Patient education: Aortic dissection (The Basics)

What is an aortic dissection? — 

This is a condition that causes sudden and severe pain in the chest, back, or belly. It involves the aorta, which is the main blood vessel that comes out of the heart and carries blood to the body (figure 1).

The aorta has different parts. The part that comes out of the heart and goes toward the neck is called the "ascending thoracic aorta." From there, it curves around (this is called the "aortic arch") and goes down toward the belly. The part of the aorta that goes toward the belly is called the "descending thoracic aorta" (figure 1). The part of the aorta in the belly is called the "abdominal aorta."

An aortic dissection can happen anywhere in the aorta.

In an aortic dissection, the inner wall of the aorta gets damaged or tears. Many times, the tear is in the first part of the descending aorta (figure 2). Because of this:

●Blood gets stuck in the damaged part of the wall – As a result, the body's organs, which get their blood from the aorta, might not get enough blood. This can lead to problems such as a heart attack, brain damage, damage to other organs, or not enough blood flowing to the legs or arms. If this happens, it is an emergency.

●The wall of the aorta can burst open – This causes lots of internal bleeding and is an emergency.

An aortic dissection is a serious condition. Many people who have an ascending aortic dissection or a severe descending aortic dissection don't survive, even with treatment.

What are the symptoms of an aortic dissection? — 

An aortic dissection causes sudden, severe, sharp, and "tearing" pain in the chest, back, or belly.

People can have other symptoms, too, depending on the problems caused by the aortic dissection:

●If blood flow to the brain is affected, this can cause a stroke. If this happens, a person might faint or have trouble talking or moving part of their body.

●If blood flow to the heart is affected, a person might feel like they are having a heart attack.

●If blood flow to the organs is affected, a person might have problems with those organs. Examples include kidney damage or intestinal problems.

●If blood flow to the arms or legs is affected, a person's arms or legs might feel cool to the touch or become painful.

Is there a test for an aortic dissection? — 

Yes. Tests that show there is a tear in the aorta include:

●Chest X-ray – This does not show the tear, but can show whether the aorta is wider than normal.

●CT angiogram – This is an imaging test that creates pictures of the blood vessels. It can often show where the tear is located. It can also help the doctor see if blood flow to important organs or the arms and legs is affected. A similar test called an "MR angiogram" might be done later to check the aorta after treatment.

●Echocardiogram ("echo") – This uses sound waves to create pictures of the heart and aorta. There are different ways a doctor can do an echo:

•"Transthoracic echo" – The doctor puts a thick wand on the chest and moves it around.

•"Transesophageal echo" – The doctor puts a tube with a wand on the end into the mouth and down into the esophagus. They move the wand into the esophagus wall to look at the heart and aorta, which are in front of it. Doctors usually do a transesophageal echo to look for an aortic dissection when a person cannot get a CT or MR angiogram, or to look at how the heart might be affected.

How is an aortic dissection treated? — 

Treatment depends on a person's symptoms and whether the aortic dissection is in the ascending or descending aorta.

An aortic dissection in the ascending aorta is treated right away with surgery to fix the aorta. That's because this type of aortic dissection is an emergency. If it is not repaired, it can damage the heart, cause a stroke, or lead to death. The surgeon won't know how much of the aorta needs fixing until they are doing the surgery. In some cases, the entire aorta needs to be repaired.

An aortic dissection in only the descending aorta can be treated in different ways, depending on how much of the aorta is affected. If a person's condition starts off less severe, they will be treated with:

●Strong pain medicines

●Medicines to lower their blood pressure or slow their heartbeat

If the descending aortic dissection affects how blood flows to important organs or the arms and legs, this is also an emergency. When this happens, people usually have a procedure or surgery to fix the aorta. This is done in 2 main ways:

●Endovascular repair – The doctor makes a cut ("incision") in a blood vessel at the top of the thigh. Then, they insert a special tube called a "stent graft" into the blood vessel. The tube is folded down before it is inserted. Once the tube is inside the blood vessel, the doctor puts it in the damaged part of the aorta to hold down the dissection flap. Then, they unfold the graft. This graft does not need to be sewn into place. Blood flows through the graft (figure 3).

●Open surgery – The doctor cuts the chest open and replaces the damaged aorta with a graft. Blood flows normally through it.

People who have an unrepaired, descending aortic dissection also need lifelong treatment. They need to:

●Take 1 or more blood pressure medicines every day

●Avoid heavy exercise

●Get regular follow-up imaging tests – These can check if the dissection is getting bigger or leaking. People whose condition gets worse sometimes need an endovascular stent graft or surgery.

More on this topic

Patient education: Chest pain (The Basics)
Patient education: Abdominal aortic aneurysm (The Basics)
Patient education: Thoracic aortic aneurysm (The Basics)
Patient education: Stroke (The Basics)
Patient education: Heart attack (The Basics)
Patient education: Echocardiogram (The Basics)
Patient education: High blood pressure in adults (The Basics)
Patient education: Medicines for high blood pressure (The Basics)
Patient education: Advance directives (The Basics)
Patient education: Marfan syndrome (The Basics)

Patient education: Chest pain (Beyond the Basics)
Patient education: Abdominal aortic aneurysm (Beyond the Basics)
Patient education: Stroke symptoms and diagnosis (Beyond the Basics)
Patient education: Heart attack (Beyond the Basics)
Patient education: High blood pressure in adults (Beyond the Basics)
Patient education: High blood pressure treatment in adults (Beyond the Basics)