of 50 and 65, and tends to affect men more commonly than women. The main symptom is a sudden, intense, radiating pain in the chest, upper back or abdomen, which some people describe as a shearing or ripping sensation. An aortic dissection requires emergency treatment and, in most cases, surgery to repair the blood vessel.

Risks

The aorta is the biggest blood vessel in the body, and runs from the heart into the abdomen. An aortic dissection is a splitting or tearing of this blood vessel. This causes bleeding, which can be small or large, depending on the size of the split. Aortic dissection is more common in men than in women and it most often occurs between age 50 and 65. Risk factors for this condition include high blood pressure, smoking and high cholesterol levels. People who have a known weakness of the aortic walls (an aortic aneurysm), or who have had angina, a heart attack or a stroke are at increased risk of this condition. Less common causes are cocaine use and chest injuries (car accidents), which can put pressure on the aorta and cause it to split. Certain inherited diseases are also known to increase the risk of aortic dissection, such as Marfan syndrome and Turner's syndrome.

Symptoms

The symptoms of aortic dissection may be difficult to distinguish from those of other heart conditions. The main symptom is a sudden, intense pain in the chest and upper back, commonly described as a shearing or ripping sensation. This pain may spread to the back, arms or legs, depending on the locations of the dissection. People who have an aortic dissection may have cold hand or feet. They may also feel nauseous, short of breath, sweaty, dizzy and weak, and may collapse, depending on the amount of blood loss.

Diagnosis

The diagnosis is made by a doctor based on the symptoms and appearance of the affected person. In an emergency situation, an ultrasound scan may be done immediately to confirm the diagnosis. Other tests which help confirm the diagnosis are an electrocardiogram (ECG), X-rays of the chest and abdomen, and a CT scan (computed tomography) or MRI scan (magnetic resonance imaging scan).

Treatment

Treatment of aortic dissection involves surgery to repair the tear in the blood vessel. This is often a major surgery, and may be an emergency procedure. Medications to reduce blood pressure are often needed in the long-term to protect the repaired area.

Prevention

Good blood pressure control, reducing cholesterol levels, giving up smoking and regular exercise may all help to reduce the risk of aortic dissection. Avoiding the use of cocaine and other stimulants may also help prevent some episodes of aortic dissection, especially in people who have other risk factors.

Other names for aortic dissection

  • aortic tear