Diagnosis

Detecting an aortic dissection can be tricky because the symptoms are similar to those of a variety of health problems. Doctors often suspect an aortic dissection if the following signs and symptoms are present:

  • Sudden tearing or ripping chest pain
  • Widening of the aorta on chest X-ray
  • Blood pressure difference between right and left arms

Although these signs and symptoms suggest aortic dissection, more-sensitive imaging techniques are usually needed. Frequently used imaging procedures include:

  • Transesophageal echocardiogram (TEE). This test uses high-pitched sound waves to produce an image of the heart. A TEE is a special type of echocardiogram in which an ultrasound probe is inserted through the esophagus. The ultrasound probe is placed close to the heart and the aorta, providing a clearer picture of your heart than would a regular echocardiogram.
  • Computerized tomography (CT) scan. CT scanning generates X-rays to produce cross-sectional images of the body. A CT of the chest is used to diagnose an aortic dissection, possibly with an injected contrast liquid. Contrast makes the heart, aorta and other blood vessels more visible on the CT pictures.
  • Magnetic resonance angiogram (MRA). An MRI uses a magnetic field and pulses of radio wave energy to make pictures of the body. An MRA uses this technique to look at blood vessels.

Treatment

An aortic dissection is a medical emergency requiring immediate treatment. Therapy may include surgery or medications, depending on the area of the aorta involved.

Type A aortic dissection

Treatment for type A aortic dissection may include:

  • Surgery. Surgeons remove as much of the dissected aorta as possible, block the entry of blood into the aortic wall and reconstruct the aorta with a synthetic tube called a graft. If the aortic valve leaks as a result of the damaged aorta, it may be replaced at the same time. The new valve is placed within the graft used to reconstruct the aorta.
  • Medications. Some medications, such as beta blockers and nitroprusside (Nitropress), reduce heart rate and lower blood pressure, which can prevent the aortic dissection from worsening. They may be given to people with type A aortic dissection to stabilize blood pressure before surgery.

Type B aortic dissection

Treatment of type B aortic dissection may include:

  • Surgery. The procedure is similar to that used to correct a type A aortic dissection. Sometimes stents — small wire mesh tubes that act as a sort of scaffolding — may be placed in the aorta to repair complicated type B aortic dissections.
  • Medications. The same medications that are used to treat type A aortic dissection may be used without surgery to treat type B aortic dissections.

After treatment, you may need to take blood pressure lowering medication for life. In addition, you may need follow-up CTs or MRIs periodically to monitor your condition.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Oct. 28, 2014
References
  1. Manning WJ. Clinical manifestations and diagnosis of aortic dissection. http://www.uptodate.com/home. Accessed Sept. 8, 2014.
  2. Manning WJ. Management of aortic dissection. http://www.uptodate.com/home. Accessed Sept. 8, 2014.
  3. AskMayoExpert. Thoracic aortic aneurysm and dissection. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.
  4. JCS Joint Working Group. Guidelines for diagnosis and treatment of aortic aneurysm and aortic dissection. Circulation Journal. 2013;77:789.
  5. Prevention: What you can do. Centers for Disease Control and Prevention. http://www.cdc.gov/heartdisease/what_you_can_do.htm. Accessed Sept. 8, 2014.