Aortic Dissection: What It Is, Symptoms, Treatment and More

sick african man with heart attack or chest pain; portrait of african man suffering from heart attack, chest pain, health care concept; young adult african man or black man model
sick african man with heart attack or chest pain; portrait of african man suffering from heart attack, chest pain, health care concept; young adult african man or black man modelAdobe Stock
Medically Reviewed By:
Mark Arredondo, M.D.

FRIDAY, Feb. 10, 2023 (HealthDay News) -- When you feel sudden severe chest or upper back pain, it’s easy to assume what’s happening is a heart attack.

It could be, but it could also be an aortic dissection — a condition that can be severe and often fatal.

Despite the fact that an aortic dissection from a tear in the major artery known as the aorta killed actors John Ritter and Alan Thicke, many aren’t familiar with the condition, or its symptoms and risk factors.

Knowing them could save your life.

That could matter to millions: The death rate for people who have an aortic dissection has been rising over the past decade, especially among women and Black adults, research published recently in the Journal of the American Heart Association shows.

“We have more room to improve in the prevention and management of aortic dissections," study author Dr. Salik Nazir, an interventional cardiology fellow at Baylor College of Medicine in Houston, said when the study came out.

What is aortic dissection?

The aorta is the major artery carrying blood out of the heart, according to the National Library of Medicine (NLM).

A tear can extend along the wall of the aorta, causing blood to flow between its layers. That’s dissection, which can either lead to rupture of the aorta or decreased blood flow to organs, according to the NLM.

Shaped like a cane, the aorta delivers blood through other arteries to the brain, muscles and cells, according to the American Heart Association (AHA). It has an inner, middle and outer layer.

An aortic aneurysm is a weakened or bulging area in the aorta that can lead to either rupture or dissection.

Nearly 10,000 people died in 2019 from aortic aneurysms or dissections and nearly 60% were men, according to the U.S. Centers for Disease Control and Prevention.

An abdominal aortic aneurysm is more common than the thoracic type, which happens in the chest, according to the CDC.

"The [death] rate for an aortic dissection is about 1% an hour for the first 48 hours, making every second count," Dr. Ali Azizzadeh, director of vascular surgery at Cedars-Sinai Smidt Heart Institute in Los Angeles, said recently. "Equally as important is seeking care, whenever possible, at a medical center with specialized, comprehensive services in treating aortic dissections."

Types of aortic dissection

Two types of aortic dissection can happen: Type A and Type B.

In the first, dissections are in the upper aorta, which is also called the ascending aorta, according to the University of Chicago Medicine (UCM). Type A dissections must be treated immediately because they can cause failure of the aortic valve, heart attack or a rupture that can fill the sac around the heart with blood.

Type B is also potentially fatal. It happens in the lower aorta, in the section after the arteries that feed the brain and arms, according to UCM.

What causes aortic dissection?

Common risks vary from something sudden, such as blunt trauma to the chest during a car accident, to something that builds over time such as high blood pressure, according to NLM.

Hardening of the arteries, aging, heart surgery, pregnancy, connective tissue disorders, straining during body building, swelling of blood vessels due to other conditions, smoking and illegal drugs can also factor in, according to NLM.

Aortic dissection symptoms

Symptoms include pain in the chest, jaw, neck, back, shoulder or abdomen. It can be immediate and “stabbing,” according to the AHA.

Other symptoms can include difficulty breathing, fainting, limb weakness, intense sweating and paleness.

Chest pain in acute coronary syndrome versus aortic dissection?

Chest pain in acute coronary syndrome can be caused by a heart attack and unstable angina, but it is a term for conditions that suddenly block blood flow to the heart, according to the AHA.

Aortic dissection treatment

Treatment can vary from surgery to medication, according to the AHA. Medication isn’t an option in an emergency but could be used to reduce blood pressure.

Most Type A dissections are treated with surgery, according to NYU Langone Health in New York City, while most Type B dissections are treated with medication.

Patients may be able to have minimally invasive endovascular surgery that includes stent placement or more extensive open-heart surgery to repair the tear, according to NYU Langone. Some Type B dissections and chronic dissections will need endovascular surgery.

Can aortic dissection heal itself? Typically, no, according to vascular surgeon Dr. Rami Tadros, who discusses the condition on New York’s Mount Sinai Health System’s YouTube page. While some Type B dissections may be managed with medication, others cannot.

How to prevent aortic dissection

Maintaining healthy blood pressure levels long-term is the best prevention, according to UCM.

Don’t smoke, maintain an ideal weight, wear a seatbelt to help prevent injury from a car accident and talk with your doctor about risk factors, suggests the Mayo Clinic.

Go to an emergency room if you have severe chest, back or stomach pain, and ask doctors to check you for an aortic dissection.

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