What is Aortic Dissection?
The Aorta is the largest blood vessel when compared to other blood vessels in the body. It is the part through which the blood from your heart is carried to the rest of your body. When the aorta tears, the blood will flow towards unwanted areas. This means there will be some blood that continues traveling to places it shouldn’t, and there is some blood that remains where it is. A tear leads to the separation of two layers of the Aorta, namely the middle and inner aorta layers; this 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 due to high blood flow.
When this occurs, the aorta must be repaired immediately because it is a fatal condition. Aortic Dissection is considered a medical emergency. It’s more common to have Aortic Dissection in the aorta region within the chest area, but it can occur in the abdominal aorta. When an Aortic Dissection occurs in the abdominal area, it is called abdominal Aortic Dissection.
Symptoms of Aortic Dissection
Aortic Dissection symptoms are similar to the symptoms of other diseases, which is why it can be difficult to detect it. But there are some common symptoms that can point to Aortic Dissection and they are as follows.
- You feel light-headed and you might become unconscious suddenly.
- You may have difficulty breathing even when you are resting.
- You might feel a tingling sensation in your toes or fingers.
- You might feel nauseous.
- You might experience mild pain in areas such as your chest, neck, or jaw.
- You may start to have difficulty with swallowing food.
- You might have trouble speaking, all of a sudden.
- You might experience unbearable abdominal pain.
- You may experience severe pain in your upper back area which feels like a tearing sensation.
- You might be sweating more than usual.
- You might start feeling anxious.
- You might experience intense pain that moves to various parts of your body.
- You may experience blurry vision.
- You may experience difficulty in breathing, while lying flat on your bed.
- You might experience weakness on only one side of your body.
- You might notice that one arm’s pulse or thigh’s pulse is much weaker compared to the other.
- You may experience intense chest pain that feels like ripping pain.
- You may have a fever.
- You might experience difficulty in walking.
- You may experience numbness in your fingers and toes.
Causes of Aortic Dissection
- Aortic Dissection usually occurs in the regions 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.
- A condition that you may have since birth can be the cause of Aortic Dissection. Conditions that are associated with aorta problems, such as an enlarged aorta, can lead to Aortic Dissection. An example is Marfan syndrome.
- Aortic Dissection can be caused due to a motor vehicle accident. This is when your chest, or any part of your chest area, is badly injured during an accident. This is a rare cause but it can cause Aortic Dissection.
Types of Aortic Dissections:
This is the common type of Aortic Dissection and is considered more life-threatening than Type B Aortic Dissection. In Type A Aortic Dissection, the tear takes place in the upper aorta which is called the ascending aorta. The ascending aorta has coronary arteries which supply the heart with blood. The tear can occur in the location where the aorta leaves the heart but it can go down to the abdominal area.
In this type of Aortic Dissection, the tear occurs in the lower part of your aorta also called 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 area. The branches of the abdominal aorta are responsible for supplying blood to most of the major organs in the body.
Are you at risk?
Some factors can make you more prone to having an Aortic Dissection. The following are common Aortic Dissection risk factors.
- Aortic Dissections are more common in men who are in their 50s to 80s.
- People who have uncontrolled hypertension or high blood pressure are at higher risk.
- Smoking increases the chances of Aortic Dissection.
- People who have a bicuspid valve are more prone to Aortic Dissections.
- Atherosclerosis increases the chances of having an Aortic Dissection.
- An aortic aneurysm that already exists increases your chances of Aortic Dissection.
- Men are more likely than women to have Aortic Dissections.
- Pregnancy increases the risk of Aortic Dissection even if the woman is healthy.
- People who use cocaine are at a higher risk of Aortic Dissection.
- Some types of resistance training such as weightlifting can lead to Aortic Dissection.
- Atherosclerosis can increase the chances of Aortic Dissection.
- When the arteries are narrow, called coarctation, can increase the chance of Aortic Dissection.
- Certain heart surgeries can increase the risk of Aortic Dissection.
