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What is aortic dissection?
Aortic dissection is a life-threatening condition where the innermost layer of the largest blood vessel in the body (the aorta) tears.
Blood flows into the space between the inner and middle layers of the aorta, which causes these layers to separate (dissect). Then the outside wall of the aorta may tear open.
A dissection usually happens spontaneously and suddenly. It causes intense pain.
If not caught and treated, it can cause loss of blood flow to your organs, stroke, heart attack, and even death.
Most common symptoms
If you have sudden and severe upper chest pain or upper back pain (or both) that feels like a ripping or tearing sensation, get immediate, emergency medical attention. —Dr. Sunny Varshney
The symptoms of aortic dissection come on suddenly.
Signs include severe chest and/or upper back pain that feels like a tearing or ripping sensation, severe abdominal pain, loss of consciousness, and trouble breathing.
You can also have stroke-like symptoms, including trouble speaking, vision changes, weakness in one side of the body, or difficulty walking.
- Sudden, severe chest and/or upper back pain
- Sudden loss of consciousness
- Sudden abdominal pain
- Trouble breathing
- Stroke-like symptoms, such as trouble speaking, vision changes, and/or weakness in one side of the body
Aortic dissection is a life-threatening condition.
If you are experiencing severe chest pain, sudden fainting or abdominal pain, trouble breathing, or any of the other symptoms of an aortic dissection, you should go to the ER or call 911.
What is the main cause of aortic dissection?
Sometimes, an aortic dissection is brought on in a moment of significant emotional or physical stress (e.g., heavy weight lifting). Don’t dismiss it as muscle pain or indigestion because if aortic dissection is left untreated, it is typically fatal. —Dr. Varshney
Aortic dissection happens when the inner layer of the aorta (called the intima) tears.
There are several different factors that can weaken the aorta and cause an aortic dissection. These can include high blood pressure, plaque in the arteries, chest trauma from something like a car accident, an aortic aneurysm (a bulge in the aorta), or cigarette smoking.
Abnormalities in the heart or the aorta that are congenital (present at birth), like Marfan syndrome, can also cause a dissection.
Less common conditions like connective tissue disorders, inflammatory conditions, or infections like syphilis or tuberculosis also put you at higher risk.
Risk factors for aortic dissection:
- High blood pressure (hypertension).
- Plaque in the arteries (atherosclerosis).
- Smoking cigarettes, which contributes to high blood pressure and plaque build-up.
- Chest trauma, from an accident.
- Aortic aneurysm (enlargement or bulging of the aorta).
- Bicuspid aortic valve disease or other congenital heart and aorta syndromes (such as Marfan syndrome).
Less common risk factors include:
- Connective tissue disorders like Ehlers-Danlos syndrome or Loeys-Dietz syndrome that weaken blood vessels.
- Inflammatory conditions such as giant cell arteritis.
- Aortitis (inflammation of the aorta) due to infections like syphilis or tuberculosis.
Treatment for aortic dissection
I once had a patient who had his second aortic dissection at a relatively young age and without traditional risk factors. We did genetic testing and he was diagnosed with a rare connective tissue disorder (e.g., Marfan syndrome). Even though there is no specific treatment for this disorder, we could give him valuable information on his prognosis. We also suggested screening tests for his family members, some of whom were found to have the same connective tissue disorder. —Dr. Varshney
You’ll need to be admitted to the hospital, but treatment depends on which part of the aorta is damaged.
If the dissection is in the part of the aorta close to the heart (called a Type A dissection), emergency surgery is typically required. The surgeon will remove the torn portion of the blood vessel and replace it with synthetic graft material.
If the dissection is further away from the heart (called a Type B dissection), you’ll be admitted to the intensive care unit (ICU) and given blood pressure-lowering medications through an IV line (intravenously). Then, oral medicine will be given over several days to continue to lower your blood pressure.
Sometimes Type B dissections also need urgent surgery, if the tear involves important arteries coming off the aorta (like those that bring blood to the kidneys or spine). You may also need surgery if the dissection is quickly growing despite the blood pressure medications.
The medications used to lower blood pressure include:
- Beta blockers (such as labetalol or metoprolol): These lower your heart rate and can lower blood pressure, which reduces the chance of a dissection getting larger or rupturing the aorta.
- Calcium channel blockers (such as nicardipine): These lower your blood pressure by causing the muscle cells around the blood vessel to relax.
- ACE inhibitors (such as captopril or lisinopril): These are oral medications to transition to after blood pressure has been stabilized with IV drugs.
What is the survival rate for aortic dissection?
The chance of survival depends directly on how quickly you get to a hospital and the type of tear. Once there, the survival rate depends on the type of tear. For Type A, the in-hospital survival rate after surgery is approximately 70% to 80%. For Type B, it's about 90%.
Without any treatment, the chance of dying from an aortic dissection is 1% to 3% per hour after it happens. About 20% of people with aortic dissection die before they get to the hospital.
You will need to follow up with a cardiologist (heart specialist) or vascular medicine specialist (a doctor who specializes in diseases of the arteries and veins). If you had surgery or any other procedure to repair the aorta, your surgeon will tell you when to come back for a re-check.
You may need regular scans of your aorta to make sure the repair is intact. Your medications may have to be adjusted periodically to make sure that your blood pressure and heart rate are under good control.
- If you smoke, stop. Smoking cigarettes raises your risk of high blood pressure and plaque build-up in the arteries. Both of these conditions can increase your risk for an aortic dissection.
- Make sure your blood pressure is within normal range (at or below 120/80). Well-controlled blood pressure can lower your risk significantly.
- If you have any congenital abnormalities, connective tissue disorders, or an aortic aneurysm, talk to a cardiologist or vascular medicine specialist. They can help identify when your aorta may need to be repaired before a dissection happens.
Dr. Varshney is a board-certified Internist and current Cardiovascular Medicine Fellow at Brigham and Women's Hospital / Harvard Medical School. He earned his undergraduate degree in Biomedical Engineering from Washington University in St. Louis (2010) and graduated first in his class from the University of Texas Southwestern Medical School (2014). He then completed an internal medicine residency at Brigham and Women's Hospital / Harvard Medical School. Following this, he worked as a hospitalist at Brigham and Women's Hospital for 1 year while completing multiple projects spanning translational, clinical, and implementation research. He then began Cardiovascular Medicine Fellowship at Brigham and Women's Hospital in 2018.
Dr. Varshney is interested in the evidence-based design, development, evaluation, and implementation of technologies to improve outcomes for patients with cardiovascular disease. He has a particular interest in remote monitoring and mechanical circulatory support devices and is pursuing multiple academic endeavors in these areas. He plans to complete additional clinical training in the care of patients with advanced heart failure, cardiac transplantation, or need for mechanical circulatory support after completing Cardiovascular Medicine Fellowship. He has published multiple articles in the peer-reviewed medical literature and has written for other outlets including U.S. News & World Report and Doximity.