Aortic dissection

An aortic dissection is a medical emergency in which a tear happens in the inner layer of the body's main artery. That artery is called the aorta. Blood rushes through the tear. This causes the inner and middle layers of the artery to split, called a dissection. If the blood goes outside the artery, aortic dissection is often deadly.

Aortic dissection isn't very common. It usually happens in men in their 60s and 70s. Symptoms of aortic dissection may seem like those of other health conditions. This often leads to delays in diagnosis. Early diagnosis and fast treatment of aortic dissection greatly improve the chance of survival.

Aortic dissection and aortic aneurysm

A thoracic aortic aneurysm occurs when a weak spot in the wall of the aorta begins to bulge, as shown on the left image. Having an aneurysm increases the risk of rupture or a tear in the aorta's lining (dissection), as shown in the image on the right.

An aortic dissection may feel like a heart attack or another heart condition. Symptoms of aortic dissection may include:

• Sudden severe chest or upper back pain that spreads to the neck or back. The pain may feel like something is tearing or ripping.
• Sudden severe stomach pain.
• Loss of consciousness.
• Shortness of breath.
• Symptoms like those of a stroke, including sudden vision problems, trouble speaking, and weakness or loss of movement on one side of the body.
• Leg pain and trouble walking.

Call 911 or your local emergency number if you have:

• Severe chest or stomach pain.
• Sudden shortness of breath.
• Symptoms of stroke, such as sudden trouble seeing, speaking or moving.

An aortic dissection is caused by a weakened area in the aorta's wall.

Aortic dissections are divided into two groups, depending on which part of the aorta is affected:

• Type A. This more common and dangerous type involves a tear in the part of the aorta where it exits the heart. The tear also can happen in the upper aorta, called the ascending aorta. The tear may spread into the stomach area.
• Type B. This type involves a tear only in the lower aorta, called the descending aorta. It also may spread into the stomach area.

Things that raise the risk of aortic dissection include:

• High blood pressure, also called hypertension.
• A buildup of fats, cholesterol and other substances in and on the artery walls. This is a condition called atherosclerosis.
• A bulge in the wall of the body's main artery, called an aortic aneurysm.
• An aortic valve with two flaps rather than the usual three, called a bicuspid aortic valve.
• Narrowing of the aorta at birth, called aortic coarctation.

Certain genetic diseases also raise the risk of an aortic dissection, including:

• Turner syndrome. High blood pressure, heart conditions and other health conditions may result from this syndrome.
• Marfan syndrome. This condition weakens connective tissue, which supports various structures in the body. People with this disorder often have a family history of aortic aneurysms or aortic dissections.
• Other connective tissue disorders. These include Ehlers-Danlos syndrome, a group of connective tissue disorders that involve loose joints and fragile blood vessels. These also include Loeys-Dietz syndrome, which causes twisted arteries, especially in the neck.
• Inflammation of the arteries. Also called giant cell arteritis, this condition also may raise the risk of aortic dissection.

Other possible risk factors for aortic dissection include:

• Sex assigned at birth. Men are more likely to have aortic dissection than women.
• Age. Aortic dissection is more likely in people age 60 and older.
• Cocaine use. This illegal drug raises blood pressure for a limited time.
• Pregnancy. Aortic dissections can happen in otherwise healthy people during pregnancy, but this doesn't occur often.
• Intense weightlifting. Strenuous resistance training raises blood pressure during the activity. This may raise the risk of aortic dissection.

Possible complications of aortic dissection include:

• Death due to severe internal bleeding.
• Organ damage, such as kidney failure or life-threatening damage to the intestines.
• Stroke.
• Backward flow of blood through the aortic valve, called aortic regurgitation.
• Poor blood flow caused by a buildup of fluid in the sac that surrounds the heart. This condition is called cardiac tamponade.

You can lower your risk of an aortic dissection by preventing chest injury and taking steps to keep your heart healthy.

• Manage blood pressure, blood sugar and cholesterol. If you have high blood pressure, get a blood pressure measuring device to help you check your numbers at home. If you have high blood sugar or high cholesterol, work with your healthcare professional to bring your levels down.
• Do not smoke. If you smoke, quit. Ask your healthcare team for help.
• Eat a healthy diet. Cut back on sodium and table salt. Choose plenty of fruits, vegetables and whole grains.
• Stay active. Each week, aim to get 150 minutes of moderate physical activity or 75 minutes of vigorous activity, or a mix of both.
• Manage weight. Eat healthy and exercise regularly to manage your weight. Ask your healthcare team what a healthy weight is for you.
• Get enough sleep. Try to get 7 to 9 hours of sleep a night.
• Wear a seat belt. This lowers the risk of chest injury during a car accident.

Tell your healthcare team if you have a family history of aortic dissection, a connective tissue disorder or a bicuspid aortic valve. If you have a genetic condition that raises your risk of aortic dissection, your care team may recommend medicines, even if your blood pressure is healthy.

If you have an aortic aneurysm, find out how often you need checkups and if surgery is needed to repair it.