There are some genetic diseases that can put you at risk of Aortic Dissection. These are as follows:
- Marfan syndrome is a condition that occurs when the connective tissue is weak. The connective tissue is responsible for supporting several body structures. People who have this problem have a family history of Aortic Dissections or aortic aneurysms.
- Inflammatory conditions can increase the risk of Aortic Dissection. Some types of inflammatory conditions include syphilis and giant cell arteritis.
- Connective tissue disorders can lead to Aortic Dissection. Some examples of these disorders are Loeys-Dietz syndrome which causes 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 diseases and high blood pressure, which can lead to an increased risk of Aortic Dissection.
Complications that may arise
Aortic Dissection can lead to a decrease in blood flow, or can stop blood flow, which can damage the legs, brain, kidneys, heart, or intestines.
- Aortic Dissection can lead to a stroke, which is fatal.
- One of the major complications of Aortic Dissection is that death can occur due to chronic internal bleeding.
- Aortic regurgitation can occur due to Aortic Dissection.
- When organs are damaged, certain life-threatening conditions such as intestinal damage and kidney failure can occur.
- Cardiac tamponade can be one of the complications of Aortic Dissection.
Prevention of Aortic Dissection
The following are some ways in which you can prevent Aortic Dissection.
- You should get your heart checked annually by your doctor, so that they can detect any early signs of Aortic Dissection.
- If you suffer from high blood pressure then you need to find ways to control your high blood pressure. You can keep a machine at home that helps monitor your blood pressure, on a regular basis.
- You should wear a seat belt when you are driving a car. Since sometimes chest injuries can lead to Aortic Dissections, you need to keep yourself protected while driving.
- Smoking is one of the biggest risk factors of Aortic Dissection and so decreasing the number of cigarettes you smoke daily can help. You should work towards quitting smoking, this will decrease the risk of Aortic Dissection.
- You should add fruits and vegetables to your diet so you eat healthily. Maintaining ideal body weight is essential to ensure you don’t develop Aortic Dissection.
- If you have atherosclerosis, you should get it treated immediately. After the treatment, you should work with your doctor to ensure you know how to control the hardening of arteries, so that your risk decreases.
- You should exercise regularly because it’s good for your overall health and can help reduce the chances of Aortic Dissection.
- If you have a genetic disorder such as Ehlers-Danlos syndrome that increases your risk then you should speak to your doctor about prevention strategies. He might suggest medications or treatment options that can reduce the risk.
- If you already have an aortic aneurysm then you should 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, then you must find ways to manage it, in advance. You can speak to your doctor about this because they can recommend what you can do to reduce the risk of Aortic Dissection.
Aortic Dissection Diagnosis
As stated earlier, it can be tricky to detect Aortic Dissection just by symptoms alone because these symptoms can resemble other types of health conditions too. Your doctor will take a look at your medical history, your family history, and listen to your heart. If there is any abnormal sound or if a heart murmur is heard over your aorta then there is a chance that it is due to Aortic Dissection. Your doctor will listen to your abdomen and your lungs too with the help of a stethoscope to diagnose Aortic Dissection. Some of the signs that can point to Aortic Dissection are the differences between the blood pressure in your left arm and your right arm.
Your doctor may detect a difference in blood pressure in your legs and arms, which can mean Aortic Dissection has occurred. Low blood pressure in certain areas can indicate Aortic Dissection. If you are exhibiting signs of shock even though your blood pressure is normal, it can indicate Aortic Dissection. If you are showing any symptoms that are similar to those of a heart attack, then it might be an Aortic Dissection. Another sign is if you experience chest pain that seems like a ripping and unbearable pain that develops suddenly out of nowhere. Some of the signs discussed can indicate other problems too.
Your doctor might suggest you take other tests to ensure Aortic Dissection is correctly diagnosed. For instance Aortic Dissection radiology can be recommended. Some of the procedures your doctor might recommend are as follows.
