Signs and Symptoms
Aortic dissection symptoms are caused by a decrease of blood flowing to the rest of the body and can mimic other heart problems. Aortic dissection symptoms can include:
- Sudden, severe tearing or ripping pain in the chest or upper back, which can radiate to the neck
- Pain can move to the abdomen, arms and legs as the aortic dissection gets worse
- Shortness of breath and trouble breathing when lying flat (orthopnea)
- Swallowing difficulties from pressure on the esophagus
- Difficulty speaking, loss of vision, weakness on one side of the body
- Anxiety and a feeling of doom
- Fainting or dizziness
- Heavy sweating(clammy skin)
- Nausea and vomiting
- Pale skin
Diagnosis
To diagnose an aortic dissection, we ask questions about your medical history and do a physical exam. We then use advanced diagnostic procedures and technology to effectively diagnose, inform treatment and carefully monitor the condition. Diagnostic procedures can include:
Angiogram: A thin tube (catheter) is inserted into a blood vessel and dye is injected to make the blood vessel visible during an X-ray. This can show any blood clots or other blood vessel issues.
Chest X-ray: A common imaging test of the lungs, heart and aorta.
Contrast-enhanced CT scan: A thin tube (catheter) is inserted into a blood vessel and dye is injected to make the aorta visible to X-rays. Computers capture the images and produce a highly detailed view of the aorta.
Ultrasound: An ultrasound device can measure blood pressure on various points of your arm or leg, which will help the physician determine if you have any blockages and how quickly blood flows through your arteries.
Echocardiogram: This ultrasound exam uses soundwaves to take moving pictures of the heart’s chambers and valves.
Magnetic resonance imaging (MRI): A large magnet, radio waves and a computer are used to produce pictures of the heart and blood vessels.
Transesophageal echocardiography (TEE): A thin tube sent through mouth, down the throat and into the esophagus, near the upper chambers of the heart, produces sound waves for clear pictures of the heart and blood vessels connected to the heart.
Causes
An aortic dissection occurs when the walls of the aorta are weakened. Factors that cause that weakening can include:
- Blood vessel swelling due to conditions including arteritis and syphilis
- Blunt trauma to the chest
- Buildup of fat and plaque on the inside of the walls of the arteries
- Heart surgery or heart procedures
- High blood pressure
- Infection in the aorta
- Narrowing of the aorta
In rare instances, the aortic wall can be weakened by conditions that increase blood pressure, such as pregnancy, high-intensity weight lifting and other strenuous resistance training.
Risk Factors
Aortic dissection is rare. Risk factors that can contribute to the condition include:
Age: Most abdominal aortic aneurysms occur in people over age 65.
Aortic valve problems – People born with a bicuspid aortic valve are at higher risk for aortic aneurysm.
Gender: Men develop abdominal aortic aneurysms more often than women.
Connective tissue disease: Conditions like Marfan syndrome can contribute to aortic aneurysms.
Prevention
While some risk factors like age and heredity cannot be controlled, there are ways you can help to prevent an aortic dissection:
Practice good heart health: Watch what you eat, exercise and avoid smoking,
Take your medications as prescribed: If you have high blood pressure, high cholesterol or diabetes, be certain to take your prescribed medications as directed.
Get scanned: If you are a male between 65 and 70 and have ever smoked, your physician may recommend a simple screening test. It’s a painless and fast ultrasound that can determine if your aortic walls have weakened or if a dissection has occurred.
Prognosis
Aortic dissection is life threatening. The condition can be managed with surgery if it is done before the aorta ruptures. Less than half of the people with a ruptured aorta survive.
Treatment and Recovery
An aortic dissection is a medical emergency that requires immediate treatment. Treatment depends on the size and location of the dissection as well as your overall health. Aortic dissection treatment can include:
Medication
If the size of the aortic dissection is small, medication may be used to reduce heart rate and lower blood pressure to prevent the dissection from worsening.
Surgery
The most effective aortic dissection treatment is surgery. You may be recommended for traditional open surgery or a less invasive procedure called endovascular surgery. The type of aortic dissection surgery recommended for you depends upon the location and appearance of the aneurysm and your health.
During open aortic dissection surgery, the weakened section of the vessel will be removed and replaced with a graft of artificial material. If there is a leak in the aortic valve (the valve that regulates blood flow from the heart into the aorta), a valve replacement may also be recommended during the procedure.
During endovascular aortic dissection surgery, a stent graft is positioned inside the diseased section of the aorta. The stent acts as a liner to form a stable channel for blood flow.
Recovery After Surgery
Depending upon how your body heals, you will be in the hospital for up to 10 days after open surgery and it may be three to six months before you feel able to fully resume your normal activities. After endovascular surgery, you will be in the hospital for a few days and it may be four to six weeks before you fully recover.
Complications
If an aortic dissection is not diagnosed and treated, it could cause serious health problems. Those problems can include:
Rupture: Because the aorta is the main supplier of blood to the body, a rupture could cause life-threatening bleeding. This creates an emergency surgical situation.
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