Aortic Dissection:
Your guide to aortic dissection causes, symptoms and treatment.
1. What is Aortic Dissection?
Have you ever wondered how your heart pumps blood to your entire body? The aorta is the largest blood vessel in your body. It is the path through which the blood from your heart is carried to the rest of your body. When the aorta tears, the blood flows towards unwanted areas. This means some blood will travel to places it shouldn’t, while the rest continues to the right destinations.
A tear in the aorta leads to the separation of two layers of the blood vessels – the middle layer and the inner layer. This separation is called Aortic Dissection. There are chances that the outermost layer of the aorta can burst due to the tearing of the inner layer, which is generally caused by high blood flow.
When this occurs, the aorta needs to be repaired immediately because it is a fatal condition. Aortic Dissection is considered a medical emergency. It is more common within the chest area but can occur in the abdominal aorta as well. When an Aortic Dissection occurs in the abdominal area, it is called Abdominal Aortic Dissection. The treatment for Aortic Dissection can range from medication to surgery, depending on various factors.
2. Symptoms of Aortic Dissection
The symptoms of Aortic Dissection are like those of other diseases, which is why it can be difficult to detect. But some common symptoms point to Aortic Dissection, such as:
- Feeling light-headed or becoming unconscious suddenly.
- Difficulty breathing even when resting.
- A tingling sensation in the toes or fingers.
- Nausea.
- Mild pain in the chest, neck or jaws.
- Difficulty swallowing food.
- Suddenly have trouble speaking.
- Unbearable abdominal pain.
- Severe pain in your upper back, which feels like a tearing sensation.
- Sweating more than usual.
- Increased anxiety.
- Intense pain that moves to various parts of the body.
- Blurry vision.
- Difficulty breathing while lying flat on the bed.
- Weakness on only one side of the body.
- One arm’s pulse or one thigh’s pulse is much weaker than the other.
- Intense chest pain that feels like a ripping pain.
- Fever.
- Difficulty walking.
- Numbness in the fingers and toes.
3. Causes of Aortic Dissection
Aortic Dissection usually occurs in the regions of the blood vessel that are weaker than the rest of the aorta. When the blood pressure is high, it can lead to the aortic tissue becoming weaker, which leads to easy tearing of the aorta layers.
Some conditions present since birth can also cause Aortic Dissection. These conditions are usually associated with aortic problems, such as an enlarged aorta. An example is Marfan syndrome.
Aortic Dissection can also be caused by a motor vehicle accident, especially if the chest or any part of the chest area is badly injured. However, this is a rare cause of Aortic Dissection.
4. Types of Aortic Dissections:
Type A
This is the common type of Aortic Dissection, although it is considered more life-threatening than Type B. In Type A Aortic Dissection, the tear takes place in the upper aorta, called the ascending aorta. The ascending aorta has coronary arteries that supply the heart with blood. The tear can occur in the location where the aorta leaves the heart, but it can also go down to the abdominal area.
Type B
In this type of Aortic Dissection, the tear occurs in the lower part of your aorta, called the descending aorta. The branches of the descending aorta are responsible for supplying blood to some of the chest structures and ribs. The tear can eventually extend to the abdomen. The branches of the abdominal aorta are responsible for supplying blood to most of the major organs in the body.
5. Are you at risk?
Some conditions can make you more prone to Aortic Dissection, such as:
- It is more common in men who are in their 50s to 80s.
- People who have uncontrolled high blood pressure (hypertension) are at higher risk.
- Smoking increases the risk.
- People who have a bicuspid valve are more prone to Aortic Dissection.
- Atherosclerosis increases the risk.
- An aortic aneurysm that already exists increases your chances of developing this condition.
- Men are more likely than women to have Aortic Dissection.
- Pregnancy increases the risk, even if you are healthy.
- People who use cocaine are at a higher risk.
- Some types of resistance training, such as weightlifting, can lead to Aortic Dissection.
- Narrowing of the arteries are narrow, called coarctation, can increase the risk.
- Certain heart surgeries can also increase the risk.
Some genetic diseases that can put you at risk of Aortic Dissection include:
- Marfan syndrome is a condition that occurs when the connective tissue is weak. The connective tissue is responsible for supporting several body structures. Those with a family history of this condition are more likely to develop Aortic Dissections or aortic aneurysms.
