Aortic dissection is a very rare but life-threatening cardiovascular condition in which the inside lining of the main artery (the aorta) that carries blood away from the heart tears. If the tear in the lining is not treated before the aorta ruptures, the survival rate is less than half.
What Is the Aorta?
The aorta is the main artery that carries blood from the heart to the rest of your body. The aorta is exposed to the highest blood pressure in the body. Like all arteries, the aorta has a smooth layer on the inside, a thick layer of muscle in the middle and a rough layer on the outside. Rarely, this inner lining can tear, and blood will flow between the layers of the artery wall, pushing the layers apart. This means that the pressure of the blood flow can rupture the aorta, causing serious internal bleeding. It also means that blood is no longer flowing adequately to the body’s organs and tissues that are normally supplied by the aorta.
Who Is at Risk of Aortic Dissection?
Aortic dissection can happen to anyone, but men 60–80 years old are at the greatest risk. The following conditions, among others, can increase the risk of aortic dissection:
- Existing aortic aneurysm. An aneurysm is a weakened or bulging area in an artery, which can rupture. A preexisting aneurysm is a risk factor for aortic dissection, and aortic dissection can also cause an aneurysm to form.
- High blood pressure. Hypertension, or high blood pressure, can progressively damage the wall of the aorta, weakening it and making it more likely to tear.
- Atherosclerosis. Atherosclerosis, or “hardening of the arteries,” is when a fatty, waxy substance called plaque builds up in the artery wall. This same disease process is behind heart attacks and the majority of strokes. Plaques that form in the wall of the aorta can weaken the artery wall, making it more susceptible to tearing.
- Trauma to the chest. Blunt trauma to the chest, such as from a car accident, can cause aortic dissection.
- Coarctation of the aorta. This is a congenital (present at birth) defect in which a portion of the aorta is narrowed. Even if this condition is treated and corrected, people who were born with coarctation of the aorta are more susceptible to a weakened aorta wall and resultant aneurysm or dissection.
- Bicuspid aortic valve. A valve between your heart and the aorta regulates blood flow. Normally, this valve has three flaps (leaflets) that open and close to control blood flow. However, someone who is born with a bicuspid valve only has two leaflets. Over time, this valve can leak or stiffen. Some medical researchers think the bicuspid valve is part of a larger connective tissue disorder (the tissues that hold the body together) that affects the walls of the aorta as well, leaving the aorta more susceptible to weakening, bulging, tearing and rupturing.
- Marfan syndrome, Ehlers-Danlos syndrome, Loeys-Dietz syndrome and other connective tissue disorders. These syndromes affect the connective tissues of the body, which hold the body together. These connective tissue disorders can lead to an enlarged aorta or separation of the layers of the aorta’s wall. This makes the aorta more likely to burst or tear.
- Pregnancy. Very rarely, a woman may experience aortic dissection during pregnancy. Typically, the patient will have one or more of the risk factors above that have gone undiagnosed until the additional cardiovascular stressors of pregnancy reveal them.
Diagnosing Aortic Dissection
The symptoms of aortic dissection can mimic a heart attack or stroke. They are:
- Sudden chest pain, often described as a tearing sensation, or pain in the upper back
- Sudden dizziness or fainting
- Sudden nausea or vomiting
- Sudden, severe anxiety
- Sudden shortness of breath
- Sudden difficulty in speaking, vision loss or weakness or paralysis on one side
Aortic dissection is a life-threatening emergency that must be treated emergently. If you or someone you are with has these symptoms, dial 9-1-1 immediately. Even if it is not aortic dissection, it could be a heart attack, stroke or other serious health issue.
Doctors diagnose aortic dissection based on symptoms of chest pain, a murmur in the chest or other unusual sound, a visibly wider aorta on a chest X-ray and blood pressure differences between the left and right arms or between the arms and legs.
The diagnosis will be confirmed through use of more sophisticated imaging techniques, such as:
Treating Aortic Dissection
Treatment depends on where in the aorta the dissection occurs. A dissection can occur in the aorta where it leaves the heart (the ascending aorta), or it can occur in the part of the aorta (descending) that runs down to the rest of the body. If the dissection is in the ascending part of the aorta, it will be treated with surgery. If the dissection is in the descending portion, it may require surgery, a less invasive catheter-based procedure or medications only. The goal of medications will primarily be to lower blood pressure.
Questions to Ask Your Healthcare Provider
- Do I have the risk factors for aortic dissection? If so, what do I need to do or know?
- If my imaging test revealed an aortic aneurysm or tear, what are the next steps?
- I survived an aortic dissection. What do I need to do moving forward? Will I need additional procedures or surgeries? What medications do I need to take? How often should I have follow-up tests?
Aortic dissection is a rare but life-threatening condition. An important risk factor for aortic dissection and a range of other cardiovascular diseases is high blood pressure (hypertension). To learn more about hypertension, visit the SecondsCount High Blood Pressure condition center.
Some forms of congenital heart disease (heart defects that are present at birth) increase the risk of aortic dissection. For more on coarctation of the aorta, bicuspid aortic valve or Marfan syndrome, visit SecondsCount’s Congenital Heart Disease condition center.