Aortic Dissection

Aortic Dissection Overview

An aortic dissection is a serious condition in which a tear develops in the inner layer of the aorta, the major artery carrying blood out of the heart. Blood flows through the tear into the middle layer of the aorta, causing the inner and middle layers to separate or dissect. If the blood causes the outer wall of the aorta to rupture, the condition often becomes fatal.

An aortic dissection most often occurs in the thoracic (chest) portion of the artery, but it may develop anywhere along the aorta. An aortic dissection is classified in two groups depending on the location of the affected part of the aorta.

Type A. The more common and dangerous type of aortic dissection. It involves a tear in the first ascending portion of the aorta where it exits the heart.
Type B. A tear in the descending portion of the aorta, that portion which extends into the abdomen.

Symptoms

Aortic dissection symptoms mirror those of other heart-related problems, but often begin suddenly. The most common symptom is severe chest pains, usually described as stabbing and tearing sensations that often change position. These pains usually start in the upper back or behind the chest bone and then radiate to the shoulders, down the neck and even into the abdomen and hips. Other symptoms include:

Disorientation and decreased sensation and movement throughout the body
Loss of consciousness or fainting
Shortness of breath
Profuse sweating and clammy skin
High blood pressure
Different pulse strength in each arm
Stroke

Risk Factors

The exact cause of aortic dissection is unknown, but the leading risk factors include hardening of the arteries—atherosclerosis, weakened and bulging artery (aortic aneurysms) and uncontrolled hypertension (high blood pressure), the latter factor being found in at least two-thirds of all cases. Other aortic issues, such as valve defects and constriction of the aorta, may play a part.

Gender and age may pose a factor in this condition, which occurs in about two out of every 10,000 people, most often in men aged 40 to 70. Cocaine use has also been implicated as a factor because it abruptly elevates blood pressure to very high levels. In rare circumstances, pregnant women are vulnerable to aortic dissection.

In other extreme cases, a traumatic injury to the chest (for example, during a motor vehicle accident) may cause an aortic dissection.

In addition, people with certain genetic diseases are more likely to have an aortic dissection. These include:

Turner’s Syndrome. High blood pressure, heart issues and other health conditions may result from this disorder and lead to an aortic dissection.
Marfan Syndrome. People with this condition, in which connective tissue is exceptionally weak, often have a family history of aneurysms. These weak blood vessels are vulnerable to tears.
Ehlers-Danlos Syndrome. Another connective tissue disorder characterized by skin that bruises and tears easily, loose joints and fragile blood vessels.

Aortic Dissection Prevention

The best way to prevent an aortic dissection is to keep your blood pressure under control and properly treat atherosclerosis. Drugs such as angiotensin II receptor blockers, angiotensin-converting enzyme (ACE) inhibitors and beta blockers may reduce the likelihood of dissection.

Reduce Your Risk of Aortic Dissection

You may lower your chances of developing an aortic dissection through several methods:

Control your blood pressure.
Don’t smoke.
Maintain a healthy diet, controlling calories, monitoring cholesterol intake and being screened for diabetes.
Wear a seatbelt and take other safety precautions.
Understand your personal and family medical history. If your family has a history of aortic dissection, you and your Wellstar physician should discuss screening.

Tests and Screenings

Detecting an aortic dissection can be tricky because most of the symptoms mirror other health problems, particularly those of the heart. Although tearing, radiating chest pain and blood pressure differences between the right and left arms often indicate an aortic dissection, sensitive imaging techniques are required to establish a firm diagnosis. These procedures include:

Computerized Tomography (CT) Scan with a dye. CT scans generate X-rays to produce cross-sectional images of the body. Often, an iodine-based contrast injected via IV make the heart, aorta and other blood vessels easily visible on the scans.
Magnetic Resonance Angiogram (MRA). An MRA is a specific use of a magnetic resonance imaging (MRI) scan to look at blood vessels.
Transesophageal Echocardiography (TEE). A TEE is a special type of echocardiogram in which an ultrasound probe is inserted into the esophagus. Because of the probe’s proximity to the heart and the aorta, it provides a clearer picture of your heart than with a regular echocardiogram performed across the chest wall.

Aortic Dissection Diagnosis

If screening tests or check-ups reveal abnormal results, your Wellstar physician will perform further evaluations regarding an aortic dissection.

Procedures

Heart Catherization
Computerized Tomography (CT) Scan

Aortic Dissection Treatment

An aortic dissection is a medical emergency that requires immediate medical attention and requires hospitalization. Treatment may involve medications or surgery, depending on the severity and location of the condition. Medications, such as intravenous beta blockers and sodium nitroprusside, reduce the heart rate and blood pressure. After treatment, many patients require blood pressure medication for the rest of their lives and often require follow-up CT or MRA scans every six to 12 months to monitor their condition.

In every case, your Wellstar physician will help you weigh the benefits of each treatment approach and make an experienced recommendation for the best outcome. You can feel confident your decision will be based on both your input and the expertise and recommendations of your experienced physician.

Taking Care of Type A Aortic Dissection

Type A aortic dissections are the more common and dangerous types of dissection because they involve a tear near the heart. Immediate surgery is the preferred treatment. During surgery, the Wellstar cardiothoracic or vascular surgeon removes as much of the dissected aorta as possible and then reconstructs the vessel with a graft. Often, people with a Type A aortic dissection will need to have their aortic valve replaced as well.

Taking Care of Type B Aortic Dissection

This type of dissection involves a tear in the descending aorta and may be treated with either medication or surgery. Some surgical options are similar to those for Type A aortic dissections, but sometimes stents—small mesh tubes that act as a sort of scaffolding—can repair Type B aortic dissections.

Ongoing Care for Aortic Dissection

Wellstar offers world-class, community-based physicians based in state-of-the-art medical centers and hospitals with access to the latest technologies and other medical resources. They are dedicated to:

Help you create and maintain healthy lifestyles
Offer advice to prevent illness and injuries
Provide early and appropriate care of acute illness to prevent its progression

Vascular Institute

Staffed by interventional cardiologists, interventional radiologists and vascular surgeons, the Wellstar Vascular Institutes at Kennestone, Cobb and Douglas hospitals provide accurate diagnosis and efficient treatment for vascular disease. The Wellstar Vascular Institute offers patient-focused care, minimally invasive treatment options and concentrated expertise.