Aortic Dissection

Aortic dissection is a medical emergency that occurs when a tear forms in the inner layer of the aorta—the main artery that carries blood from the heart to the rest of the body. This tear allows blood to enter between the layers of the aortic wall, creating a false channel and separating (dissecting) the layers. If left untreated, it can lead to rupture, organ failure, or sudden death.

Although relatively rare, aortic dissection is extremely dangerous. It requires immediate diagnosis and intervention to prevent fatal complications. This blog provides a detailed overview of aortic dissection, including its types, causes, symptoms, diagnosis, treatment, and long-term outlook.

What Is Aortic Dissection?

The aorta is the largest artery in the body and has three layers:

1. Intima (inner layer)

2. Media (middle layer)

3. Adventitia (outer layer)

In aortic dissection, the intima tears, allowing blood to surge into the media, creating a false lumen. As pressure builds, the dissection can extend along the aorta and branch vessels. This compromises blood flow to vital organs and may lead to rupture, causing massive internal bleeding.

Types of Aortic Dissection

Aortic dissections are classified based on the location and extent of the tear. The two main classification systems are:

1. Stanford Classification

• Type A: Involves the ascending aorta (with or without the descending aorta). It’s the most dangerous and accounts for about 60-70% of cases.

• Type B: Involves only the descending aorta, distal to the left subclavian artery.

2. DeBakey Classification

• Type I: Involves the ascending and descending aorta

• Type II: Involves only the ascending aorta

• Type III: Involves only the descending aorta

Causes and Risk Factors

Aortic dissection is often associated with chronic high blood pressure and connective tissue disorders. The risk increases with age but may also occur in younger individuals with predisposing conditions.

Common Causes and Risk Factors:

1. Hypertension (High Blood Pressure)

• Present in 75–80% of cases

• Causes stress on the aortic wall over time

2. Connective Tissue Disorders

• Marfan syndrome

• Ehlers-Danlos syndrome

• Loeys-Dietz syndrome
  These conditions weaken the structural integrity of the aorta.

3. Aortic Aneurysm

An existing aneurysm can increase the likelihood of dissection.

4. Atherosclerosis

Plaque buildup in the arteries can damage the aortic wall.

5. Trauma

Severe blunt chest trauma, often from car accidents, can trigger a tear.

6. Bicuspid Aortic Valve

A congenital defect of the aortic valve can weaken the ascending aorta.

7. Cocaine or Amphetamine Use

Stimulants can cause sudden spikes in blood pressure, leading to dissection.

8. Pregnancy

Rarely, dissection can occur during the third trimester or postpartum due to increased blood volume and hormonal changes.

Signs and Symptoms

The symptoms of aortic dissection can mimic other cardiovascular conditions, such as a heart attack, which makes diagnosis challenging.

Classic Symptoms:

• Sudden, severe chest pain (often described as tearing or ripping)

• Pain may radiate to the back, neck, jaw, or abdomen

• Sudden onset of shortness of breath

• Syncope (fainting or near-fainting)

• Stroke-like symptoms (slurred speech, paralysis)

• Weak or absent pulse in one arm or leg

• Difference in blood pressure between arms

• Rapid or weak pulse

Type A dissections often cause chest pain, while Type B dissections may present with abdominal or back pain.

Complications

Aortic dissection can lead to a host of life-threatening complications:

• Aortic rupture – massive internal bleeding

• Cardiac tamponade – fluid buildup around the heart

• Organ ischemia – lack of blood flow to organs (kidneys, intestines, brain)

• Aortic valve insufficiency – causing heart failure

• Stroke

• Paraplegia – due to spinal cord ischemia

Diagnosis

Prompt diagnosis is critical to reduce mortality. The following tools are commonly used:

1. Imaging Tests

• CT Angiography (CTA) – most widely used and accurate

• Transesophageal Echocardiography (TEE) – ideal for unstable patients

• Magnetic Resonance Angiography (MRA) – used when CT is not suitable

• Chest X-ray – may show widened mediastinum but is not definitive

2. Electrocardiogram (ECG)

Used to rule out myocardial infarction, although it may appear normal in dissection.