- Inflammatory conditions, such as syphilis and giant cell arteritis, can increase the risk of Aortic Dissection.
- Connective tissue disorders can lead to Aortic Dissection. Some examples of these disorders are Loeys-Dietz syndrome, which causes the arteries to twist and Ehlers-Danlos syndrome, which causes blood vessels to become fragile and tear easily.
- Turner’s syndrome causes health conditions such as heart disease and high blood pressure, which can increase the risk of Aortic Dissection.
6. Complications Associated with Aortic Dissection
Aortic Dissection can lead to a decrease in blood flow or can stop blood flow completely. Depending on which body part this occurs, it can damage the legs, brain, kidneys, heart or intestines. Other complications that this condition can lead to include:
- A stroke, which can be fatal.
- Death due to chronic internal bleeding.
- Aortic regurgitation.
- When the organs are damaged, certain life-threatening conditions, such as intestinal damage and kidney failure, can occur.
- Cardiac tamponade.
7. Prevention of Aortic Dissection
Here are some ways in which you can prevent Aortic Dissection:
- Get your heart checked annually by your doctor, so that they can detect any early symptoms of Aortic Dissection.
- If you suffer from high blood pressure, keep a machine to monitor your blood pressure at home on a regular basis, so that you can keep it under control.
- Wear a seat belt while driving a car. Accident-related chest injuries can lead to Aortic Dissection, so keep yourself protected while driving.
- Smoking is one of the biggest risk factors for Aortic Dissection. So, decrease the number of cigarettes you smoke daily. The best option is to work towards quitting smoking completely.
- Add fresh fruits and vegetables to your diet. Maintaining an ideal body weight is essential to minimising the risk of Aortic Dissection.
- If you have atherosclerosis, get it treated immediately. After the treatment, work with your doctor to ensure you know how to control the hardening of arteries to decrease the risk of Aortic Dissection.
- Exercise regularly, since it is good for your overall health.
- If you have a genetic disorder, such as Ehlers-Danlos syndrome, that increases your risk, speak to your doctor about prevention strategies. They might suggest medications or treatment options that can reduce the risk of Aortic Dissection.
- If you already have an aortic aneurysm, speak to your doctor about repair options, and whether you need monitoring and how often.
- If you are suffering from any condition that can potentially increase your risk of Aortic Dissection, speak to your doctor to learn how to manage it to reduce the risk of Aortic Dissection.
8. Aortic Dissection Diagnosis
As stated earlier, it can be tricky to detect Aortic Dissection by the symptoms alone because these warning signs can resemble other types of health conditions. Your doctor will look at your medical history and family history and listen to your heart. If there is any abnormal sound or if a heart murmur is detected over your aorta, it might be due to Aortic Dissection. Your doctor will listen to your abdomen and your lungs too with a stethoscope to diagnose Aortic Dissection. One warning sign of Aortic Dissection is a difference between the blood pressure in your left arm and your right arm.
Your doctor might also check for any differences in blood pressure between your legs and arms, which can indicate that Aortic Dissection has already occurred. Low blood pressure in certain areas is also a symptom of Aortic Dissection. If you are exhibiting signs of shock despite your blood pressure being normal, it can indicate Aortic Dissection. This condition is also indicated if you are showing any symptoms like those of a heart attack. Another sign is chest pain that seems like a ripping and unbearable pain that develops suddenly. However, remember that some of these signs can also indicate other problems.
Your doctor might suggest that some tests to confirm the diagnosis. For instance, radiology might be recommended. Some of the other procedures your doctor might recommend include:
- A chest X-ray or radiography: Ionizing radiation is used in tiny doses to get clear images of your chest area. It can be used by your doctor to monitor your heart, chest and lungs. This is one of the fastest tests and is useful for emergencies.
- An MRI of the chest: This is a test that uses radio waves and magnetic fields to create images of your chest area. Your doctor can use a dye, known as contrast, for the MRI. This helps them see particular areas with more clarity.
- An MRA or Magnetic Resonance Angiogram: This is a technique used to take a closer look at your blood vessels to detect any problems. A mix of radio waves, a magnetic field and a computer are used to detect abnormalities in the blood vessels.
- Aortic angiography: This is used to monitor blood flow through the aorta. It uses a catheter, inserted through one of your blood vessels and guided to the aorta. X-rays and a dye are used to clearly see the blood flowing through the aorta. Your doctor will view the images live on a monitor to see if any blockages are present.
