An aortic dissection is a tear in the inner layer of the wall of the aorta. The aorta is the largest artery in the body, carrying blood directly from the heart to the rest of the body.
The aorta and its branches carry all the blood from the heart out to the rest of the body. When there is a weakening of the wall of the aorta for any reason, blood flow can cause a tear in the wall. This tear forms a tube or canal within the wall of the aorta. Though the aorta goes down into the abdomen, this condition usually starts in the chest. In some cases, blood flowing within this canal can reenter the aorta or perforate into the body and cause massive bleeding and even death.
The most common symptoms of aortic dissection include: chest pain, which is usually severe and may go through to the back. The pain may also move around as the condition spreads to involve more of the aorta.shortness of breathweaknessfaintingparalysis (not being able to move a body part), which is uncommon
Common causes of aortic dissection include: high blood pressuretrauma to the chest, such as a crush injury from a motor vehicle crashhereditary diseases that weaken the wall of the aortacongenital heart disease (heart abnormalities present at birth)pregnancyany disease that weakens or damages the wall of the aortasurgery or other procedures, which may damage the aorta
Treatment of any underlying disease, especially high blood pressure, can help prevent aortic dissection. High blood pressure should be treated before problems occur, especially in people with inherited diseases who are at higher risk of complications.
The history and physical exam may make a healthcare provider suspect aortic dissection. An electrocardiogram (ECG), may reveal a pattern associated with high blood pressure. A chest X-ray may show an abnormally shaped aorta. The X-ray may also show fluid in the lungs, known as pulmonary edema, or around the heart, known as pericardial effusion.
Special X-ray tests are used to confirm the diagnosis. A cardiac catheterization involves the insertion of a tube through the skin and into an artery. This tube can be threaded up into the aorta and injected with contrast agent. As the contrast agent moves through the aorta, pictures can be taken. If a dissection is present, it can be seen. Other types of special X-rays can also be used to make the diagnosis.
In many cases of aortic dissection, there are no long-term effects. Individuals are either treated successfully or die. Death may occur instantly in some cases. In other cases, permanent body damage can occur. For example, a person may become paralyzed or have a heart attack or stroke.
Aortic dissection is not contagious, and poses no risk to others.
People with aortic dissection are treated in the hospital. Medical treatment is started to lower the blood pressure and make sure the heart does not pump with too much force. Surgery is needed for many people with this condition.
People who have a dissection that is far enough down the aorta from the heart are sometimes treated with medications instead of surgery. This is often done if the person is not well enough to withstand surgery. However, these people may need emergency surgery if the aorta starts to leak, gets bigger, or blocks off the blood supply to an organ or limb.
All surgery carries the risk of infection and bleeding, but, in this case, there is a significant chance of death, especially if the surgery is carried out on an emergency basis. Heart and blood pressure medications may also cause side effects. These may include allergic reactions, stomach upset, or other side effects, depending on the medication used.
If a person has surgery, the aortic dissection is often "cured." The problem area of the aorta may be cut out, fixed, or bypassed with an artificial piece of artery known as a graft. People treated with medications are watched for blood pressure control or symptoms that may require surgery.
People who have surgery need a period of monitoring during recovery. This is done to make sure the heart and aorta are healing properly. People usually need close monitoring of their heart rhythm and blood pressure. Special X-ray tests may be used to follow up on people after surgery. Any new or worsening symptoms should be reported to the healthcare provider.
Merck Manual, 1999
Harrison's Principals of Internal Medicine, 1991
Current Medical Diagnosis and Treatment, 1996