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Overview
What Is Aortic Dissection?
Aortic dissection is a life-threatening tear in the inner layer of the aorta, the large artery that carries blood away from the heart. Blood can enter the tear and separate the layers of the aortic wall, creating a second passage called a false channel or false lumen. This can reduce blood flow to organs and limbs or cause the aorta to rupture. It most often affects older adults and people with high blood pressure, aortic disease, or inherited conditions that weaken the artery wall.
Emergency Warning Signs
Emergency Warning Signs of Aortic Dissection
Seek emergency care
Call emergency services now
Suspected aortic dissection is a medical emergency. Call emergency services immediately for sudden severe pain or other warning signs; do not drive yourself or wait for symptoms to improve.
- Sudden severe chest or upper-back pain
- Fainting
- Stroke-like symptoms
- Sudden shortness of breath
- Sudden severe chest pain
- Sudden severe back pain
- Abdominal pain
- Fainting
- Weakness or numbness on one side
- Trouble speaking
- Shortness of breath
- A weak or absent pulse in one limb
Symptoms
Symptoms of Aortic Dissection
- Sudden severe chest pain
- Sudden severe back pain
- Abdominal pain
- Fainting (syncope)
- Shortness of breath
- Difficulty speaking (aphasia or dysarthria)
- Weakness or numbness (neurologic deficit)
- A difference in pulse or blood pressure between limbs
Symptoms vary according to where the dissection occurs and which organs or tissues lose blood flow. Aortic dissection symptoms can resemble a heart attack or stroke, so sudden symptoms require emergency evaluation rather than online advice or observation at home.
Causes
Causes of Aortic Dissection
A weakened or damaged aortic wall may develop a tear in its inner layer. Blood then pushes into the wall and separates its layers, forming a false lumen. This channel can extend along the aorta, block arteries that supply the brain or other organs, or rupture outward. Long-term high blood pressure, age-related wall changes, aortic disease, and inherited conditions can all contribute to this process.
How Is an Aneurysm Different From a Dissection?
An aortic aneurysm is a bulge or enlargement in a weakened section of the aortic wall. A dissection is a tear that allows blood to track between the wall layers. An aneurysm can increase stress on the wall and may sometimes dissect or rupture, but an aneurysm and a dissection are not the same condition, and not every aneurysm will dissect or rupture.
Risk Factors
Risk Factors for Aortic Dissection
Inherited and non-modifiable
- Older age
- Family history of aortic disease
- Bicuspid aortic valve
- Coarctation of the aorta
- Connective-tissue disorders such as Marfan, Loeys-Dietz, or vascular Ehlers-Danlos syndromes
Modifiable or manageable
- Long-term high blood pressure
- Smoking
- Known aortic aneurysm, including a thoracic or ascending aortic aneurysm
- Atherosclerosis
- Stimulant drug use
- Poorly controlled cardiovascular disease
Sudden intense exertion, pregnancy, or major trauma can sometimes trigger a dissection in an already vulnerable aorta, but these events are not causes for most people. Managing blood pressure and other cardiovascular risks is important, especially for people with an aortic aneurysm or an inherited risk.
Complications
Complications of Aortic Dissection
- Aortic rupture can cause life-threatening internal bleeding.
- Cardiac tamponade can occur when blood collects around the heart and prevents it from filling normally.
- Aortic valve leakage can make the heart work harder and reduce forward blood flow.
- A heart attack can result when the dissection blocks a coronary artery.
- A stroke can occur when blood flow to the brain is interrupted.
- Kidney injury can develop when the renal arteries or overall blood flow are affected.
- Intestinal ischemia can occur when the intestines do not receive enough blood.
- Limb ischemia can cause pain, weakness, or tissue damage in an arm or leg.
- Death can occur if rupture or severe loss of blood flow is not treated promptly.
The risk of complications depends on the dissection’s location, how quickly treatment begins, and whether branch arteries or the heart are affected. Aortic rupture and blocked blood flow can damage multiple organs, which is why this condition requires urgent specialist care.
