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A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M.; 2013.

A.D.A.M. Medical Encyclopedia.

Aortic dissection

Aortic aneurysm - dissecting

Last reviewed: May 27, 2014.

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.

Aortic dissection

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:

  • One in which blood continues to travel
  • Another where blood stays still

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).

Aortic 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:

  • Can be described as sharp, stabbing, tearing, or ripping
  • Is felt below the chest bone, then moves under the shoulder blades or to the back
  • Can move to the shoulder, neck, arm, jaw, abdomen, or hips
  • Changes position, often moving to the arms and legs as the aortic dissection gets worse

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

Other symptoms may include:

  • Pain in the abdomen
  • Stroke symptoms
  • Swallowing difficulties from pressure on the esophagus

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.

  • Dissections that occur in the part of the aorta that is leaving the heart (ascending) are treated with surgery.
  • Dissections that occur in other parts of the aorta (descending) may be managed with surgery or medicines.

Two techniques may be used for surgery:

  • Standard, open surgery. This requires a surgical incision that is made in the chest or abdomen.
  • Endovascuar aortic repair. This surgery is done without any major surgical incisions.

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:

  • Treating and controlling hardening of the arteries (atherosclerosis)
  • Keeping high blood pressure under control, especially if you are at risk for dissection
  • Taking safety precautions to prevent injuries that can cause dissections
  • If you have been diagnosed with Marfan or Ehlers-Danlos syndrome, making sure you regularly follow-up with your doctor

References

  1. Isselbacher EM. Diseases of the aorta. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 78.

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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Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

What works?

  • Endovascular versus conventional medical treatment for chronic type B aortic dissection (a tear in the lining of the aortic artery)Endovascular versus conventional medical treatment for chronic type B aortic dissection (a tear in the lining of the aortic artery)
    Aortic dissection is a potentially life‐threatening condition that occurs when a tear in the inner lining of the aorta (usually in the chest portion of the artery) causes bleeding between the inner and outer layers of the wall of the aorta. The layers become separated (or dissected) creating a false channel for blood to flow. It is the most common emergency affecting the aorta. Symptoms include sudden, severe, sharp chest pain that spreads to the neck or down the back, sudden difficulty speaking, a weak pulse and loss of consciousness. Aortic dissections typically occur in adults aged between 60 and 70 years, with more males than females. The main cause is thought to be high blood pressure. An aortic dissection is classified depending on where it begins in the aorta and if it is acute or chronic. Acute dissections are diagnosed within 14 days after the first symptoms appear; while chronic ones are diagnosed after 14 days. This review looked at chronic type B dissections, which begin in the descending part of the aorta (the section of the artery that moves down through the chest and abdomen). Patients with this type of aortic dissection have traditionally been treated with blood pressure lowering medications, with good short‐term results (annual survival in excess of 80%). They have, however, increased long‐term mortality. In the long term, medical treatment alone may put some patients at risk of serious complications such as progressive aortic enlargement, poor blood flow to some organs or the extremities, and aortic rupture. Patients with these life‐threatening complications require urgent treatment of the dissected aorta by open surgery or, more recently, endovascular thoracic aortic stent grafting (TEVAR). TEVAR reduces the number of early deaths compared with open surgical treatment.
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Figures

  • Aortic rupture, chest x-ray.
    Aortic aneurysm.
    Aortic dissection.

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