Patient education: Aortic dissection (The Basics)

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 anywhere in the aorta.

In an aortic dissection, the inner wall of the aorta gets damaged or tears. Many times, the tear is in the first part of the descending aorta (figure 2). Because of this:

●Blood gets stuck in the damaged part of the wall – As a result, the body's organs, which get their blood from the aorta, 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. If this happens, it is an emergency.

●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. If blood flow to the brain is affected, a person might faint or have trouble talking or moving part of the body. If blood flow to the heart is affected, a person might feel like they are having a heart attack. If blood flow to the arms or legs is affected, a person's arms or legs might feel cool to the touch or become painful.

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 wider than normal.

●A CT angiogram – Imaging tests create pictures of the inside of the body. These particular tests show the blood vessels. These can often show where the tear is located. They can also help the doctor see if blood flow to important organs or the arms and legs is affected. A CT angiogram is usually done if an aortic dissection has just happened. A MR angiogram might be done later, to check the aorta after treatment.

●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, or to look at how the heart might be affected.

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. If it is not repaired, this type of aortic dissection can damage the heart or lead to death. The surgeon won't know how much of the aorta needs fixing until they are actually doing the surgery. In some cases, the entire aorta needs to be replaced.

An aortic dissection in only the descending aorta can be treated in different ways, depending on how much of the aorta is affected. If a person's condition starts off less severe, 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 affects the way the blood flows to important organs or the arms and legs, this is also an emergency. When this happens, people usually have a procedure or surgery to fix the aorta. This is done in 2 main ways:

●Endovascular stent graft – To fix the aorta this way, the doctor makes a cut in a blood vessel at the top of the thigh. Then the doctor inserts a special tube called a "stent-graft" into the blood vessel. This tube is made from man-made materials. It is folded down before it is inserted. Once it is inside the blood vessel, the doctor positions it within the damaged part of the aorta to hold down the dissection flap. Then the doctor unfolds the graft. This graft does not need to be sewn into place. Blood flows through the graft (figure 3).

●"Open" surgery – In this surgery, the doctor cuts the chest open and replaces the damaged aorta with a graft. Blood flows normally through it.

People who have an unrepaired, descending aortic dissection also need life-long treatment. They need to:

●Take one 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 – People whose condition gets worse sometimes end up needing an endovascular stent graft or surgery.

More on this topic

Patient education: Chest pain (The Basics)
Patient education: Abdominal aortic aneurysm (The Basics)
Patient education: Heart attack (The Basics)
Patient education: Stroke (The Basics)
Patient education: Syncope (fainting) (The Basics)
Patient education: Heart failure (The Basics)
Patient education: High blood pressure in adults (The Basics)
Patient education: Echocardiogram (The Basics)
Patient education: Medicines for high blood pressure (The Basics)
Patient education: Advance directives (The Basics)
Patient education: Marfan syndrome (The Basics)
Patient education: Thoracic aortic aneurysm (The Basics)

Patient education: Chest pain (Beyond the Basics)
Patient education: Abdominal aortic aneurysm (Beyond the Basics)
Patient education: Stroke symptoms and diagnosis (Beyond the Basics)
Patient education: Syncope (fainting) (Beyond the Basics)
Patient education: Heart failure (Beyond the Basics)
Patient education: Heart attack (Beyond the Basics)
Patient education: High blood pressure in adults (Beyond the Basics)