Aortic Dissection

Pain is the leading symptom of aortic dissection. A person typically has a sudden onset of pain at the moment of dissection. The pain is usually described as ripping or tearing and as the worst pain ever experienced. It is usually in between the shoulders on the back and might radiate to the arms or the neck. Less frequently, the pain can be felt as chest pain. The pain is very difficult to distinguish from that of angina or a heart attack.

Other symptoms may include:

• Numbness and the inability to move the legs.
• Sweating.
• Nausea.
• Fainting.
• Pale skin.

Aortic dissection can be caused by atherosclerosis (hardening of the arteries) and high blood pressure, traumatic injury to the chest, such as being hit by the steering wheel of a car during an accident, and conditions that are present at birth, such as Marfan syndrome or Ehlers-Danlos syndrome.

Any one or any combination of the following may cause aortic dissection:

• High blood pressure. Most patients with an aortic dissection have had high blood pressure for many years. The high blood pressure accelerates the natural processes of tissue aging and damage to the tissue, promoting a weakness of the aortic wall and increasing the risk for a tear.
• Chest injury. Severe chest injury, such as might occur in an automobile accident, may also cause aortic dissection.
• Diseases of the connective tissue. Either Marfan syndrome or Ehlers-Danlos syndrome can damage the connective tissue in the middle of the aortic wall. This damage can lead to aortic dissection.
• Other diseases. Certain diseases increase the risk of an aortic dissection. These include lupus, polycystic kidney disease, Cushing's syndrome, giant cell arteritis

A family history of aortic dissection is also a risk factor.

Pregnancy can also increase the risk of a dissection. This risk is caused by the combination of hormonal effect on the tissue structure (elastin fibers) and additional high blood pressure stress.

Illegal drugs that raise blood pressure, such as cocaine, increase the risk of a dissection.

Your doctor will ask about your symptoms, health, and family medical history, and will do a physical exam. You may be asked if you've been hit hard in the chest or been in a car crash.

You may have a CT scan, an MRI, or a transesophageal echocardiogram to diagnose an aortic dissection.

During a physical exam, your doctor will listen to your heart, check your pulse and blood flow, and see how your nerves and brain are working. Because aortic dissection can look like other health problems, you might need several tests. These may include a blood test, a chest X-ray, or an electrocardiogram (EKG).

Aortic dissection needs immediate treatment. Doctors will work to ease your pain and lower your heart rate. If your blood pressure is too high, you will get treatment to lower it. You will get medicine and fluids to support your blood pressure if it's too low.

The treatment depends in part on where the dissection is located. There are two types: type A and type B.

Type A means that the aorta has a dissection near the heart. This is usually treated with emergency open heart surgery. In surgery, the torn part of the aorta is replaced or repaired with a human-made graft.

Type B means that the dissection is somewhere else in the aorta. These are usually treated with medicines. If the aorta ruptured or there are other problems, a procedure or surgery may be done to repair or replace the aorta with a human-made graft.