What is Aortic Dissection?
An aortic dissection is an emergency with your aorta, which is the largest blood vessel in your body and the main artery that carries blood from out of your heart. If you have a dissection of the aorta, it means that blood is leaking outside of the arterial lumen, or interior of the blood vessel. The leaking blood causes a split between the inner and middle layers of the wall of the aorta as it progresses. This can happen if the inner layer of your aorta tears.
Sometimes blood hemorrhages from a rupture in the tiny vessels that supply the outside and middle walls of your aorta. This can potentially cause weakening of the inner layer of the aorta where a tear then could occur, leading to an aortic dissection.
The danger is that the dissection channels blood out of your aorta. This could cause fatal complications, such as rupture of the dissected artery or severe blockage of blood flow where it should be occurring through the normal lumen of the aorta. Serious complications can arise if the dissection ruptures and sends blood into the space around your heart or lungs.
Types of Aortic Dissection
The aorta travels upward when it first leaves your heart. This is called the ascending aorta. It then arches downward, passing from your chest into your abdomen. This is known as the descending aorta. A dissection can occur in the ascending or descending part of your aorta. Aortic dissections are classified as type A or type B:
Most dissections start in the ascending section, where they’re classified as type A.
Dissections that start in the descending aorta are classified as type B. They tend to be less life-threatening than type A.
Causes of Aortic Dissection
Although the exact cause of aortic dissections is unknown, doctors believe that high blood pressure is a contributing factor because it causes strain on the walls of your arteries.
Anything that weakens your aortic wall can cause a dissection. This includes inherited conditions in which your body tissues develop abnormally, such as Marfan’s syndrome, atherosclerosis, and accidental injuries to the chest.
Aortic Dissection Risk factor
According to the Mayo Clinic, your risk of an aortic dissection increases with age and is higher if you’re a male or if you’re in your 60s or 80s.
The following factors can also increase your risk:
- high blood pressure
- conditions such as Marfan’s syndrome, in which your body’s tissues are weaker than normal
- prior surgery on the heart
- smoking tobacco
- atherosclerosis, which is the process of injury, calcified fatty/cholesterol plaque accumulation, and hardening of your arteries
- motor vehicle accidents involving chest injuries
- a faulty aortic valve
- cocaine use, which can cause severe abnormalities in your cardiovascular system
- a congenitally narrowed aorta
Symptoms of Aortic Dissection
The symptoms of an aortic dissection can be difficult to distinguish from those of other heart conditions, such as a heart attack.
Chest pain and pain in the upper back are the most common symptoms of this condition. There’s typically severe pain, coupled with a feeling that something is sharp or tearing in your chest. Unlike in the case of a heart attack, the pain usually begins suddenly when the dissection starts to occur and seems to move around.
Some people have milder pain, which is sometimes mistaken for muscle strain, but this is less common.
Other signs and symptoms include:
- dizziness or confusion
- weakness or paralysis on one side of the body
- a weaker pulse in one arm than in the other
- trouble speaking
Diagnosing Aortic Dissection
Your doctor will examine you and use a stethoscope to listen for abnormal noises coming from your aorta. When your blood pressure is taken, the reading may be different in one arm than in the other.
A test called an electrocardiogram (EKG) looks at electrical activity in the heart. Sometimes an aortic dissection can be mistaken for a heart attack on this test, and sometimes you can have both conditions at the same time.
You will likely need to have imaging scans done. These can include:
- an MRI scan with angiography
- a transesophageal echocardiogram (TEE)
- a chest X-ray
- a contrast-enhanced CT scan
A TEE involves passing a device that emits sound waves down your throat into your esophagus until it’s close to the area at the level of your heart. The ultrasound waves are used to create an image of your heart and aorta.
Aortic Dissection Treatment
Type A dissection requires emergency surgery.
Type B dissection can often be treated with medication, rather than surgery, if not complicated.
You’ll receive drugs to relieve your pain. Morphine is often used in this case. You’ll also get at least one medication to lower your blood pressure, such as a beta-blocker.
The torn section of the aorta is removed and replaced with a synthetic graft. If one of your heart valves has been damaged, this is also replaced.
If you have type B dissection, you may need surgery if the condition continues to worsen even when your blood pressure is under control.
Long-term outlook for people with Aortic Dissection
If you have a type A dissection, emergency surgery before the aorta ruptures gives you a good chance of surviving and recovering. Once your aorta has ruptured, your chances of survival decrease.
Early detection is essential. An uncomplicated type B dissection is usually manageable in the long term with medication and careful monitoring.
If you have a condition that increases your risk of aortic dissection, such as atherosclerosis or hypertension, making adjustments in your lifestyle choices in terms of diet and exercise may help lower your risk for an aortic dissection. Your doctor can prescribe proper medication therapy for hypertension or high cholesterol, if need be. Additionally, not smoking tobacco products also benefits your health.