DefinitionAortic dissection occurs when the layers of the aorta separate. The aorta is the main artery leading from the heart. Arterial walls have three 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 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.
|Heart and Main Vessels|
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CausesAortic dissection is usually caused by elevated high blood pressure or a diseased aorta. This usually is the result of atherosclerosis .
Risk FactorsFactors that may increase your chance of aortic dissection include:
- Chest injury or surgical mishap
- Hereditary connective tissue disorders, such as Ehlers-Danlos syndrome or Marfan's syndrome
- Late pregnancy
- High cholesterol
- Untreated, late stage syphilis
SymptomsAortic dissection may cause:
- Sudden, ripping pain in the chest and or back
- Shortness of breath
- Sudden weakness
DiagnosisAortic dissection is a 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
- Aortography—x-rays taken after dye is injected into the aorta through a surgically placed catheter
TreatmentTreatment 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:
SurgeryThe chest is opened, and the aorta is repaired. A stent may be used to replace the damaged segment of aorta.
Medical TreatmentYour blood pressure will be reduced to minimize stress on the aorta. You may undergo repeat imaging studies every 6-12 months to detect further dissection.
PreventionTo help reduce your chance 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
American Heart Association
Family Doctor—American Academy of Family Physicians
The College of Family Physicians of Canada
Aortic dissection. The Merck Manual Professional Edition website. Available at: http://www.merckmanuals.com/professional/cardiovascular%5Fdisorders/diseases%5Fof%5Fthe%5Faorta%5Fand%5Fits%5Fbranches/aortic%5Fdissection.html. Updated May 2014. Accessed August 20, 2014.
Isselbacher K, et al. Harrison's Principles of Internal Medicine. 14th ed. New York: McGraw-Hill; 1998.
Mukherjee D, Eagle KA. Aortic dissection–an update. Curr Probl Cardiol. 2005 Jun;30(6):287-325.
Thoracic aortic aneurysm and dissection. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 11, 2014. Accessed August 20, 2014.
8/20/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Jacobs JE, Latson LA, et al. American College of Radiology (ACR) Appropriateness Criteria for acute chest pain: suggested aortic dissection. Available at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/AcuteChestPainSuspectedAorticDissection.pdf. Updated 2014. Accessed August 20, 2014.
- Reviewer: Michael J. Fucci, DO
- Review Date: 12/2014
- Update Date: 12/20/2014
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