Aortic dissection

Overview

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.

When to see a doctor

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.

Risk factors

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.

Prevention

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.

Treatment

An aortic dissection is a medical emergency that needs treatment right away. Treatment may include surgery or medicines, depending on the area of the aorta involved.

Type A aortic dissection

Treatment for type A aortic dissection may include:

• Surgery. Surgery is done to remove as much of the damaged aorta as possible and stop blood from leaking into the aortic wall. A lab-made tube called a graft is used to rebuild the aorta. 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.
• Medicines. Medicines can help reduce the heart rate and lower blood pressure. Lowering blood pressure can prevent the aortic dissection from getting worse. Medicines also may be used to control blood pressure before surgery.

Type B aortic dissection

Treatment of type B aortic dissection may include:

• Medicines. The same medicines used to treat type A aortic dissection may be used without surgery to treat type B aortic dissections.
• Surgery. Surgery for type B aortic dissection is similar to that used to treat a type A aortic dissection. Sometimes, small wire mesh tubes called stents may be placed in the aorta to keep it open. The stents are used to repair complicated type B aortic dissections.

After treatment for aortic dissection, you may need to take medicine for life to control blood pressure. You may need regular CT scans or MRI scans to check your heart and blood vessels.