Aortic dissection (patient information)

Associate Editor-In-Chief:

What is aortic dissection?
Aortic dissection is when the layers within the aortic wall separate, which cause bleeding into and along the walls of the aorta, the major artery carrying blood out of the heart.

What are the symptoms of aortic dissection?
The symptoms usually begin suddenly, and include severe chest pain. The pain may:
 * Be described as sharp, stabbing, tearing, or ripping
 * Be felt below the chest bone, then moves under the shoulder blades or to the back
 * Move to the shoulder, neck, arm, jaw, abdomen, or hips
 * Change position -- pain typically moves to the arms and legs as the aortic dissection gets worse

Other symptoms may include:
 * Changes in thought ability, confusion, disorientation
 * Decreased movement in any part of the body
 * Decreased sensation in any part of the body
 * Dizziness
 * Dry mouth
 * Dry skin
 * Fainting
 * Nausea and vomiting
 * Pallor
 * Profuse sweating (clammy skin)
 * Rapid, weak pulse
 * Shortness of breath -- difficulty breathing when lying flat (orthopnea)

What causes aortic dissection?
The exact cause is unknown, but risks include atherosclerosis (hardening of the arteries) and high blood pressure. Traumatic injury is a major cause of aortic dissection, especially blunt trauma to the chest. Hitting the steering wheel of a car during an accident is a common traumatic cause.

Other risk factors and conditions associated with the development of aortic dissection include:
 * Aging
 * Bicuspid aortic valve
 * Coarctation (narrowing) of the aorta
 * Connective tissue disorders
 * Ehlers-Danlos syndrome
 * Heart surgery or procedures
 * Marfan syndrome
 * Pregnancy
 * Pseudoxanthoma elasticum
 * Vascular inflammation due to conditions such as arteritis and syphilis

When to seek medical care
If you have symptoms of aortic dissection or severe chest pain, call 911 or your local emergency number, or go to the emergency room as quickly as possible.

Treatment options
Type A aortic dissections require immediate surgery to repair the aorta. Type B aortic dissections may be treated with medication first. Drugs that lower blood pressure may be prescribed. These drugs may be given through a vein (intravenously). Strong pain relievers are usually needed. Heart medications such as beta-blockers may reduce some of the symptoms. If the aortic valve is damaged, valve replacement is necessary. If the heart arteries are involved, a coronary bypass is also performed. Treatment options will be based on whether the patient has type A or type B aortic dissection.

What to expect (Outlook/Prognosis)
Aortic dissection is life threatening. However, the condition may be managed with surgery if it is done before the aorta ruptures. Less than half of patients with ruptured aorta survive.

Possible complications

 * Aortic rupture causing rapid blood loss, shock
 * Bleeding from the aorta
 * Blood clots
 * Cardiac tamponade
 * Heart attack
 * Not enough blood flow past the dissection
 * Permanent kidney failure
 * Stroke