Aortic dissection is a grave condition characterized by a tear in the inner layer of the body’s primary artery, the aorta. This tear prompts a rush of blood through the opening, leading to a division of the inner and middle layers of the aorta, known as dissection. When the blood breaches the outer wall of the aorta, aortic dissection becomes highly lethal. This condition primarily affects men in their 60s and 70s. Aortic dissection is an extremely life-threatening condition, with approximately 40% of patients succumbing to immediate rupture and severe bleeding. The risk of fatality can escalate rapidly, with a potential mortality rate of 1% to 3% per hour until prompt medical intervention is received. Should you experience symptoms such as intense chest pain or signs of a stroke, it is imperative to dial 911 or seek emergency medical care without delay. 

Causes of Aortic Dissection

Several factors can contribute to the development of aortic dissection. Uncontrolled high blood pressure, the use of stimulant or illicit drugs like methamphetamine or cocaine, high-intensity weightlifting, and certain hereditary and genetic conditions such as Marfan Syndrome, Vascular Ehlers-Danlos Syndrome (VEDS), Loeys-Dietz Syndrome, and Turner Syndrome are known risk factors. Additionally, a family history of thoracic aortic aneurysm or dissection, the presence of aneurysms (weakened and bulging areas) in the aorta, chest trauma from accidents, structural heart problems such as coarctation of the aorta and bicuspid aortic valve, high cholesterol with atherosclerosis, and smoking can all increase the risk.

Types of Aortic Dissection

Aortic dissection can be classified into two types: Type A and Type B. Type A dissections involve the ascending aorta, which is the part closest to the heart. The tear may extend through the descending aorta towards the abdomen. This type is more common and necessitates immediate treatment or surgery. Type B dissections, on the other hand, do not involve the ascending aorta and originate in the descending aorta. In some cases, Type B dissections can be managed with medication and may not require surgical intervention.

Treatments for Aortic Dissection Primarily Involve

  • Surgery: Surgical intervention is often necessary for aortic dissection. The specific procedure depends on the location and severity of the dissection. Surgery aims to repair or replace the damaged portion of the aorta to prevent further complications.
  • Medication: Medications such as beta-blockers may be prescribed to manage blood pressure and heart rate, reducing the stress on the aorta and potentially slowing down the progression of the dissection. Other medications, such as pain relievers, may be used to manage symptoms.

Matters to Inquire When Consulting a Doctor

  • How is aortic dissection diagnosed?
  • What are the possible risk factors related to aortic dissection?
  • Can you suggest any specific precautions I should take to prevent further complications?
  • How long will the treatment for aortic dissection last?
  • Are there any alternative treatment options or complementary therapies that may be beneficial?
  • Can you explain the surgical procedure in more detail?
  • What are the potential complications or risks associated with the recommended treatment?
  • Are there any restrictions or limitations on physical activity that I should be aware of?
  • Will I require long-term medication, and if so, what are the potential side effects?
  • Are there any support groups or resources available for individuals with aortic dissection?

Clinical Signs 

  • Sudden and severe chest pain
  • Pain radiating to the back or between the shoulder blades
  • Tearing or ripping sensation in the chest
  • Unequal blood pressure in both arms
  • Weak or absent pulses in one or both arms
  • Abnormal heart sounds, such as murmurs or abnormal heart rhythms
  • Fainting or loss of consciousness
  • Shortness of breath
  • Sweating
  • Anxiety or sense of impending doom
  • Weakness or paralysis of the limbs
  • Hoarseness or difficulty speaking
  • Swelling or pain in the abdomen
  • Cold or clammy skin
  • Low blood pressure
  • Nausea or vomiting

Risk Determinants

  • Uncontrolled high blood pressure
  • Taking stimulants or illicit drugs (such as methamphetamine or cocaine)
  • Engaging in high-intensity weightlifting
  • Presence of hereditary and genetic conditions, including Marfan Syndrome, Vascular Ehlers-Danlos Syndrome (VEDS), Loeys-Dietz Syndrome, and Turner Syndrome
  • A known family history of thoracic aortic aneurysm or thoracic aortic dissection
  • Presence of an aneurysm, which refers to a weak and bulging area of the aorta
  • Chest trauma or injury resulting from an accident
  • Structural heart problems, such as bicuspid aortic valve and coarctation of the aorta
  • High cholesterol levels leading to atherosclerosis
  • Smoking