- A chest X-ray or radiography might be required for determining if you have Aortic Dissection or not. Ionizing radiation is used in tiny doses and this is used to get 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 is another test that you may need to take. In this test, radio waves and magnetic fields are used for creating your chest area pictures. Your doctor can use a dye known as contrast during an MRI. This helps your doctor see particular areas with more clarity in the pictures. An abnormal chest MRI can indicate Aortic Dissection.
- An MRA or Magnetic Resonance Angiogram can be performed. This technique is used to take a closer look at your blood vessels to detect any problems that may be there. A mix of radio waves, magnetic field, and a computer are used in this procedure to detect anything abnormal with your blood vessels.
- Aortic angiography is used to monitor blood flow through the aorta. This test utilizes a catheter that is 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 and he will be able to see if any blockages are present.
- CT scan of the chest can be done. CT scans are used for producing images of your body and a CT scan of your chest can be used to diagnose if Aortic Dissection has taken place. This is 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 that are produced.
- Your doctor might suggest an echocardiogram which is another way to take a look at how your heart is working. It helps the doctor take a look at how your heart is functioning. During this test, high-frequency sound waves are placed on your chest. These help to show the heart chambers and valves which help your doctor see how well the heart is pumping.
- Transesophageal echocardiogram or TEE is a type of echocardiogram. TEE is used to create images of your heart with the help of sound waves which have a high-pitch. An instrument is inserted through your esophagus 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 is used to particularly take a closer look at the large blood vessels in your body. The test uses high-frequency sound waves and can detect arteriosclerosis in the legs or your arms. In some cases, blood pressure cuffs may be put around your arms, thighs, or different areas of your body.
Your doctor might take other tests before taking some of the tests mentioned above. For example, before performing a chest MRI, your doctor might take a blood test. In many cases, your doctor will make sure that the signs are not indicating a heart attack with the help of a test called the troponin test. The results of some of the tests may require additional tests but this depends on the results of your 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.
Aortic Dissection Treatment
Aortic Dissection treatment is necessary as soon as it is diagnosed. The treatment of Aortic Dissection depends on where the dissection has occurred on the aorta and other factors. The treatment options are as follows.
Treatment of Type A Aortic Dissection
In the ascending Aortic Dissection, your doctor might prescribe medications. Medications used for lowering your blood pressure are often prescribed as these help to reduce the heart rate as well. Examples of such medications include nitroprusside and beta-blockers. These medications help to prevent the Aortic Dissection from getting worse. These can be used before surgery is performed on people with ascending Aortic Dissection. This helps to maintain the right level of blood pressure before the surgery takes place.
In the case of surgery, your doctor will remove the aorta parts that have dissected. Another key point is your doctor will block the blood from entering the aortic wall which can cause further damage and create complications. The aorta is then created again with the help of a graft which is essentially a synthetic tube. If the aortic valve is leaking as a result then replacement surgery is performed at the same time. The graft is used to place the new valve so that 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 by your doctor. In Type B Aortic Dissection, surgery might not be required when you are prescribed those medications. If surgery is required then the method is similar to that of type B surgery. However, there are chances that your doctor might use stents in case you have acute Aortic Dissection that is categorized as type B. A stent is used to keep a blocked path open and is a tiny tube made of plastic or metal. A stent can restore blood flow, and stent-grafts may be used which are large stents that are often used in the case of large arteries.
Regardless of what type of Aortic Dissection you are getting the surgery, there are two ways in which the Aortic Dissection surgery can be performed. The first way is open surgery which is the standard surgery. In this surgery, an incision is made in your abdomen or your chest and the surgery is performed. In the second type of surgery, called endovascular aortic repair, there are no major incisions made and your doctor uses a catheter and x-rays to repair your aorta. A small bandage is sufficient to be placed in the wound area in this type of surgery because it is a minor surgery.
