Definition

Aortic dissection is a condition in which there is bleeding into and along the wall of the aorta (the major artery from the heart). This condition may also involve abnormal widening or ballooning of the aorta (aneurysm).

Alternative Names

Aortic aneurysm - dissecting

Causes

Aortic dissection involves bleeding into and along the wall of the aorta (the major artery from the heart), most often because of a tear or damage to the inner wall of the artery. This usually occurs in the thoracic (chest) portion of the aorta, but may also occur in the abdominal portion.

The exact cause is unknown, but risks include atherosclerosis (hardening of the arteries) and high blood pressure. Traumatic injury is a major cause of aortic dissection, especially blunt trauma to the chest as can be caused by hitting the steering wheel of a car during an accident.

Aortic dissection may also be associated with other injury, infection, congenital (present from birth) weakness of the aorta, collagen disorders (such as Marfan's syndrome, pseudoxanthoma elasticum, Ehlers-Danlos syndrome, relapsing polychondritis, or abdominal aortic aneurysm). Pregnancy, valve disorders (including aortic insufficiency), and coarctation of the aorta may also be associated with aortic dissection.

Aortic dissection occurs in approximately 2 out of every 10,000 people. It can affect anyone, but is most often seen in men aged 40 to 70.

Symptoms

chest pain
- sudden, severe, sharp, stabbing, tearing, or ripping
- located below the sternum, then radiates under the shoulder blades or to the back
- may radiate to shoulder, neck, arm, jaw, abdomen, or hips
- location may change -- pain typically moves distally (to arms and legs) as the aortic dissection progresses in the same direction
changes in thought ability, confusion, disorientation
decreased movement, any location
decreased sensation, any location
intense anxiety, anguish
pallor
rapid pulse
profuse sweating
dry skin/mouth, thirst
nausea and vomiting
dizziness, fainting
shortness of breath -- difficulty breathing when lying flat (orthopnea)

The symptoms usually begin suddenly.

Additional symptoms that may be associated with this disease:

excessive yawning
clammy skin
weak or absent pulse
cough
high blood pressure

Exams and Tests

Listening with a stethoscope at the chest and abdomen may reveal a "blowing" murmur over the aorta, a heart murmur, or other abnormality. There may be decreased (weak) pulses in the arms and hands.

There may be low blood pressure, bulging neck veins, or signs resembling a heart attack. There may be signs of shock (inadequate blood flow to the body tissues), but with normal blood pressure.

Aortic dissection or aortic aneurysm may be revealed on:

Echocardiogram -- ultrasound examination of the heart
Transesophageal echocardiogram (TEE)
Chest x-ray -- may show mediastinal (chest) widening or pleural effusion (fluid in the lining of the lung)
Chest MRI or CT scan of chest with dye
Aortic angiography
Doppler ultrasonography (occasionally performed)

Treatment

The goal of treatment is prevention of complications. Hospitalization is required.

Antihypertensives (drugs that lower blood pressure) may be prescribed, and these may be given through a vein (intravenous). Potent pain relievers are usually needed. Cardiac medications such as beta-blockers may reduce some of the symptoms.

Surgical repair or replacement of the section of aorta is curative in some cases. If the aortic valve is compromised by the dissection, aortic valve replacement is necessary. If the coronary (heart) arteries are involved, a coronary bypass is also performed.

Outlook (Prognosis)

Aortic dissection is life-threatening. The likelihood of death within the first 48 hours is 1% per hour for untreated patients. The disorder is curable with surgical repair if it is performed before aortic rupture. Less than half of patients with ruptured aorta survive.

Possible Complications

bleeding from the aorta
aortic rupture causing rapid blood loss, shock
clot formation
insufficient circulation past the area of the dissection
irreversible kidney failure
stroke
heart attack
cardiac tamponade -- a condition where fluid acccumulates in the lining of the heart, which impairs the heart's ability to pump out blood

When to Contact a Medical Professional

If symptoms indicate aortic dissection or severe chest pain, call 911 or go to the emergency room as quickly as possible.

Prevention

Adequate treatment and control of atherosclerosis (hardening of the arteries) and high blood pressure may reduce the risk. Take safety precautions to prevent injuries. Many cases are not preventable.