Overview
Aortic dissection is a serious, life-threatening condition in which a tear occurs in the inner layer of the aorta — the large blood vessel that carries blood from the heart to the rest of the body. Blood surges through the tear, causing the inner and middle layers of the aorta to separate (dissect). If the blood-filled channel ruptures through the outside aortic wall, it can cause fatal bleeding.
Aortic dissection is a medical emergency that requires immediate treatment. It most commonly affects men in their 60s and 70s, though it can occur in younger people with underlying connective tissue disorders or a family history of aortic disease. The incidence is estimated at 3–4 cases per 100,000 people per year.
Without prompt treatment, aortic dissection can lead to severe complications such as stroke, organ damage, aortic rupture, and death. Recognizing the symptoms early and seeking emergency care can save lives.
Symptoms
Symptoms of aortic dissection usually appear suddenly and may include:
Primary symptom:
• Sudden, severe chest pain — often described as a tearing, ripping, or stabbing sensation
• The pain may start in the chest and radiate to the back, between the shoulder blades, or to the neck, jaw, or arms
Other common symptoms:
• Severe back pain
• Shortness of breath
• Loss of consciousness or fainting
• Weak or absent pulse in one arm or leg
• Difficulty speaking or slurred speech
• Vision problems
• Sweating and clammy skin
• Nausea and vomiting
• Sudden paralysis or weakness on one side of the body
• Rapid, weak pulse
• Cold, pale, or blue extremities
Symptoms can vary depending on where the dissection occurs and whether it affects blood flow to vital organs.
Causes and Risk Factors
Aortic dissection occurs when the inner layer of the aorta tears, allowing blood to flow between the layers of the aortic wall. Common causes and risk factors include:
Chronic high blood pressure (hypertension):
• The most common risk factor for aortic dissection
• Long-standing, poorly controlled hypertension weakens the aortic wall over time
Connective tissue disorders:
• Marfan syndrome
• Ehlers-Danlos syndrome (vascular type)
• Loeys-Dietz syndrome
• Turner syndrome
Other cardiac and vascular conditions:
• Bicuspid aortic valve
• Aortic aneurysm
• Aortic coarctation
• Atherosclerosis (hardening of the arteries)
• Inflammatory diseases (giant cell arteritis, Takayasu arteritis)
Trauma and lifestyle factors:
• Chest or back trauma (e.g., car accident)
• Cocaine use
• Heavy lifting or extreme physical exertion
• Pregnancy (in rare cases)
Genetic and family history:
• Family history of aortic dissection or aortic aneurysm
• Genetic mutations associated with connective tissue disorders
Types of Aortic Dissection
Aortic dissection is classified based on the location and extent of the tear:
Stanford Classification:
• Type A: Involves the ascending aorta (the part of the aorta closest to the heart). This is the most dangerous type and usually requires emergency surgery.
• Type B: Involves only the descending aorta (the part further from the heart). This type is often managed with medications unless complications arise.
DeBakey Classification:
• Type I: Originates in the ascending aorta and extends to the descending aorta.
• Type II: Confined to the ascending aorta.
• Type III: Originates in the descending aorta and extends distally.
• Type IIIa: Limited to the descending thoracic aorta.
• Type IIIb: Extends below the diaphragm.
Additionally, dissections can be classified as acute (within 2 weeks of onset) or chronic (more than 2 weeks after onset).
Treatment
Aortic dissection is a medical emergency. Treatment depends on the type of dissection and the patient's condition:
Immediate emergency care:
• Hospitalization in an intensive care unit (ICU)
• Blood pressure control with intravenous medications (beta-blockers, vasodilators)
• Pain management with opioids
• Continuous monitoring of heart rate, blood pressure, and organ function
Surgery for Type A dissection:
• Emergency surgery is usually required to repair the ascending aorta
• The damaged section of the aorta is replaced with a synthetic graft
• The aortic valve may also be repaired or replaced if affected
• In some cases, the coronary arteries need to be reattached
Treatment for Type B dissection:
• Medications to control blood pressure and heart rate
• Pain management
• Endovascular stent grafting (minimally invasive procedure) if complications occur
• Surgery if there is evidence of organ damage or aortic rupture
Long-term management:
• Lifelong blood pressure control with medications
• Regular imaging surveillance with CT or MRI
• Lifestyle modifications (avoiding heavy lifting, managing stress)
• Genetic counseling and screening for family members if a hereditary condition is suspected
• Cardiac rehabilitation and follow-up care