- CT scan of the chest: CT scans are usually done with the help of a contrast liquid, which helps to make some blood vessels, the heart, and the aorta stand out in the CT images.
- Echocardiogram: This is another way to take a look at how your heart is working. During this test, high-frequency sound waves are placed on your chest. These help to show the heart chambers and valves, which allow your doctor to see how well the heart is pumping.
- Transoesophageal echocardiogram or TEE: This is a type of echocardiogram used to create images of your heart with the help of high-pitched sound waves. An instrument is inserted through your oesophagus for an ultrasound. It is specifically located near the aorta and the heart so that a detailed image of the area can be viewed.
- Doppler ultrasonography: This provides a closer look at the large blood vessels in your body. The test uses high-frequency sound waves to detect arteriosclerosis in your legs or arms. In some cases, blood pressure cuffs may be put around your arms, thighs, or other areas of your body.
Your doctor might recommend other tests before the tests mentioned above. For example, before performing a chest MRI, your doctor might require a blood test. In many cases, your doctor will make sure that the signs do not indicate a heart attack with the help of a troponin test. The results of some of the tests may indicate the need for additional tests. Your doctor will let you know about the tests and what you need to do to prepare in advance for some of the tests.
9. Aortic Dissection Treatment
Since Aortic Dissection is a serious condition, treatment is necessary as soon as it is diagnosed. The treatment depends on where the dissection has occurred on the aorta and other factors. Here’s a look at the common treatment options.
Treatment of Type A Aortic Dissection
In Ascending Aortic Dissection, the doctor might prescribe medications to lower your blood pressure to help reduce the heart rate as well. Examples of such medications include nitroprusside and beta-blockers. These medications help prevent the dissection from getting worse and can be used before surgery is performed on people with Ascending Aortic Dissection. It helps maintain the right level of blood pressure before the surgery takes place.
During Aortic Dissection surgery, the surgeon will remove the parts of the aorta that have been dissected. Another key point is the doctor will block the blood from entering the aortic wall to prevent further damage and complications. The aorta is then recreated with the help of a graft, which is essentially a synthetic tube. If the aortic valve is leaking, replacement surgery is performed at the same time. The graft is used to place the new valve so that the aorta can be reconstructed to avoid further leakage.
Treatment of Type B Aortic Dissection
The same types of medications used in Type B Aortic Dissection can be prescribed for Type B. In Type B Aortic Dissection, surgery might not be required when these medications are prescribed. If surgery is recommended, the method is similar to that of Type A surgery. However, there are chances that the doctor uses stents in case of acute Aortic Dissection that is categorised as Type B. A stent is a tiny tube made of plastic or metal and is used to keep a blocked path open. A stent can restore blood flow, and stent-grafts, which are large stents often used in cases of large arteries, may be used.
Regardless of what type of Aortic Dissection, there are two ways in which the surgery can be performed. The first way is open surgery, which is the standard procedure. In this surgery, an incision is made in the abdomen or chest for the surgery. In the second type of surgery, called endovascular aortic repair, there are no major incisions made, and the doctor will use a catheter and X-rays to repair your aorta. A small bandage is sufficient on the wound area in this type of surgery because it is a minor surgery.
10. The Road to Recovery
Aortic Dissection can be fatal, but if surgery is performed before the rupture of the aorta, it can be managed. Once treatment starts, the patient might be required to take blood pressure medications for the rest of their life. The doctor will continue to monitor their condition with the help of an MRI or CT scan, depending on the situation. This will help them monitor the aorta and ensure that it is functioning as it should and there are no further problems. It will take at least one month to recover from the surgery. The time the patient needs to spend in the hospital will depend on the type of surgery performed.
In most cases, doctors advise against driving for some time till recovery takes place. In the case of open-heart surgery, it might take at least a few months to heal completely. The person might not regain their normal energy levels soon, but they will return eventually. You need to ensure the patient gets enough rest so that they can recover well. The doctor might suggest a special diet to ensure that the right nutrient intake. Depending on any other additional surgery, the doctor will let you know about the recovery options.
11. Aortic Dissection FAQs: All Your Concerns Addressed!
Q. How common is Aortic Dissection?
Aortic Dissection affects 2 in every 10,000 people and can occur at any age.
