What is an Aortic Dissection?

Aortic dissection is a serious condition that occurs when the aorta wall's inner muscles tear and allow blood to split apart the other muscle layers of the aortic wall. Aortic dissection can happen if the walls of the aorta become weak. The aorta is your largest artery and it brings oxygenated blood to all parts of the body. It has a thick wall of three layers of muscle that protects it from the high pressure generated when the heart pumps. 

There is reason to be concerned if you have an aortic dissection: If the aorta’s walls rupture, bleeding can damage organs, cause damage to the aortic valve, cause a stroke and lead to death.

Baptist Health is known for advanced, superior care for patients with heart disease and the diagnosis, treatment and management of aortic dissection. You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Types of Aortic Dissection

There are several types of aortic dissection. All the types involve a tear in the aorta that can sometimes lead to serious complications. The types vary by the location and severity of the tear.

Types of aortic dissection:

• Type A aortic dissection: The tear occurs in the ascending aorta. This section of the aorta curves upward from the heart. Type A aortic dissection is more common and more dangerous than Type B. 
• Type B aortic dissection: The tear occurs in the descending aorta. Surgery is often not needed for this type of aortic dissection.
• Acute aortic dissection: Most aortic dissections are acute. Acute means that the condition triggers symptoms immediately. It can be life-threatening. 
• Chronic aortic dissection: Rarely, aortic dissections are chronic. Chronic means that they do not cause instant symptoms. Instead, you may not be aware of the aortic dissection for two weeks or longer. Most chronic aortic dissections fall into the Type B category. 

Signs and Symptoms

Aortic dissection symptoms are caused by a decrease of blood flowing to the rest of the body and can mimic other heart problems. Aortic dissection symptoms can include:

• Sudden, severe tearing or ripping pain in the chest or upper back, which can radiate to the neck
• Pain can move to the abdomen, arms and legs as the aortic dissection gets worse
• Shortness of breath and trouble breathing when lying flat (orthopnea
• Swallowing difficulties from pressure on the esophagus
• Difficulty speaking, loss of vision, weakness on one side of the body
• Anxiety and a feeling of doom
• Fainting and dizziness
• Heavy sweating (clammy skin)
• Nausea and vomiting
• Pale skin

Causes

An aortic dissection occurs when the walls of the aorta are weakened. Factors that cause that weakening can include:

• Blood vessel swelling due to conditions including arteritis and syphilis
• Blunt trauma to the chest
• Buildup of fat and plaque on the inside of the walls of the arteries
• Heart surgery or heart procedures
• High blood pressure
• Infection in the aorta
• Narrowing of the aorta

In rare instances, the aortic wall can be weakened by conditions that increase blood pressure, such as pregnancy, high-intensity weight lifting and other strenuous resistance training.

Risk Factors

Aortic dissection is rare. Risk factors that can contribute to the condition include:

Age: Most abdominal aortic aneurysms occur in people over age 65.

Aortic valve problems: People born with a bicuspid aortic valve are at higher risk for aortic aneurysm.

Gender: Men develop abdominal aortic aneurysms more often than women.

Connective tissue disease: Conditions like Marfan syndrome can contribute to aortic aneurysms.

Prevention

While some risk factors like age and heredity cannot be controlled, there are ways you can help to prevent an aortic dissection:

Practice good heart health: Watch what you eat, exercise and avoid smoking,

Take your medications as prescribed: If you have high blood pressure, high cholesterol or diabetes, be certain to take your prescribed medications as directed.

Get scanned: If you are a male between 65 and 70 and have ever smoked, your physician may recommend a simple screening test. It’s a painless and fast ultrasound that can determine if your aortic walls have weakened or if a dissection has occurred.

Diagnosis

To diagnose an aortic dissection, we ask questions about your medical history and do a physical exam. We then use advanced diagnostic procedures and technology to effectively diagnose, inform treatment and carefully monitor the condition. Diagnostic procedures can include:

Angiogram: A thin tube (catheter) is inserted into a blood vessel and dye is injected to make the blood vessel visible during an X-ray. This can show any blood clots or other blood vessel issues.

Chest X-ray: A common imaging test of the lungs, heart and aorta.

Contrast-enhanced CT scan: A thin tube (catheter) is inserted into a blood vessel and dye is injected to make the aorta visible to X-rays. Computers capture the images and produce a highly detailed view of the aorta.

Ultrasound: An ultrasound device can measure blood pressure on various points of your arm or leg, which will help the physician determine if you have any blockages and how quickly blood flows through your arteries.

Echocardiogram: This ultrasound exam uses soundwaves to take moving pictures of the heart’s chambers and valves.

Magnetic resonance imaging (MRI):A large magnet, radio waves and a computer are used to produce pictures of the heart and blood vessels.

Transesophageal echocardiography (TEE): A thin tube sent through mouth, down the throat and into the esophagus, near the upper chambers of the heart, produces sound waves for clear pictures of the heart and blood vessels connected to the heart.

Aortic Dissection Prognosis

Aortic dissection is life-threatening. The condition can be managed with surgery if it is done before the aorta ruptures. Less than half of the people with a ruptured aorta survive.

Treatment and Recovery

An aortic dissection is a medical emergency that requires immediate treatment. Treatment depends on the size and location of the dissection as well as your overall health. Aortic dissection treatment can include:

Medication

If the size of the aortic dissection is small, medication may be used to reduce heart rate and lower blood pressure to prevent the dissection from worsening.

Surgery

The most effective aortic dissection treatment is surgery. You may be recommended for traditional open surgery or a less invasive procedure called endovascular surgery. The type of aortic dissection surgery recommended for you depends upon the location and appearance of the aneurysm and your health.

During open aortic dissection, the vessel's weakened section will be removed and replaced with a graft of artificial material. If there is a leak in the aortic valve (the valve that regulates blood flow from the heart into the aorta), a valve replacement may also be recommended during the procedure.

During endovascular aortic dissection surgery, a stent graft is positioned inside the diseased section of the aorta. The stent acts as a liner to form a stable channel for blood flow.

Recovery After Surgery

Depending on how your body heals, you will be in the hospital for up to 10 days after open surgery and it may be three to six months before you fully resume your normal activities. After endovascular surgery, you will be in the hospital for a few days and it may be four to six weeks before you fully recover.

Complications

If an aortic dissection is not diagnosed and treated, it could cause serious health problems. Those problems can include:

Rupture: Because the aorta is the main supplier of blood to the body, a rupture could cause life-threatening bleeding. This creates an emergency surgical situation.