An aortic dissection is a serious and potentially life-threatening condition that occurs when a tear forms in the inner layer of the aorta, the large artery that carries blood from the heart to the rest of the body. This tear allows blood to flow between the layers of the aortic wall, causing them to separate—or "dissect." If left untreated, the dissection can extend along the length of the aorta and may lead to rupture, organ damage, or stroke. Prompt diagnosis and treatment are critical.

Aortic dissections are classified based on where they occur and how extensive they are:

• Type A Dissection – Involves the ascending aorta and may extend to the descending aorta. This is the more dangerous type and typically requires emergency surgery.
• Type B Dissection – Involves only the descending aorta and may be managed with medication or endovascular repair if stable.

Certain health conditions and risk factors increase the likelihood of developing an aortic dissection:

• Chronic Hypertension – High blood pressure weakens the aortic wall.
• Connective Tissue Disorders – Such as Marfan or Ehlers-Danlos syndrome.
• Aortic Aneurysms – Increase the risk of a tear.
• Trauma – Severe chest injuries, such as those from car accidents.
• Family History – Genetic predisposition may play a role.
• Older age – Typically see over age of 60.
• Smoking and tobacco use
• Stimulant use (e.g., cocaine or amphetamines)

Aortic dissection symptoms often come on suddenly and severely, making early recognition and emergency care critical. The symptoms may vary depending on the location and extent of the dissection, as well as which organs or arteries are affected.

• Severe chest or upper back pain described as tearing or ripping
• Shortness of breath
• Weak pulse or difference in blood pressure between arms
• Fainting or dizziness
• Stroke-like symptoms such as vision changes, slurred speech, or weakness on one side of the body

These are medical emergencies—call 911 immediately if they occur.

Quick diagnosis is critical. Tests used include:

• CT Angiography – Fast and detailed imaging of the aorta.
• MRI or Transesophageal Echocardiogram (TEE) – These tools offer detailed visualization of the aortic wall and may be used when CT is not feasible or additional information is needed.
• Chest X-ray – While not definitive, it may show signs suggestive of an enlarged or abnormal aorta.

Patients suspected of having an aortic dissection are typically evaluated rapidly in an in the Emergency Setting.

Treatment for aortic dissection depends on the type, location, and severity of the dissection, as well as the patient’s overall condition.

• Emergency Open Surgery – Required for Type A dissections, which involve the ascending aorta. Surgery involves repairing or replacing the damaged portion of the aorta to prevent rupture or cardiac complications.
• Medication Management – For uncomplicated Type B dissections, treatment typically includes blood pressure and heart rate control using medications to reduce stress on the aortic wall.
• Endovascular Repair – A minimally invasive option usually reserved for select Type B dissections. A stent graft is inserted through small incisions to reinforce the aorta from the inside.

If not diagnosed and treated quickly, aortic dissection can result in life-threatening complications:

• Rupture of the Aorta – A complete tear of the aortic wall that causes severe internal bleeding and is often fatal without immediate intervention.
• Organ Damage – Due to disrupted blood flow to kidneys, brain, or other organs.
• Stroke or Heart Attack – Dissection can limit blood flow to the brain or coronary arteries, increasing the risk of neurological and cardiac events.

While not all aortic dissections can be prevented, certain steps can significantly reduce your risk:

• Keep blood pressure within a healthy range through lifestyle changes and medication if needed
• Avoid smoking and recreational drug use, particularly stimulants like cocaine
• Manage cholesterol to reduce arterial damage
• Get regular checkups if you have a family history of aortic disease or connective tissue disorder such as Marfan or Ehlers-Danlos syndrome