Aortic Dissection Symptoms, Causes & Treatment Options

Aortic dissection is a dangerous condition that occurs when the aorta (largest blood vessel in the body) becomes damaged and the inner layer tears away. This separation leads to blood inappropriately accumulating between the layers of the aorta, which may result in rupture of the vessel if under significant pressure.

Aortic Dissection Symptom Checker

Take a quiz to find out if your symptoms point to aortic dissection

Contents

  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. References

What Is Aortic Dissection?

Summary

Aortic dissection is a life-threatening diagnosis which involves damage to the largest artery in your body, called the aorta [1]. There are various types of dissection, depending on the location of the damage, and these types may involve different management steps. Common causes include persistent or uncontrolled high blood pressure, underlying genetic disorders, or trauma.

Aortic dissections can lead to severe injury and possible death if the aorta becomes completely torn or ruptured [2]. Aortic dissections can also spread along the aorta and directly affect the heart or other vital organs and cause significant damage [3].

Common symptoms include chest pain, and chest pain traveling to the back or neck, abdominal pain, dizziness or nausea and sweating, shortness of breath, and uncontrolled high blood pressure. The classic symptom is described as severe and sudden chest pain that feels sharp or tearing in nature and the worst pain ever felt [4,5].

Treatment revolves around the type or location of the aortic dissection and may involve IV medications with close monitoring or emergent surgical intervention.

Recommended care

Aortic Dissection Symptoms

Main symptoms

Aortic dissection is an uncommon disease, but it has a high rate of mortality if untreated [4,5]. Pain is the most common symptom, and it is present in roughly 90% of cases [5]. As noted above, this is usually sudden and severe and has a sharp quality in nature. The pain may be in the chest or upper back, abdomen or lower back, and the neck or jaw. However, some people may experience nausea and vomiting, dizziness, or passing out [5].

  • Chest pain: This can be related directly to the increased pressure and stretch as the aorta may expand. Direct involvement of the heart/coronary vessels can also mimic symptoms of a heart attack.
  • Back pain: Sometimes the chest pain travels or radiates to the back, especially in the upper region.
  • Neck pain: If the dissection also involves vessels leading from the aorta to the head, it can also cause neck discomfort.
  • Palpitations or fast heart rate: Your heart may be beating very quickly in response to the blood pooling into the false lumen
  • Lightheadedness or dizziness: Similar to neck pain, if the dissection involves other vessels leading to the head, this can cause you to feel like passing out, and may also cause visual changes and headache.
  • Shortness of breath: In aortic dissection, decreased proper blood flow to the heart and vital organs can cause you to feel short of breath as you need more oxygenation.
  • Nausea or vomiting
  • High blood pressure: Hypertension is one of the common causes of aortic dissection, and you may have elevated blood pressures due to pain as well as part of your body’s response to the disease. Less commonly, low blood pressure can be seen, which is a sign of decompensation and serious injury

Aortic Dissection Causes

The aorta is made up of 3 layers or walls, with the innermost layer being the most stretchable and dynamic [2]. When there is increased pressure or force (i.e. uncontrolled high blood pressure) and structural weakening, this can tear the inner walls of the aorta [1,2]. This then leads to blood flow into a “secondary channel” in between the layers of the aorta, which is called the false lumen [2]. Blood flow into a false lumen creates further damage to the aorta, which prevents blood from properly flowing to the rest of the body.

Hypertension

High blood pressure has been noted in about 75% of people who end up developing an aortic dissection [1]. As mentioned above, high blood pressure can wear down the inner layer of the aorta over time, and make it more prone to tear. In addition, high cholesterol can lead to “atherosclerosis” or hardening of arteries and damage the integrity of the aorta wall [4].

Genetic Disorders

Certain genetic disorders increase the risk of aortic dissection due to underlying anatomical or tissue related weaknesses in the aorta [4].

  • Marfan syndrome
  • Loeys-Dietz syndrome
  • Ehlers-Danlos syndrome
  • Hereditary TAA/D (thoracic aortic aneurysm/dissection)

Trauma and exposures

Direct impact from blunt or penetrating trauma can cause injury to the aorta and lead to a dissection as well. Cardiac procedures or certain exposures i.e. drug use can also increase the risk [4].