Q. I have heard that Aortic Dissection can be fatal. Is this true?
Yes, it is true. However, if Aortic Dissection is detected on time and treatment starts immediately, chances of survival improve drastically. The prognosis depends on how quickly you are diagnosed and treated.
Q. When should I call my doctor?
You should contact your doctor the moment you observe the symptoms of Aortic Dissection. If you observe chest pain that has developed suddenly, contact a doctor immediately. If you can, go to the emergency room immediately to ensure prompt diagnosis and treatment.
Q. I have a genetic condition that can increase my chances of Aortic Dissection. Is there a way to prevent Aortic Dissection in my case?
Yes, there is. While some genetic conditions can increase your risk, some types of medications can help prevent Aortic Dissection. Discuss the problem with your doctor to get the right type of prescription medication.
Q. Are there any risks of Aortic Dissection surgery?
There are some risks associated with the surgery, such as heart attack, bleeding, lung infections, risks due to anaesthesia and stroke. Death can also occur in some cases. But the risks of surgery differ from person to person. After the surgery, ensure that the incision is checked regularly. If it swells up or you notice the incision is leaking, call the doctor immediately.
Q. Are there any precautions that I need to take after surgery?
You need to ask your doctor about the activities and exercises that can be performed. If exercise is allowed, ask about the intensity. Usually, you will be advised to not participate in any strenuous exercise because it can affect the aortic wall by putting pressure on it. Mild exercise is generally recommended but you should double-check with the doctor.
Q. What is the main cause of Aortic Dissection?
Aortic Dissection is the result of a weakened area of the aortic wall. One of the common causes of this condition is chronic high blood pressure, which puts stress on the aortic tissue and makes it more susceptible to tearing.
Another rare cause of Aortic Dissection can be congenital conditions. Some people are born with a weakened and enlarged aorta. Conditions like Marfan syndrome or bicuspid aortic valve are also associated with the weakening of the walls of the blood vessels. Aortic Dissection can also be caused by traumatic injury to the chest area.
Certain genetic diseases have also been linked to Aortic Dissection, including:
- Turner’s syndrome
- Marfan syndrome
- Connective tissue disorders, such as Ehlers-Danlos syndrome and Loeys-Dietz syndrome
- Inflammatory conditions, such as giant cell arteritis and syphilis.
Q. What is the survival rate of an Aortic Dissection?
Proper diagnosis and treatment are the keys to recovery. Around 1 in 5 patients with Aortic Dissection die before reaching the hospital. Without treatment, the mortality rate is 1% to 3% per hour during the first 24 hours, 30% during the first week, 80% at 2 weeks, and 90% at 1 year. For treated patients, the hospital mortality rate is about 30% for proximal dissection and 10% for distal.
Q. How do they fix an Aortic Dissection?
Aortic dissection surgery is very complex. For a traditional open-heart surgery, a small incision is made in the chest or abdomen. The exact spot varies depending on the location of the dissection. After the incision, the blood-pumping function of the heart and lungs is replaced by a heart bypass machine. During the surgery, once the tear is found, artificial (synthetic) grafts replace the damaged parts of the aorta. If the aortic valve is damaged, the surgeon may also insert a replacement valve. After the process is completed, the heart bypass machine is removed, and the incision is closed.
For the endovascular method, the surgeon attaches a synthetic graft to the end of a tube (catheter). Using X-ray images as a guide, the graft is threaded through the artery to the affected part of the aorta.
Q. Is Aortic Dissection painful?
Typically, a patient with Aortic Dissection often complains of severe chest pain. The location of the pain indicates where the dissection has occurred. Anterior chest pain and chest pain that mimic acute myocardial infarction are usually associated with an anterior arch or aortic root dissection. A descending aorta is often indicated by tearing or ripping pain in the interscapular area. The pain typically changes as the dissection evolves.
Q. What does Aortic Dissection pain feel like?
Typically, Aortic Dissection presents as a sudden, severe chest, back or abdominal pain that is characterised as ripping or tearing in nature. Some might not have any pain at all, while others feel severe pain as if they are having a heart attack.
Q. How do you diagnose Aortic Dissection?
Detecting an aortic dissection can be tricky as the symptoms are similar to a variety of other health problems. Frequently used imaging procedures to diagnose Aortic Dissection include:
- Transesophageal echocardiogram (TEE)
- Computerized tomography (CT) scan
- Magnetic resonance angiogram (MRA)
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