What is an aortic dissection? — An aortic dissection 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 of the aorta that comes out of the heart and heads toward the neck is called the “ascending aorta.” From there, the aorta curves around (this is called the “aortic arch”) and heads down toward the belly. The part of the aorta that heads toward the belly is called the “descending aorta” (figure 1). An aortic dissection can happen in either the ascending or descending aorta.
In an aortic dissection, the inner wall of the aorta gets damaged or tears. Most often, the tear is in the first part of the descending aorta. Because of this:
- Blood gets stuck in the damaged part of the wall – As a result, the body’s organs might not get enough blood. This can lead to problems such as a heart attack, brain damage, kidney damage, intestinal problems, or not enough blood flowing to the legs or arms.
- 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. For example, people might faint, or have trouble talking or moving part of the body (if blood flow to the brain is affected). Or the arms or legs can feel cool to the touch (if blood flow to the arms or legs is affected).
Is there a test for an aortic dissection? – Yes. Tests that show the doctor that there is a tear in the aorta include:
- A chest X-ray – This does not show the tear, but can show whether the aorta is bigger than normal.
- An echocardiogram (also called an “echo”) – This test uses sound waves to create a picture of the heart and aorta. There are different ways a doctor can do an echo. For a “transthoracic echo,” the doctor puts a thick wand on a person’s chest and moves it around. For a “transesophageal echo,” the doctor puts a tube with a wand on the end into a person’s mouth and down into the esophagus. The doctor presses the wand against the esophagus wall to create images of the heart and aorta. Doctors usually do a transesophageal echo to look for an aortic dissection.
- Other imaging tests, such as a CT or MRI scan – Imaging tests create pictures of the inside of the body.
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.
An aortic dissection in the descending aorta is treated in different ways, depending on how serious the condition is. If a person’s condition is not so serious, he or she will be treated with:
- Strong pain-relieving medicines
- Medicines to lower the blood pressure or slow down the heartbeat
- A breathing tube (if he or she is having trouble breathing) – A breathing tube is a tube that goes down the throat and into the lungs. The other end is attached to a machine that helps with breathing.
If the descending aortic dissection is serious, people usually need surgery or a procedure to fix the aorta. This is done in 2 main ways:
- “Open” surgery – In this surgery, the doctor cuts the chest open and replaces the damaged aorta with a tube called a “graft.” This tube is made from man-made materials. It is sewn into place. Blood can flow normally through it.
- Endovascular stent graft – To fix the aorta this way, the doctor makes a cut in a blood vessel at the top of the thigh. He or she puts a folded graft in the blood vessel and threads it up to the damaged part of the aorta. Then the doctor unfolds the graft. This graft does not need to be sewn into place. Blood flows through the graft (figure 2).
People who have an aortic dissection also need life-long treatment. They need to:
- Take 1 or more blood pressure medicines every day.
- Avoid heavy exercise.
- Get regular follow-up imaging tests to check if the dissection is getting bigger or leaking. If the aortic dissection gets worse, people might need to have surgery.