What Are The Signs And Symptoms Of An Aortic Dissection?

Aortic dissection is a life-threatening situation in which there is a tear within the layers of the wall of the aorta. The aorta is the major artery that carries blood out of the heart.

Symptoms of Aortic Dissection

The symptoms of aortic dissection can be similar to other cardiac emergencies as it’s a significant heart problem. You should call 911 if you experience any of these signs of aortic dissection:

• A sensation that something is tearing, ripping, or shearing. This symptom happens because the aortic actually is tearing, and the layers of the aortic wall are ripping or shearing apart.
• Sudden onset of severe pain in the chest, stomach, abdomen, or upper back. The pain can radiate down the back or to the neck.
• Shortness of breath
• Leg paralysis or pain
• Difficulty walking
• Loss of consciousness
• Sudden symptoms similar to a stroke, in which you have difficulty seeing or speaking, or you have paralysis or weakness on one side of your body
• Pulse that is weaker on one side of the body than the other

These symptoms always constitute a medical emergency. Even if you are not experiencing an aortic dissection, you could be having a heart attack or stroke.

An Overview of Aortic Dissection

The aorta has three layers in its walls, the inner layer, middle layer, and outer layer. Think of the aorta as a pipe. If the inner layer of the pipe develops a tear or rip, the pressure of the heart pumping blood through the aorta will force some blood to flow between the inner and middle layers of the wall. A pool of blood will develop and press on the outer layer of the wall.

The reason they call this situation aortic dissection is that the flow of blood splits, or dissects, into two channels or “currents.” The two currents cause three things to happen.

• Less blood will flow to the organs that the aorta serves because the main channel of blood flow in the aorta is lessened by the tear diverting some of the blood coming out of the heart. Your internal organs, including the brain, can sustain injury from the lack of blood flow.

• The building pressure from the accumulating blood pool between the inner and middle layers of the aortic wall can burst through the outer layer of the aortic wall, causing a rupture of the aorta. Ruptures of the aorta are usually fatal. A rupture is almost always inevitable in with aortic dissections unless the patient undergoes successful emergency repair of the tear.

• The aorta can widen or “balloon” because of the dissection. This ballooning can create an aneurysm, which can rupture.

Two Types of Aortic Dissection

The location of the tear in the aorta will determine whether it is a Type A or Type B dissection.

• Type A aortic dissections are more dangerous than Type B. Type A are also more common than Type B. When the tear is in the upper aorta (ascending aorta) or where the aorta leaves the heart, it is a Type A. These tears can extend from that origin down to the abdomen.

• Type B aortic dissections are less common and a little less dangerous, although these tears can be fatal. With Type B dissections, the tear is only in the lower aorta (descending aorta), without upper aorta involvement. Type B tears can extend from the origin point down into the abdomen.

How the Doctors Diagnose an Aortic Dissection

Since aortic dissection symptoms are similar to those of many other severe cardiac emergencies, it can be hard for doctors to differentiate between these conditions. The patient needs immediate treatment for a chance at survival, and a correct diagnosis can make the difference between life and death.

Some of the distinguishing signs that can lead a doctor to suspect aortic dissection as opposed to a different cardiac condition are:

• A chest X-ray reveals a widening of the aorta
• The patient reports feeling a sudden pain, similar to ripping or tearing
• The blood pressure is different between the left and right arms

To confirm the diagnosis of aortic dissection and isolate the location for purposes of surgical repair, doctors often use imaging tests that are more sensitive than a standard chest x-ray. Physicians often use these types of imaging tests in these situations:

• Transesophageal echocardiogram (TEE). The medical professional will insert an ultrasound probe through the esophagus and navigate it close to the heart and aorta to create an image of the heart from high-pitched sound waves.

• Computerized tomography (CT) scan. Doctors use this cross-sectional imaging study to get more detail of the heart, aorta, and other blood vessels than a standard chest x-ray provides.

• Magnetic resonance angiogram (MRA). This type of imaging study uses magnetic fields and pulses of radio waves to generate higher-resolution pictures of the blood vessels.