  • Coronary artery bypass surgery
  • Aortic valve replacement
  • Motor vehicle accident
  • Cocaine use

Inflammatory conditions

There are certain infectious or autoimmune diseases that can lead to aortic dissection due to inflammation of the aorta [4].

  • Giant cell arteritis
  • Syphilis
  • Takayasu arteritis

Aortic Dissection Symptom Checker

Take a quiz to find out if your symptoms point to aortic dissection

Treatment Options, Relief, and Prevention for Aortic Dissection

Treatment

Aortic dissection, once identified, needs prompt treatment and emergent evaluation by specialists.

Medications

Blood pressure needs to be appropriately reduced immediately as well as heart rate through medications such as intravenous beta-blockers. This helps decrease some of the force on the aorta [1,5]. Pain medications should also be provided to help decrease the body’s overall stress response [5]. Additional medications may be added to help with blood pressure reduction.

Type A vs Type B dissection

Ultimately, cardiothoracic or vascular surgery specialists should be involved in the treatment process, since certain types of dissections may require emergency surgery [1].

Your aorta starts off upwards from the heart and then makes an arch, and descends into the abdomen from the chest region [4]. Generally, aortic dissections located more proximal (to the heart), or part of the ascending aorta, may require surgery. These are classified as type A dissections [4].

Dissections located further away (from the heart and chest region) may be managed with medications and close observation [4]. These are often classified as type B dissections and involve the descending portion of the aorta [4]. If any vital organs are also directly injured by the aortic dissection, then emergent surgery may be necessary [4].

Prevention

As with all cardiac and blood vessel-related health, it’s important to maintain a healthy lifestyle in order to lower the risk of developing an aortic dissection [1]. Actively managing your blood pressure as well as diet control, smoking cessation, and regular exercise are important parts of primary prevention.

In particular, if you have a family member with a history of aortic dissection or aneurysm, you should speak with your doctor about potential screening tests and exams to look for any early signs [1]. As mentioned above, there are certain genetic disorders such as Marfan syndrome that may increase a person’s risk for dissection.

If you have already experienced an aortic dissection and have been treated, your specialists (including your cardiologist or surgeon) may prescribe medications such as a beta-blocker to help decrease your heart rate and blood pressure [4]. Often, your doctor will plan for routine follow up scans of your aorta to reassess the condition. You may also be placed on daily aspirin and cholesterol-lowering medications [4].

In summary, prevention involves the following:

  • Healthy diet and regular exercise (as guided by your doctor)
  • Avoidance of smoking
  • Taking important prescribed medications regularly to help control blood pressure, heart rate, and cholesterol levels
  • Normal body weight
  • Controlling any other active conditions such as diabetes

When to Seek Further Consultation for Aortic Dissection

If you experience any of the symptoms noted above, especially in the setting of particular risk factors mentioned such as high blood pressure or cholesterol, or underlying inflammatory disease, or genetic conditions such as Marfan syndrome or Ehlers-Danlos syndrome or Loeys-Dietz syndrome, please go to the emergency department for further evaluation.

There are many other diagnoses that may be considered with the same symptoms, and your doctor may perform additional lab tests or imaging studies to determine the cause of your symptoms.

Aortic dissection is a life-threatening and dangerous condition that requires immediate attention and therapy.

References

  1. Braverman AC. Acute Aortic Dissection. Circulation. 2010; 122(2): 184-188

  2. Criado FJ. Aortic Dissection. Texas Heart Institute Journal. 2011; 38(6): 694-700

  3. Pape LA, Awais M, Woznicki EM, Suzuki T, Trimarchi S, et al. Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection. Journal of the American College of cardiology. 2015; 66(4): 350-358

  4. Salameh MJ. Ratchford EV. Aortic Dissection. Society for Vascular Medicine. 2016; 21(3):276-280

  5. Strayer RJ, Shearer PL, Hermann LK. Screening, Evaluation, and Early Management of Acute Aortic Dissection in the ED. Current Cardiology Reviews. 2012; 8(2): 152-157