Aortic dissection
Also called: Dissecting aneurysm
This can be a medical emergency. Call emergency services immediately for sudden severe chest or back pain.
A tear in the inner lining of the aorta lets blood force its way between the layers of the wall, splitting it apart. It is a surgical emergency with high mortality.
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What happens in the body
Blood enters a tear in the intima and tracks along the media, creating a false channel that can block branch arteries or rupture outward.
Causes
- Tear in the aortic intima
Risk factors
- Uncontrolled high blood pressure
- Marfan, Ehlers–Danlos and Loeys–Dietz syndromes
- Bicuspid aortic valve
- Cocaine use
- Previous aortic surgery
- Pregnancy (rarely)
Symptoms
- Sudden, severe tearing or ripping chest or back pain
- Pain moving down the back
- Different blood pressures in each arm
- Stroke symptoms, fainting, limb or abdominal pain from blocked branches
Diagnosis — tests and examinations
- CT angiography (fastest)
- Transoesophageal echocardiography
- Chest X-ray may show a widened mediastinum
Treatment
Medicines and medical treatment
- Rapid lowering of heart rate and blood pressure (IV beta-blockers)
- Pain relief
Operations and procedures
- Emergency open surgery for type A (ascending aorta) dissection
- Thoracic endovascular aortic repair (TEVAR) for complicated type B
Self-care, home remedies and lifestyle
- Lifelong blood-pressure control and imaging surveillance after recovery
Possible complications
- Rupture
- Cardiac tamponade
- Stroke
- Kidney or bowel ischaemia
- Aortic regurgitation
Prevention
- Blood pressure control; surveillance and elective surgery for people with inherited aortic disease
Outlook
Untreated type A dissection kills 1–2% of patients per hour at first; emergency surgery greatly improves survival.
When to see a doctor
Call emergency services immediately for sudden severe chest or back pain.
Sources and further reading
These sources cover this condition. They have not been checked against every statement on this page.
Related conditions
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