What is thoracic aortic dissection?

An aortic dissection is the most common disorder of the aorta that brings a patient to the emergency room. That’s often because there is severe pain associated with this disorder.

The aorta is the main blood vessel that carries blood from the heart to the rest of the body and extends from the chest to the lower abdomen. Sometimes, with aging, high blood pressure, or other changes, a section of the aorta may weaken and tear. Tearing of the inner layers of the vessel walls allows blood to flow into the middle layer of the aorta, separating the inner and outer layers. This tearing is called a dissection. When the dissection occurs in the part of the aorta that runs through the chest, it’s called a thoracic aortic dissection.

There are two types of thoracic aortic dissection: Type A dissection and Type B dissection.

• Type A dissection occurs in the area of the thoracic aorta just above the arteries that go to the heart. This type of dissection often requires surgery.
• Type B dissection involves the descending aorta and begins just below the subclavian artery (the artery to the left arm). This type of dissection traditionally has been managed with medication.

There is no one cause of thoracic aortic dissection. However, it’s believed that patients with atherosclerosis (hardening of the arteries) or high blood pressure are at increased risk of tearing of the aortic wall.

Other risk factors include:

• Family history
• Smoking
• Heart disease
• Blunt trauma to the chest
• Genetic disorders, such as Marfan syndrome or Ehlers-Danlos syndrome

Aortic dissection is rare. It can affect anyone, but is most common in men ages 40 to 70.

What are the symptoms?

Symptoms of acute thoracic aortic dissection are often sudden and include severe pain, often described by patients as a very sharp or tearing pain in the chest or in the back between the shoulder blades. The pain may radiate to the shoulder, neck, arm, jaw, abdomen or hips, and the location may change as the aortic dissection progresses. In addition to this sharp pain, patients often suffer from:

• Dizziness
• Profuse sweating
• Rapid pulse
• Difficulty walking
• Confusion

Sometimes the dissection obstructs branches of the aorta such as the arteries to the legs, resulting in severe leg pain. If an artery to a kidney is blocked, that can result in severe high blood pressure.

Missed diagnoses

Unfortunately, thoracic aortic dissection is under-diagnosed and under-treated because the symptoms often are mistaken for other conditions, such as a heart attack. Many people do not know they suffer from a thoracic aortic dissection. It is a potentially life-threatening condition and requires prompt and accurate diagnosis immediately after symptoms appear. If left untreated, 75 percent of sufferers die in the first two weeks and 90 percent die in the first three months.

What should I do if I suffer from these symptoms?

Acute aortic dissection is life-threatening, so it’s important to get medical attention immediately.