What is aortic dissection?

The aorta is the major artery that carries blood from the heart to the rest of the body.  Aortic dissection occurs when the inner layer of the aorta’s artery wall splits open (dissects).  This is more likely to occur where pressure on the artery wall from blood flow is high.  One such place is the ascending aorta (the first segment of the aorta), where the aorta originates from the heart’s left ventricle (pumping chamber).  This is the part of the aorta closest to the heart (thus the name proximal aorta).

When the aortic wall splits, the pulses of blood get inside the artery wall and under the inner layer.  This makes the aorta split further.  This tear usually continues distally (away from the heart) down the descending aorta and into its major branches.  Less often the tear may run proximally (back toward the heart).

Aortic dissection can also start in the descending (distal) segment of the aorta.

What are the symptoms of aortic dissection?

Acute aortic dissection causes sudden chest pain.  This pain is often described as very severe and tearing; it’s associated with cold sweat.  The pain may be localized to the front or back of the chest.  Typically the pain moves as the dissection gets worse.  Other symptoms and signs depend on the arterial branches involved and compression of nearby organs.

Who is prone to have aortic dissection?

Men have aortic dissection more often than women do.  The male-to-female ratio ranges from 2:1 to 5:1.  The peak age of occurrence of proximal dissection is between ages 50 and 55.  Distal dissection occurs most often between ages 60 and 70.  High blood pressure is the most common factor predisposing the aorta to dissection.  It’s implicated in 62-78 percent of cases. 

Aortic diseases are also predisposing factors.  These diseases include...

• aortic dilation
• aortic aneurysm
• congenital aortic valve abnormalities
• coarctation of the aorta
• Marfan syndrome

What can be done about it?

Acute aortic dissection is an emergency; medical treatment should start as soon as possible.  The patient is admitted in the intensive care unit and drugs to lower blood pressure and heart rate are given.  In some cases emergency surgery is needed.  Recently, alternative procedures, such as placing a stent inside the aorta, have been used for high-risk surgical patients.