A dissection is a tear in the lining of your aorta, the candy cane-shaped artery that delivers oxygen-rich blood from your heart. That allows the blood to leak from the inner layer (the intima) into the middle layer (themedia). A new pathway (false lumen) is created for the blood, interfering with the aorta’s function.
Dissections require medical attention — while blood pressure medication is enough to treat some, others can threaten your life and need repair. Early diagnosis and treatment is crucial, with our team providing expert care. Learn more about the renowned team at our Complex Aortic Center, or about our dissection treatment.
Aortic Dissection Types: A and B
Some dissections are more dangerous than others, depending on the type:
- Type A: These dissections often prove fatal in a day or two if not treated. They can involve the part of the aorta that leaves the heart (the ascending aorta), including the curve that turns back toward the chest and abdomen (the aortic arch). About two-thirds also go beyond the arch, into the descending aorta.
- Type B: These dissections are found in the descending aorta in the chest, past the artery’s downward curve (the aortic arch).
More dangerous dissections can:
- Spread to other blood vessels, heart valves or the sac surrounding the heart
- Lead to additional aortic tears
- Deprive organs of oxygen and vital nutrients
Aortic Dissection Symptoms
There are several possible symptoms of an aortic dissection; some are classic and intense, while others lead to a more vague sense of feeling unwell:
- Sudden and severe “knifelike” pain in the chest or upper back: the classic symptom, and the most common
- Other pain, elsewhere in the back or in the limbs, neck, jaw, groin or abdomen
- Numbness, coolness or weakness in the limbs
- Shortness of breath
While you should still see a doctor, please keep in mind that other conditions can cause these symptoms, too — including abdominal diseases and heart problems.
Aortic Dissection: Aneurysm and Other Causes
Many dissections are caused by an aneurysm, a bulge in the aorta (learn more about aortic aneurysms). There are other potential causes and risk factors, too:
- Gender and age: Dissections mainly occur in men ages 60 to 80 — though women and other younger people can get the condition, too, especially those with risk factors.
- High blood pressure (hypertension): the most important risk factor, tied to more than 70 percent of patients
- Connective tissue disorders:
- Marfan syndrome
- Ehlers-Danlos syndrome
- Turner syndrome
- Inflammatory diseases that can damage blood vessels:
- Giant cell arteritis
- Takayasu arteritis
- Rheumatoid arthritis
- Syphilitic aortitis
- Bicuspid aortic valve: two flaps (leaflets) instead of three
- High-intensity weightlifting
- Family history
- Use of crack cocaine
Aortic Dissection Diagnosis
Our doctors take several steps to diagnose an aortic dissection:
- Medical history and physical exam:
- Severity of pain and when it started
- Other symptoms
- Possible risk factors
- Blood pressure evaluation
- Imaging tests
- X-ray: X-ray is usually the first test.
- Computed Tomography (CT) Scan: This is typically the most used and reliable means of making a diagnosis. If the suspected dissection is not an emergency, the doctor is likely to use a CT as the second step.
- Transesophageal Echocardiogram (TEE): In cases where a CT scan cannot be done (e.g., in the case of severe kidney disease) a TEE is often used to identify a dissection. This is done by placing an ultrasound probe down the esophagus.