3. Blood Tests

• D-dimer: Elevated in many cases but not specific

• Cardiac biomarkers: To rule out heart attack

Treatment Options

Management depends on the type of dissection and the patient’s condition at presentation.

Type A (Ascending Aorta): Surgical Emergency

Requires immediate open-heart surgery to:

• Replace the dissected portion of the aorta with a graft

• Repair or replace the aortic valve if involved

• Prevent rupture or cardiac tamponade

Type B (Descending Aorta): Medical or Endovascular Treatment

• Initial treatment is often medical: control blood pressure and heart rate

• Surgery or stenting if complications arise: organ ischemia, aneurysm, persistent pain

Medications

Blood pressure and heart rate control are critical for both types:

Commonly used medications:

• Beta-blockers (e.g., labetalol) – lower heart rate and BP

• Calcium channel blockers (e.g., diltiazem) – alternative to beta-blockers

• Nitroprusside – used for rapid BP control in emergencies

• ACE inhibitors or ARBs – for long-term BP management

Post-Surgical Recovery and Monitoring

Patients who survive aortic dissection require lifelong monitoring. The goal is to prevent recurrence, aneurysm formation, or other complications.

Follow-Up Includes:

• Regular imaging (CTA or MRA) to monitor the aorta

• Strict blood pressure control

• Avoid heavy lifting or strenuous activity

• Lipid-lowering agents if atherosclerosis is present

Prevention

While some risk factors are genetic, many lifestyle changes can help reduce the risk:

Tips to Prevent Aortic Dissection:

• Monitor and control blood pressure

• Avoid stimulant drugs (e.g., cocaine)

• Quit smoking

• Maintain a healthy weight and cholesterol levels

• Treat and monitor aortic aneurysms proactively

• Regular screening for high-risk individuals (e.g., Marfan syndrome)

Living with Aortic Dissection

Recovery from aortic dissection involves not just physical healing but also emotional and psychological support. Many survivors experience anxiety about recurrence or lifestyle restrictions.

Tips for Better Living:

• Take medications exactly as prescribed

• Attend regular check-ups

• Engage in moderate exercise (as advised by a doctor)

• Join a support group or speak with a counselor

• Educate close family members about warning signs

Aortic Dissection vs Heart Attack

It’s important to differentiate between aortic dissection and heart attack as the treatment protocols are very different.

FAQs on Aortic Dissection

1. Is aortic dissection hereditary?

Yes, in some cases. Conditions like Marfan syndrome and other connective tissue disorders are inherited and increase the risk.

2. What is the survival rate?

Without treatment, Type A dissection has a mortality rate of 1% per hour for the first 48 hours. With prompt surgery, survival improves dramatically. Type B has a better prognosis with medical management.

3. Can aortic dissection be cured?

It can be surgically repaired, but patients require lifelong monitoring and management to prevent future events.

4. Who should be screened?

Individuals with a family history of aortic disease, Marfan syndrome, bicuspid aortic valve, or aortic aneurysm should be screened early and regularly.

Aortic dissection is a deadly but treatable condition when identified early. Recognizing the warning signs and seeking immediate medical attention can save lives. If you or someone you know experiences sudden chest or back pain, don’t delay—go to the emergency room immediately.

Regular health checkups, blood pressure monitoring, and awareness of genetic risks are crucial for prevention. Diagnostic centres like Sparsh Diagnostic Centre offer advanced imaging and cardiovascular evaluations that aid in the early detection and management of life-threatening vascular conditions.

📍 Need help with advanced cardiovascular screening?
Visit Sparsh Diagnostic Centre today.
📞 Call/WhatsApp: 9830117733 / 8335049501
🕒 Mon–Sat: 7 AM–9 PM | Sun: 7 AM–3 PM