Aortic dissection

An aortic dissection is a life-threatening condition that results from a tear in the lining of the aorta. Read about aortic dissection symptoms, causes, and treatments. And hear from people who’ve experienced one.

What is an aortic dissection?

An aortic dissection occurs when there is a tear in the inner lining of the aorta (the large vessel that carries oxygenated blood from your heart to the rest of your body). Blood surges through the tear, causing the inner and middle layers of the aorta to separate (dissect). This slows or stops the flow of blood around your body.

It is a rare but life-threatening condition which can cause sudden death if treatment isn’t received quickly. Call 111 immediately for an ambulance if you suspect you or someone else is having one.

What is a Type A and Type B aortic dissection?

There are two main types of aortic dissection:

• Type A involves a tear which begins in the upper part of the aorta (ascending aorta), where it comes out of the heart. This is the more common and serious kind of dissection.
   
• Type B is a tear that begins in the lower part of the aorta (descending aorta), as it travels from the chest down towards the abdomen.

The terms ‘Type A’ and ‘Type B’ are used to by clinicians to categorise the kind of aortic dissection that has occurred. This system is known as the Stanford classification. Sometimes you may hear an aortic dissection referred to as a Type I, II or III, which relates to a different method of classification, known as the DeBakey classification.

How does it differ from an aortic rupture or an aortic aneurysm?

People sometimes confuse an aortic dissection with aortic rupture or aortic aneurysm, but these are three different conditions.

An aortic rupture occurs when the wall of the aorta tears completely or is ruptured as a result of trauma to the body. 

An aortic aneurysm is an abnormal bulge that occurs in the wall of the aorta. It increases the risk of having an aortic dissection. 

What are the symptoms of an aortic dissection?

Symptoms can closely resemble those of other heart conditions such as a heart attack, making it difficult to diagnose. These symptoms may include:

• Sudden severe chest or upper back pain, sometimes described as a tearing or ripping feeling
• Severe abdominal pain
• Loss of consciousness
• Breathlessness
• Fainting or dizziness
• Trouble talking or a croaky voice
• Loss of vision
• Weakness or paralysis on one side of your body (sometimes similar to stroke)
• Weak pulse in one arm compared to the other
• Leg pain or paralysis.

Read John's aortic dissection story

What causes an aortic dissection?

An aortic dissection usually occurs when there is a weakness in the wall of the aorta. There are a number of known aortic dissection risk factors. These include:

• Chronic high blood pressure (hypertension) - It is thought that ongoing high blood pressure may stress the aortic tissue, making it more likely to tear
• Coronary artery disease (atherosclerosis) - Hardened arteries increase the pressure on the aorta
• Smoking
• Aortic valve defect (heart valve disease)
• Aortic aneurysm 
• Congenital heart disease - Some people are born with heart conditions that make an aortic dissection more likely. These include bicuspid aortic valve (an aortic valve defect), Marfan syndrome and Ehlers-Danlos syndrome (both connective tissue disorders).
• Family - Aortic dissection may be more likely if there is a history of aortic dissection in your family 
• Gender - Twice as many men have aortic dissection as women
• Age - Aortic dissection is more common in people over 60
• Pregnancy - Occasionally aortic dissection can occur in pregnant women
• Cocaine use - This can increase risk of aortic dissection because of a temporary rise in blood pressure
• Strenuous weightlifting exercises - Again, a temporary rise in blood pressure which occurs during very strenuous weightlifting may increase the risk of aortic dissection
• Traumatic injury to the chest area.

Complications resulting from aortic dissection

Aortic dissection can lead to:

• Stroke 
• Damage to internal organs such as kidney failure
• Aortic valve damage 
• Cardiac tamponade (when fluid builds up in the sac around the heart putting pressure on the heart itself)
• Sudden death.

The likelihood of these complications occurring depend on the type of tear, its severity and access to treatment.

Diagnosis

Because aortic dissection symptoms may be similar to other conditions, doctors will use a number of methods to diagnose your aortic dissection. These may include:

• Chest x-ray
• Echocardiogram
• Cardiac computerised tomography (CT) scan
• Magnetic resonance imaging (MRI).

Treatment for aortic dissection

Surgery

Surgery will be needed for a Type A aortic dissection and some Type B aortic dissections. Surgeons will use a synthetic tube (graft) to replace the damaged section of aorta. Sometimes the aortic valve will also need to be replaced.

Medication

Medications such as beta blockers may be given to prevent the dissection from worsening before surgery. In some less severe Type B cases, medication alone may be used to treat the dissection.

Managing your risk factors

There are a number of steps you can take to lower your risk of aortic dissection:

• Manage high blood pressure with a low salt diet and medication if necessary
• Maintain an ideal weight
• Quit smoking
• Have regular check-ups with your doctor or nurse. Tell your doctor if you have a family history of aortic dissection, a connective tissue disorder or a bicuspid aortic valve
• Wear a seat belt when driving.

Life after aortic dissection

For people who survive the initial episode, the long-term prognosis after an aortic dissection is good. Many people survive years and decades after the event.

However, it is important to manage your condition going forward. There are a number of steps you can take to do this:

• If you’re a smoker, quit smoking
• Manage high blood pressure with medication (if prescribed) and a low salt diet
• Attend your cardiology appointments
• Undertake moderate activity
• Attend cardiac rehabilitation.

What’s it like to have an aortic dissection?

Aortic dissection is a life-changing event. A study has found that alterations in both emotional state and lifestyle was ‘frequent’ in people who survived it.

Once you’re out of hospital, it will take you a while to recover. It is normal to feel fatigued and sore from surgery and it’s important that you give yourself time to fully recover physically.

It may also take some time to heal emotionally. Don’t be surprised if you experience a wide range of emotions. People who have experienced aortic dissection are also at greater risk of experiencing depression than the general population.

Hearing about how other experiences of aortic dissection can be helpful. You can read stories from people who have survived aortic dissection on our website.

There are also a number of international aortic dissection survivor groups.

What's it like to have an aortic dissection?