Aortic Dissection

What is an Aortic Dissection

Aortic dissection happens when there is a tear in the wall of the body’s main blood vessel (aorta).

The aorta leads out of the heart (ascending aorta), curves around, and then goes down the chest (descending aorta) and into the abdomen to supply arteries with blood. The wall of the aorta has inner and outer layers.

As blood collects along the tear, one part of the aorta continues to carry blood to the body, but blood can also flow into the tear between the layers of the aorta. The torn part of the aorta fills with blood and swells.

This can reduce blood flow through the part of the aorta that is still supplying blood to the body. Aortic dissection is a medical emergency.

What are the causes?

Aortic dissection is commonly caused by weakening of the artery wall due to high blood pressure. Other causes may include:

• An injury, such as from a car crash.
• A complication from heart surgery or from a diagnostic procedure called coronary catheterization.
• Weakness of the artery wall due to birth defects that affect the connective tissues, such as Marfan syndrome.

In some cases, the cause is not known.

What increases the risk?

The following factors may make you more likely to develop this condition:

• Having certain medical conditions, such as:
  • High blood pressure (hypertension).
  • Hardening and narrowing of the arteries (atherosclerosis).
  • A condition that causes inflammation of blood vessels, such as giant cell arteritis.
• Having a bicuspid aortic valve.
• Having an aortic aneurysm.
• Being male.
• Being pregnant.
• Being older than age 60.
• Using cocaine.
• Smoking.
• Lifting heavy weights or doing other types of strength training (high-intensity resistance training).

What are the signs or symptoms?

Signs and symptoms of aortic dissection start suddenly. The most common symptoms are:

• Severe chest pain that may feel like tearing, stabbing, or sharp pain.
• Severe pain that spreads (radiates) to the back, neck, jaw, or abdomen.

Other symptoms may include:

• Trouble breathing.
• Dizziness or fainting.
• Sudden weakness on one side of the body.
• Nausea or vomiting.
• Trouble swallowing.
• Coughing up blood.
• Vomiting blood.
• Clammy skin.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms and a physical exam. This may include:
  • Listening for abnormal blood flow sounds (murmurs) in your chest or abdomen.
  • Checking your pulse in your arms and legs.
  • Checking your blood pressure to see whether it is low, or whether there is a difference between the measurements (readings) from your right arm and left arm.
• Electrocardiogram (ECG). This test measures the electrical activity in your heart.
• Chest X-ray.
• CT scan.
• MRI.
• Echocardiogram. This uses sound waves to make images of your heart.
• Blood tests.

How is this treated?

It is important to treat aortic dissection as quickly as possible. Treatment may start as soon as your health care provider thinks that you have aortic dissection. Treatment depends on where the dissection is, how severe it is, and your overall health. Treatment may include:

• Medicines to lower your heart rate and blood pressure.
• Surgery to repair your aorta using artificial material (syntheticgraft).
• A medical procedure to insert a stent-graft into the aorta (endovascular procedure). During this procedure, a long, thin tube (stent) is inserted into an artery near the groin (femoral artery) and moved up to the damaged part of the aorta. Then, the stent is opened to help improve blood flow and prevent future dissection.

Follow these instructions at home:

Activity

• Do notlift anything that is heavier than 10 lb (4.5 kg) until your health care provider approves.
• Avoid activities that could injure your chest or your abdomen. Ask your health care provider what activities are safe for you.
• After you have recovered, try to stay active. Ask your health care provider what activities are safe for you after recovery.
• Enroll in cardiac rehabilitation. This is a program that helps to improve your health and well-being. It includes exercise training, education, and counseling to help you recover.

Lifestyle

• Eat a heart-healthy diet, which includes lots of fresh fruits and vegetables, low-fat (lean) protein, and whole grains.

Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay healing after surgery. If you need help quitting, ask your health care provider.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Talk with your health care provider about how to manage stress.
• Keep all follow-up visits as told by your health care provider. This is important.

Get help right away if you:

• Develop any symptoms of aortic dissection after treatment, including severe pain in your chest, back, or abdomen.
• Have pain in your abdomen.
• Have trouble breathing or develop a cough.
• Faint.
• Develop a racing heartbeat (palpitations).

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

• Aortic dissection happens when there is a tear in the wall of the body’s main blood vessel (aorta). It is a medical emergency.
• The most common symptom is severe pain in the chest or pain that spreads (radiates) to the back, neck, jaw, or abdomen.
• It is important to treat aortic dissection as quickly as possible. Treatment usually includes medicines and surgery.
• Take over-the-counter and prescription medicines only as told by your health care provider.