Danger level: High

What is it?

The aorta is the largest blood vessel in our body, and it responsible for supplying blood to all of our organs. Aortic dissection is a life-threatening situation which occurs when a tear develops in the inner layer of the aorta.

Who gets it?

Aortic dissection is 3 times more common in men than in women. Mostly it tends to occur between the ages 40 and 70, with most cases occurring between ages 50-65.

Aortic dissection is more common in African Americans than in white people, and is even less common in people of Asian origin.

There are a few risk factors which put you at risk of having an aortic dissection:

1. High blood pressure – In more than 70% of the cases of aortic dissection, it happens to people with high blood pressure.
2. Diseases in the connective tissue – Connective tissue is a material of which certain things in our body are built, such as tendons, bones and cartilage. There are a few diseases that are specific to this tissue, including Marfan syndrome, Ehlers-Danlos and others. People with these conditions are at risk of having an aortic dissection.
3. Problems in the aorta from birth – There are all sorts of variations in the build of the aorta, with which we can be born (such as a bicuspid aortic valve and others). Having them puts you at risk of having a dissection.
4. Inflammation in your aorta – There are diseases which can cause this, including syphilis, Takayasu, Giant cell arteritis and Behcet’s disease.
5. Pregnancy – If it occurs during pregnancy, it is more common in the 3rd trimester.
6. Injury to the aorta – Such as during a motor vehicle accident.

What causes it?

Our blood vessels, including the aorta, are made of 3 layers. The innermost layer (the one in touch with the blood) is called the intima. The middle layer is called the media, and the outermost layer is called the adventitia.

In aortic dissection, a tear develops in the innermost layer – the intima. Blood enters through the tear, which causes the inner and middle layers to separate.

In an aortic dissection, there is a tear in the innermost layer, through which blood enters the middle layer. Drawing by J. Heuser.

After the blood enters between these two layers, there is a lot of pressure there, caused by the force of the blood flow. This can cause the split between the two layers to continue further down or up the aorta.

This video shows the process:

The tear which runs backwards or forwards along the aorta can cause tears in blood vessels coming out of the aorta and supplying organs in our body. This can lead to a heart attack if it gets to the blood vessels supplying the heart; a stroke, if the blood vessels supplying the brain are involved; kidney failure if it reaches the arteries supplying the kidney, and so on.

Besides that, the main risk in an aortic dissection is that the outer layer (the adventitia) will give way and tear, causing a massive blood loss and death.

How does it feel?

The main thing felt in aortic dissection is a sudden and severe chest pain. It feels as if you have been stabbed with a knife, and radiates to your back. The pain can be associated with cold sweat.

As the dissection gets worse, the pain tends to move with it.

How is it discovered?

There are a few things a doctor can do to discover if you have an aortic dissection:

1. X-rays or CT scans of the chest – They will show the problem in the aorta.
2. Echocardiography – This is an ultrasound of the heart and the area around it. It will also show if you have a dissection.

There are other methods as well, which are used less frequently to detect if you have a dissection.

How is it treated?

An aortic dissection is considered an emergency and requires an immediate treatment. According to the area in the aorta in which the tear occurred, there are two options for treating it:

1. Surgery – In the surgery, the problematic area is taken out, the tear area is blocked, and then a tube is inserted into the aorta – this “builds” the shape of the aorta again. The tube is called a graft.
2. Medications – These are drugs which take down the blood pressure, causing less stress in the area of the tear.

What happens after treatment?

About 20% of people with a dissection die before reaching the hospital. If not treated, the chances of dying from it are high.

After treatment many people will need to take medications to lower their blood pressure for the rest of their lives, in order to prevent this from happening again.

The bottom line – How do I avoid it?

The most important things is to lower your blood pressure if you have hypertension.

If you have any of the conditions mentioned above in the risk factors, you should consult your doctor on how to prevent a future dissection.

Also, when in a car, be sure to wear a seatbelt. This will reduce the risk of injury to your chest.

What next?

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