Aortic Dissection

What is aortic dissection?

An aortic dissection is a rare but often fatal condition. It typically occurs due to a tear in the inner wall of the aorta - the major artery that runs from the heart to the rest of the body. This tear causes blood to rush between the inner and middle walls of the aorta, causing them to dissect (separate). This can cause the aorta to rupture and can lead to sudden death if not treated urgently.

Aortic dissection most commonly occurs in men over the age of 60.

What are the different types of aortic dissection?

There are two types of aortic dissection:

• Stanford Type A Aortic dissection is a tear in the upper (ascending) part of the aorta, closer to the heart. This is the most common and most dangerous type, as it is more likely to cause a rupture in the aorta.
• Stanford Type B Aortic Dissection is a tear in the lower (descending) part of the aorta, further from the heart. This type is more likely to be a chronic condition that may be managed through medication and regular checkups. Type B is less likely to be life-threatening than Type A.

What is the difference between aortic dissection, aortic aneurysm, and aortic rupture?

An aortic aneurysm occurs when a weakened area of the aorta wall begins to bulge. This can increase the risk of aortic dissection, which can lead to aortic rupture, where blood bursts through all layers of the aorta wall and into the body cavity.

What are the symptoms of aortic dissection?

The most common symptom of aortic dissection is sudden, severe stabbing or ripping pain in the chest, upper back, or abdomen.

Other symptoms may include:

• shortness of breath
• fainting or losing consciousness
• low blood pressure or a weak pulse on one side of the body
• stroke-like symptoms such as weakness, numbness, or tingly on one side; trouble speaking; vision problems etc.
• leg pain
• difficulty walking

What causes aortic dissection?

Aortic dissection occurs due to weakening of the artery wall. This may be caused by:

• uncontrolled high blood pressure
• injury
• atherosclerosis
• aortic aneurysm
• heart defect of the aorta or aortic valve
• connective tissue disorders including Marfan syndrome and Ehlers-Danlos syndrome
• family history of aortic dissection
• high blood pressure during pregnancy
• cocaine or amphetamine use (which increases blood pressure)
• in rare cases, strenuous weightlifting
• other rare causes

How is aortic dissection diagnosed?

Aortic dissection can be confused with other life-threatening conditions such as heart attack, due to overlapping symptoms including sudden onset of chest pain.

To confirm a diagnosis of aortic dissection, the following tests may be performed:

• CT scan
• transoesophageal echocardiogram (TOE)
• MRI
• angiogram

How is aortic dissection treated?

Aortic dissection is a medical emergency that requires urgent treatment. Surgery and medications are the most common treatment options, but this will differ depending on the type/location of the dissection within the aorta.

Those who have had an aortic dissection may require lifelong medication to control blood pressure, along with routine checkups and scans to monitor the condition.

How can aortic dissection be prevented?

Reducing the risk of aortic dissection may include:

• effective management of blood pressure and/or diabetes
• regular checkups if you have aortic aneurysm or family history of aortic dissection
• eating a healthy diet
• quitting smoking
• exercising regularly