by Polsdorfer R

Definition

Aortic dissection is the separation of layers in the aorta. The aorta is the main artery leading from the heart. Arterial walls have 3 layers. A tear in an inner layer can admit blood under pressure that works its way between layers, causing the layers to dissect apart or separate. This process can squeeze off the main channel so that blood cannot get through the main aorta or any of its branches.

This is a life-threatening event since it can cause stroke , sudden cardiac arrest , or death due to impaired blood flow to a number of vital organs. The enlarging mass of misdirected blood can also compromise nearby structures, such as the airways, lungs, or heart. It may also rupture with catastrophic bleeding.

Heart and Main Vessels
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Causes

Aortic dissection is usually caused by elevated high blood pressure or a diseased aorta. This usually is the result of atherosclerosis .

Risk Factors

Factors that may increase your chances of aortic dissection:

Symptoms

Aortic dissection may cause:

  • Sudden, ripping pain in the chest and or back
  • Stroke
  • Fainting
  • Shortness of breath
  • Sudden weakness

Diagnosis

Aortic dissection is usually a sudden, catastrophic event that results in a medical emergency. At the hospital, the doctor will ask about your symptoms and medical history. A physical exam will be done. Imaging tests evaluate the aorta and surrounding structures. These may include:

Treatment

Treatment depends on where in the aorta the dissection occurs. Once stabilized, you will be further evaluated for the type of treatment needed. One type of aortic dissection requires immediate major surgery. Another type can often be managed without surgery (if no blood vessels are obstructed).

Treatment options may include:

Surgery

The chest is opened, and the aorta is repaired. A stent may be used to replace the damaged segment of aorta.

Medical Treatment

Your blood pressure will be reduced to minimize stress on the aorta. You may undergo repeat imaging studies every 6-12 months to detect further dissection.

Prevention

To help reduce your chances of aortic dissection:

  • Keep high blood pressure and cholesterol under control through diet and/or medications
  • Talk to your doctor about any risk factors you may have for aortic dissection

RESOURCES

American Heart Association  http://www.heart.org 

Family Doctor—American Academy of Family Physicians  https://familydoctor.org 

CANADIAN RESOURCES

Health Canada  https://www.canada.ca 

The College of Family Physicians of Canada  http://www.cfpc.ca 

References

Aortic dissection. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/cardiovascular-disorders/diseases-of-the-aorta-and-its-branches/aortic-dissection. Updated March 2017. Accessed November 30, 2017.

Thoracic aortic aneurysm. EBSCO DynaMed Plus website. Available at:  https://www.dynamed.com/topics/dmp~AN~T908572/Thoracic-aortic-aneurysm  . Updated June 1, 2017. Accessed November 30, 2017.

Thoracic aortic dissection. EBSCO Plus DynaMed website. Available at:  https://www.dynamed.com/topics/dmp~AN~T113709/Thoracic-aortic-dissection  . Updated November 22, 2016. Accessed November 30, 2017.

8/20/2014 DynaMed Plus Systematic Literature Surveillance  https://www.dynamed.com/topics/dmp~AN~T908572/Thoracic-aortic-aneurysm  : Jacobs JE, Latson LA, et al. American College of Radiology (ACR) Appropriateness Criteria for acute chest pain: suggested aortic dissection. Available at: https://acsearch.acr.org/docs/69402/Narrative. Updated 2014.

Revision Information