Road to recovery
Aortic Dissection can be fatal but if surgery is performed before the rupture of the aorta then it can be managed. Once your treatment starts, you might be required to take blood pressure medications for the rest of your life. Your doctor will continue to monitor your situation with the help of an MRI or CT scan depending on your situation. This will help your doctor monitor your aorta to ensure it is functioning as it should and there are no further problems with it. It will take you at least one whole month to recover from the surgery. The time you need to spend in the hospital depends on the surgery type performed.
You need to speak to your doctor about whether you can drive home by yourself or not. In most cases, doctors advise against it because the recovery can take time. In the case of open-heart surgery, you may require at least a few months to heal completely. You might not regain your normal energy levels soon but, eventually, they will be back. You need to ensure you get good rest so that you can recover well. Your doctor might suggest you take a special diet so you are getting all the nutrients. Depending on any other surgery that you may have had in addition, your doctor will let you know about the recovery options accordingly.
Aortic Dissection FAQs: All your concerns addressed.
Q. How common is Aortic Dissection?
- Aortic Dissection can affect people of any age and it affects every 2 people in 10,000.
Q. I have heard that Aortic Dissection can be fatal. Is this true?
- Yes, it is true. However, there is a chance that you will survive if Aortic Dissection is detected on time and treatment starts immediately. The Aortic Dissection prognosis depends on how quickly you got diagnosed and how quickly you were treated.
Q. When should I call my doctor?
- The moment you realize that you are showing symptoms of Aortic Dissection, you should contact your doctor immediately. If you have chest pain that has suddenly developed then you should contact a doctor promptly. If you can, then go to the emergency room as soon as possible to ensure prompt diagnosis and treatment.
Q. I have a genetic condition which can increase my chances of having an Aortic Dissection. Is there a way to prevent Aortic Dissection in my case?
- Yes, there is. While some genetic conditions can increase your risk, there are some types of medications that can help prevent Aortic Dissection. Discuss the problem with your doctor and he will recommend the right type of prescription medications that you can take.
Q. Are there any risks of Aortic Dissection surgery?
- There are some risks such as heart attack, bleeding, lung infections, risks due to anesthesia, and stroke that can occur due to Aortic Dissection surgery. Death can occur in some cases too. The risks of the surgery can vary for each person. After you have had the surgery, you should ensure you are regularly taking a look at the incision. If it swells or you notice the incision is draining then you should call your doctor immediately.
Q. Are there any precautions that I need to take after surgery?
- You need to ask your doctor about the activities that you can do and if you can exercise. If so, then ask about the exercise intensity. Usually, patients are advised not to do 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 your doctor before you perform any type of exercise.
Q. What is the main cause of Aortic Dissection?
- An aortic dissection is a condition of a weakened area of the aortic wall. One of the common cause of this condition is chronic high blood pressure which stresses the aortic tissue and makes it more susceptible to tearing.
Another rare cause of aortic dissection can exist by birth. You might be born with a weakened and enlarged aorta. Conditions like Marfan syndrome or bicuspid aortic valve are associated with weakening of the walls of the blood vessels. Aortic dissection can also be caused by traumatic injury to the chest area.
Certain genetic diseases can also aid in developing 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 is the main key in this condition. 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% at 1 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 belly (abdomen). The exact spot will vary as per the location of the dissection. After the incision, the blood pumping function of the heart and lungs will be replaced by a heart bypass machine. During surgery, once the tear is found, artificial (synthetic) grafts replace the damaged parts of the aorta. If your aortic valve is damaged, your 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 about severe chest pain. The location of the pain indicates where the dissection arises. Anterior chest pain and chest pain that mimics acute myocardial infarction usually are associated with an anterior arch or aortic root dissection. A descending aorta is often indicated with a 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 a sudden, severe chest, back, or abdominal pain that is characterised as ripping or tearing in nature. But one might not have any pain, whereas some 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 are -
- Transesophageal echocardiogram (TEE)
- Computerized tomography (CT) scan
- Magnetic resonance angiogram (MRA)