What is aortic dissection? Symptoms, causes and how to lower risk
An aortic dissection—a tear in the inner layer of the main artery—is a life-threatening emergency.
Aortic dissection is a sudden, life-threatening condition characterized by a tear in the inner layer of the aorta, the body's largest artery. This tear can cause blood to flow between the layers of the aorta, potentially reducing blood flow to vital organs or rupturing the aorta, which can be fatal. Aortic dissection is an uncommon but highly lethal emergency that requires rapid recognition and treatment.
The aorta has three layers, and when the innermost layer tears, it can lead to a dangerous condition called aortic dissection. This tear can be particularly dangerous if it occurs in the ascending aorta, as it can deprive the heart of blood or flood the sac surrounding the heart with blood. Such tears typically require immediate surgery. However, dissections in the lower parts of the aorta may be treatable with medication.
Certain risk factors increase the likelihood of developing aortic dissection, particularly affecting the lower part of the aorta. These include atherosclerosis, or plaque buildup in the arteries, and a family history of thoracic aortic disease. Men are more commonly affected than women, and most aortic dissections occur in people between the ages of 50 and 70. Approximately 20% of thoracic aortic aneurysms and dissections have a genetic component, with conditions like Marfan syndrome increasing risk.
The hallmark symptom of aortic dissection is sudden, severe chest or back pain, often described as tearing or ripping, and considered the worst pain of one's life. This symptom requires immediate emergency evaluation. However, many patients do not experience any symptoms leading up to the dissection, making early detection crucial.
Screening with ultrasound for abdominal aortic aneurysm is recommended for men aged 65 to 75 who have ever smoked, and additional scans may be necessary for those with a family history of thoracic aortic disease.
Early recognition of aortic dissection is vital, as it can mimic other conditions like heart attacks, pulmonary embolism, or stroke. Rapid imaging is essential to make an accurate diagnosis. While aortic dissection can be fatal, survivors can lead active, independent lives with proper care and follow-up. Management typically involves lifelong blood pressure control, regular imaging, and ongoing follow-up with a specialist.
The psychological impact of surviving such a catastrophic event can also be significant, requiring support beyond medical treatment.
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