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Go immediately to the emergency room if you experience sudden, tearing chest pains that radiate through the shoulders and into the back, and sometimes are accompanied with a cold sweat.
Acute aortic dissection is an uncommon and often lethal cause of chest pain, the mortality rate is 35 percent at 24 hours, 50 percent at 48 hours and 80 percent within 2 weeks.
* Diagnosis & Treatment of Diseases of the Aorta, Hurst’s The Heart, 10th Edition
 

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.