Aortic Dissection

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

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 hardening of the arteries and 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 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.

Symptoms:    The symptoms usually begin suddenly.

• chest pain
• sudden, severe, sharp, stabbing, tearing, or ripping
• located below the sternum, then radiates under the shoulder blades or to the back
• may radiate to shoulder, neck, arm, jaw, abdomen, or hips
• location may change -- pain typically moves distally (to arms and legs) as the aortic dissection progresses in the same direction
• changes in thought ability, confusion, disorientation
• decreased movement, any location
• decreased sensation, any location
• intense anxiety, anguish
• pallor
• rapid pulse
• profuse sweating
• dry skin/mouth, thirst
• nausea and vomiting
• dizziness, fainting
• shortness of breath -- difficulty breathing when lying flat

Additional symptoms that may be associated with this disease:

• excessive yawning
• clammy skin
• weak or absent pulse
• cough
• high blood pressure

Signs and tests   
Listening with a stethoscope at the chest and abdomen may reveal a "blowing" murmur over the aorta, a heart murmur, or other abnormality. There may be 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, but with normal blood pressure.

Aortic dissection or aortic aneurysm may be revealed on:

• Echocardiogram -- ultrasound examination of the heart
• Transesophageal echocardiogram a special ultrasound of the heart through the esophagus (food tube)
• Chest x-ray- may show chest widening or fluid in the lining of the lung
• Chest MRI or CT scan of chest with dye
• Aortic angiography
• Doppler ultrasonography

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. Potent pain relievers are usually needed. 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 heart arteries are involved, a coronary bypass is also performed.

Expectations
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 911 or go to the emergency room as quickly as possible.

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