Diagnosis
How Aortic Dissection Is Diagnosed
Clinicians combine the symptom history and physical examination with urgent imaging. They do not rely on one symptom or blood test alone. Testing helps confirm the dissection, locate it, show how far it extends, and identify effects on the heart, branch arteries, and organs.
| Test | What it can show | Typical role |
|---|---|---|
| CT angiography | Aortic tear, false lumen, branch-vessel involvement, or rupture | Common rapid confirmatory test in emergency care |
| Transesophageal echocardiography | Aortic root, valve, heart, and nearby thoracic aorta | Useful when rapid bedside or operative assessment is needed |
| MRI angiography | Detailed aortic anatomy and blood flow | Useful in selected stable patients or follow-up |
| Chest X-ray | Possible widened mediastinum or other indirect signs | May support suspicion but cannot rule out dissection |
| ECG and blood tests | Heart strain, heart attack-like changes, or organ injury | Support evaluation but do not confirm the diagnosis alone |
Type A
Type A involves the ascending aorta and usually needs urgent surgical evaluation because of the risk to the heart and nearby vessels.
Type B
Type B begins in the descending aorta, beyond the branches supplying the upper body, and may be managed with medicines or an endovascular procedure depending on complications and anatomy.
Treatment & Management
Treatment and Management of Aortic Dissection
Immediate hospital care includes intensive monitoring, pain control, and medicines that rapidly lower heart rate and blood pressure. These measures reduce stress on the aortic wall while cardiovascular and surgical specialists determine the safest repair plan.
How Is Aortic Dissection Treated?
| Approach | When it may be used | What to expect |
|---|---|---|
| Medical therapy | Initial stabilization and selected uncomplicated Type B cases | Close monitoring plus long-term blood-pressure and heart-rate control |
| Open surgery | Most Type A dissections or rupture and major heart complications | Replacement or repair of the damaged aorta with intensive postoperative recovery |
| Endovascular repair | Selected descending-aorta dissections with complications or suitable anatomy | A stent graft is placed through a blood vessel, followed by imaging surveillance |
Lifelong follow-up is usually needed after aortic dissection. This may include scheduled imaging of the aorta, strict blood-pressure control, prescribed medicines, smoking cessation, and individualized limits on strenuous activity. The treating team should guide exercise, work, and other activity decisions.
Prevention
Can Aortic Dissection Be Prevented?
- Control blood pressure through prescribed treatment, monitoring, and healthy habits.
- Do not smoke, because smoking damages blood vessels and increases cardiovascular risk.
- Take prescribed cardiovascular medicines as directed.
- Maintain a heart-healthy lifestyle with appropriate activity, nutrition, sleep, and weight management.
- Avoid stimulant drugs that can sharply raise blood pressure and heart rate.
- Attend imaging follow-up if you have a known aneurysm or other aortic condition.
People with a family history of aortic disease, an inherited connective-tissue disorder, a bicuspid aortic valve, or a known thoracic aortic aneurysm may need specialist assessment, genetic counseling, or targeted imaging. There is no single universal screening test for everyone, so surveillance should be based on personal and family risk.
Outlook and Prognosis
Outlook and Prognosis
Aortic dissection is life-threatening but treatable, and earlier emergency care improves the chance of survival. Outcomes differ between Type A and Type B disease and depend on the location of the tear, complications, organ blood flow, and overall health. Aortic rupture and other major complications can worsen the outlook.
Long-Term Follow-Up and Recurrence Risk
Continued imaging is needed to monitor the repaired or medically managed aorta and to look for aneurysm formation, enlargement, or another dissection. Recovery after hospitalization is usually gradual and may include a carefully guided return to activity, long-term medicines, and emotional support. Follow-up plans should be individualized by the treating team.
Branches
2 topics
Aortic Dissection
Cardiovascular Surgery
Aortic Dissection
Vascular Surgery
Symptoms
2 topics
Aortic Dissection
Chest Discomfort
Aortic Dissection
Chest Pain
