The aorta is the largest artery in the body. It rises from the heart's left ventricle (the major chamber that pumps blood out of the heart) and is filled with oxygen-rich blood that travels throughout the body.
Aortic dissection is a tear that develops along the inner layer of the aorta. Blood spills through the inner layer tear and into the middle layers of the aorta, causing them to separate (dissect). If the blood breaks through the outer layer of the aorta the condition can be fatal.
Aortic dissection can be classified in many ways, including how long the tear has been present (acute vs. chronic); whether the tear has caused any additional conditions, such as poor blood supply to other organs (complicated vs. uncomplicated); and the location of the tear (DeBakey and Stanford classifications).
Watch video on Aortic Dissection
Symptoms of aortic dissection typically occur soon after the tear develops and can vary from one patient to the next. Symptoms generally include:
- Severe chest pain
- Severe back pain
- Severe abdominal pain
- Shortness of breath
- Pain in the arms or legs
- Loss of consciousness
- Rapid, weak pulse
- Heavy sweating
- Pale skin
Causes and Risk Factors
The condition is rare and is most frequently diagnosed in men between the ages of 60 and 80 years of age. However, women and younger patients can develop the condition. Aortic dissection occurs in an area of the aorta that has been weakened. Weakening can occur due to:
- Chronic high blood pressure
- Marfan syndrome
- Bicuspid aortic valve
- Traumatic chest injury
- Severe hardening of the arteries (atherosclerosis)
- Inflammation of the arteries (Takayasu's arteritis)
- Aortic aneurysm
- Aortic coarctation
- Turner syndrome
- Cocaine use
- High-intensity weightlifting
Diagnosis of aortic dissection generally begins with the physician taking a medical history and performing a physical examination. During the physical exam the physician will listen to the patient's heart, lungs and abdomen using a stethoscope to see if there is any abnormal rhythm in the heartbeat.
To see the tear in the aorta, more sensitive diagnostic tests may be used. A transesophageal echocardiography is a type of echocardiography that uses an ultrasound probe inserted through the esophagus. Other imaging tests such as a magnetic resonance angiogram (MRA), CT scan or aortic angiogram may be used to view the aorta and the tear. Some of the diagnostic imaging tests require a special dye injected into the vein so that it shows up more clearly on the images.
Other laboratory tests, such as blood tests, are often performed to rule out other conditions, such as a heart attack.
Because aortic dissection is a life-threatening condition, treatment is typically needed immediately. Treatment usually involves surgery; however, in some cases, if the tear occurs in the area of the aorta that is descending into the abdomen, medication may be used to treat the condition. Medication may also be used to stabilize a patient's condition before surgery.
Surgery will focus on removing the damaged portion of the aorta and placing a graft in place of the removed portion in order to prevent blood from running into the aortic layers. The graft is generally a tube made of synthetic material that helps restore function to the damaged area. In some cases, the aortic dissection may have damaged the aortic valve. If this occurs, the valve will often be replaced during the same surgery.
Medications do not correct an aortic dissection located in the portion of the aorta coming out of the heart. However, they may be used to stabilize the patient before surgery or to treat aortic dissections located in the portion of the aorta descending into the abdomen. These medications are often used to help control blood pressure and generally include beta blockers.
The knowledgeable and highly trained staff at the Cedars-Sinai Heart Institute will work with each patient to determine the best treatment option.
Cedars-Sinai has a range of comprehensive treatment options.