Aortic dissection is a condition in which there is bleeding into and along the wall of the aorta (the major artery from the heart). This condition may also involve abnormal widening or ballooning of the aorta ( aneurysm ).

Alternative Names

Aortic aneurysm - dissecting

Causes, incidence, and risk factors

Aortic dissection involves bleeding into and along the wall of the aorta (the major artery from the heart), most often because of a tear or damage to the inner wall of the artery. This usually occurs in the thoracic (chest) portion of the aorta, but may also occur in the abdominal portion. The exact cause is unknown, but risks include atherosclerosis (hardening of the arteries) and hypertension (high blood pressure). Traumatic injury is a major cause of aortic dissection, especially blunt trauma to the chest as can be caused by hitting the steering wheel of a car during an accident. Aortic dissection may also be associated with other injury, infection, congenital (present from birth) weakness of the aorta, collagen disorders (such as Marfan's syndrome , pseudoxanthoma elasticum, Ehlers-Danlos syndrome, relapsing polychondritis, or abdominal aortic aneurysm ). Pregnancy , valve disorders (including aortic insufficiency ), and coarctation of the aorta may also be associated with aortic dissection. Aortic dissection occurs in approximately 2 out of every 10,000 people. It can affect anyone but is most often seen in men aged 40 to 70.

Signs and tests

Listening with a stethoscope (

auscultation ) at the chest and abdomen may reveal a "blowing" murmur over the aorta, a heart murmur, or other abnormality. There may be decreased (weak) pulses in the arms and hands. There may be low blood pressure, bulging neck veins, or signs resembling a heart attack. There may be signs of shock (inadequate blood flow to the body tissues), but with normal blood pressure . Aortic dissection or aortic aneurysm may be revealed on:

Echocardiogram

-- ultrasound examination of the heart

Transesophageal echocardiogram (TEE)

Chest X-ray

-- may show mediastinal (chest) widening or pleural effusion (fluid in the lining of the lung)

Chest MRI

or

CT scan of chest with dye

Aortic angiography

Doppler ultrasonography

(occasionally performed)

ECG

-- may show signs of left ventricular hypertrophy (enlargement), secondary to chronic high blood pressure

Hematocrit (a measurement of red blood cells) -- performed to evaluate

blood loss

Treatment

The goal of treatment is prevention of complications. Hospitalization is required. Antihypertensives (drugs that lower blood pressure ) may be prescribed, and these may be given through a vein ( intravenous ). Potent analgesics (pain relievers) are usually needed for pain. Cardiac medications, such as beta-blockers, may reduce some of the symptoms. Surgical repair or replacement of the section of aorta is curative in some cases. If the aortic valve is compromised by the dissection, aortic valve replacement is necessary. If the coronary (heart) arteries are involved, a coronary bypass is also performed.

Expectations (prognosis)

Aortic dissection is life-threatening. The likelihood of death within the first 48 hours is 1% per hour for untreated patients. The disorder is curable with surgical repair if it is performed before aortic rupture. Less than half of patients with ruptured aorta survive.

Complications

bleeding

from the aorta

aortic rupture causing rapid

blood loss , shock

clot

formation

insufficient circulation past the area of the dissection

irreversible

kidney failure

stroke

heart attack

cardiac tamponade

-- a condition where fluid acccumulates in the lining of the heart, which impairs the heart's ability to pump out blood

Calling your health care provider

If symptoms indicate aortic dissection or severe chest pain , call your local emergency number (such as 911) or go to the emergency room as quickly as possible.

Prevention

Adequate treatment and control of atherosclerosis (hardening of the arteries) and hypertension (high blood pressure) may reduce risk. Use safety precautions to reduce the risk of injury. Many cases are not preventable.