Aortic Dissection

What Is an Aortic Dissection?

An aortic dissection is a life-threatening condition that occurs when the inner layer of the aorta, the body's largest artery, tears. Blood rushes through the tear, causing the inner and outer layers of the artery wall to separate (dissect). If the dissection ruptures through the outer aortic wall, it can lead to severe internal bleeding and death if not treated immediately.

Aortic dissections are classified into two types:

• Type A – Involves a tear in the ascending aorta (near the heart). This type is extremely dangerous and requires immediate surgery.
• Type B – Occurs in the descending aorta (further from the heart) and may be managed with medications or minimally invasive procedures if stable.

Early diagnosis and emergency treatment are crucial to improving survival and reducing complications.

Risk Factors

Aortic dissections often develop due to underlying conditions that weaken the artery walls. Key risk factors include:

• Uncontrolled high blood pressure (hypertension) – The most significant risk factor, as it puts excess strain on the aortic walls.
• Atherosclerosis (plaque buildup) – Can weaken and stiffen the arteries.
• Genetic disorders – Conditions like Marfan syndrome, Ehlers-Danlos syndrome, and Loeys-Dietz syndrome affect connective tissue and increase the risk of aortic dissection.
• Aortic aneurysm – A bulging, weakened area of the aorta that can lead to dissection.
• Bicuspid aortic valve – A congenital heart defect that may contribute to aortic wall stress.
• Family history of aortic disease – Increases the likelihood of experiencing an aortic dissection.
• Smoking – Damages blood vessels and accelerates vascular disease.
• Cocaine or stimulant drug use – Can cause sudden spikes in blood pressure and lead to dissection.
• Pregnancy-related stress on the aorta – Rare but possible, particularly in women with connective tissue disorders.

Understanding and managing these risk factors is key to reducing the likelihood of an aortic dissection.

Symptoms

Aortic dissection symptoms often mimic those of a heart attack, making rapid diagnosis essential. Common symptoms include:

• Severe, sudden chest or upper back pain – Often described as a sharp, tearing, or ripping sensation.
• Pain that moves – The pain may migrate as the dissection progresses down the aorta.
• Shortness of breath and difficulty breathing.
• Weakness or paralysis in one side of the body (if blood flow to the brain is affected).
• Loss of consciousness or fainting.
• Differences in blood pressure between arms – A key sign of an aortic dissection.
• Cold, clammy skin, sweating, or rapid heartbeat – Signs of shock.

If you or someone else experiences these symptoms, call 911 immediately—aortic dissection is a medical emergency that requires immediate intervention.

Treatment

Treatment for aortic dissection depends on the type, severity, and location of the dissection.

Emergency Medical Management

• Blood pressure control – Medications such as beta-blockers are used to lower heart rate and blood pressure to reduce strain on the aorta.
• Pain management – To ease discomfort and reduce stress on the body.
• Oxygen therapy and IV fluids – Used to stabilize circulation before intervention.

Surgical and Minimally Invasive Treatments

• Open Aortic Repair – For Type A dissections, emergency surgery is required to replace the damaged section of the aorta with a synthetic graft.
• Endovascular Aortic Repair (TEVAR) – For Type B dissections, a stent graft may be inserted via a catheter to reinforce the aorta and restore blood flow.
• Aortic Valve Repair or Replacement – If the dissection affects the heart’s aortic valve, surgical intervention may be needed.

AtlantiCare’s vascular and cardiac specialists provide the most advanced treatment options, ensuring rapid, lifesaving care for aortic dissections.

Prevention

Since many aortic dissections are linked to underlying conditions, preventive care focuses on managing risk factors and maintaining vascular health. Key prevention strategies include:

• Control high blood pressure – Regular monitoring and medication can reduce stress on the aortic walls.
• Quit smoking – Smoking weakens blood vessels and significantly increases the risk of aortic disease.
• Monitor cholesterol and manage atherosclerosis – Keeping arteries healthy lowers the risk of complications.
• Get screened for genetic conditions – If you have a family history of aortic disease, screening can help detect risks early.
• Avoid stimulant drug use – Cocaine, amphetamines, and other stimulants can cause dangerous blood pressure spikes.
• Routine aortic imaging – High-risk individuals should undergo regular CT scans, MRIs, or echocardiograms to monitor aortic health.

By addressing risk factors early and staying proactive about heart and vascular health, the chances of developing an aortic dissection can be significantly reduced.