Alternative Names aortic dissecting intramural haematoma, dissection of the aorta, dissecting aortic aneurysm
Definition An aortic dissection is a tear in the inner layer of the wall of the aorta. The aorta is the largest artery in the body and is directly attached to the heart.
What is going on in the body? The aorta and its branches carry all the blood from the heart out to the rest of the body. When there is a weakening of the wall of the aorta for any reason, blood flow can cause a tear into the wall. This tear forms a tube or canal within the wall of the aorta. Though the aorta goes down into the abdomen, this condition usually starts in the chest. In some cases, blood flowing within this canal can reenter the aorta or perforate into the body and cause massive bleeding and even death.
What are the signs and symptoms of the condition? The most common symptoms of this condition include:
chest pain, which is usually severe and may go through to the back. The pain may also move around as the condition spreads to involve more of the aorta.
any disease that weakens or damages the wall of the aorta
surgery or other procedures, which may damage the aorta
What can be done to prevent the condition? Treatment of any underlying disease, especially high blood pressure, can help prevent this condition. In people with inherited diseases that are at high risk, blood pressure should be treated before problems occur.
How is the condition diagnosed? The history and physical examination may make a doctor suspect this condition. An ECG, or electrocardiogram, may reveal a pattern associated with high blood pressure. A chest x-ray may show an abnormal shape to the aorta. The x-ray may also show fluid in the lungs, known as pulmonary oedema, or around the heart, known as pericardial effusion. Special x-ray tests are used to confirm the diagnosis. A cardiac catheterisation involves the insertion of a tube through the skin and into an artery. This tube can be threaded up into the aorta and injected with contrast agent. As the contrast agent moves through the aorta, pictures can be taken. If a dissection is present, it can be seen. Other types of special x-ray tests can also be used to make the diagnosis.
What are the long-term effects of the condition? In many cases of dissecting aneurysm, there are no long-term effects. Individuals are either treated successfully or die. Death may occur instantly in some cases. In other cases, permanent body damage can occur. For example, a person may become paralysed or have a heart attack or stroke.
What are the risks to others? This condition poses no risk to others.
What are the treatments for the condition? People with this condition are treated in the hospital. Medical treatment is started to lower the blood pressure and make sure the heart does not pump with too much force. Surgery is needed for many people with this condition. People who have a dissection that is further from the heart are sometimes treated with medications instead of surgery. This is often done if the person is not well enough to withstand surgery. However, these people may need emergency surgery if the aorta starts to leak, gets bigger or blocks off the blood supply to an organ or limb.
What are the side effects of the treatments? All surgery carries the risk of infection, bleeding and, in this case, a very real chance of death. Heart and blood pressure medications may cause side effects. These may include allergic reactions, stomach upset and others, depending on the medication used.
What happens after treatment for the condition? If a person has surgery, the condition is often "cured." The problem area of the aorta may be cut out, fixed, or bypassed with an artificial graft, or man-made artery. People treated with medications are watched for blood pressure control or symptoms that may require surgery.
How is the condition monitored? People who have surgery need a period of monitoring during recovery. This is done to make sure the heart and aorta are healing properly. People usually need close monitoring of their heart and blood pressure. Special x-ray tests may be used to follow people after surgery.
Author: Eric Berlin, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
