Aortic Diseases & Disorders
Aortic Dissection
Aortic dissection
An aortic dissection is a tear in the inner lining of the aorta. This tear allows blood to flow through the walls of the aorta rather than remaining in the central channel (lumen). The two major types of aortic dissection, type A and type B, are defined by the location of the tear.
- Type A dissection—The tear begins in the ascending aorta and progresses throughout the vessel, often extending as far as the arteries in the leg.
- Type B dissection—The tear is located only in the descending aorta, but may extend into the abdomen.
The distinction between the two types is important, as it guides the management of the disease. Type A requires immediate surgery, to prevent death from stroke, heart attack, congestive heart failure, or bleeding. Type B dissection is considered a medical condition that can be initially treated with aggressive control of blood pressure. Additional treatments are generally reserved for complications resulting from the tear.
Symptoms of Aortic Dissection
Patients often feel as though they are having a heart attack. Specific symptoms may include:
- Sudden and severe "tearing" or "crushing" pain between the shoulder blades or behind the sternum
- Inability to find a comfortable position
- Extremely high blood pressure
- Loss of consciousness
- Shortness of breath
- Weakness
- Stroke
- Sense of doom (extreme anxiety)
Complications Associated with Aortic Dissection
Type A dissection is associated with many acute and chronic complications, if untreated. The dissection may cause:
- Exsanguinating hemorrhage: aortic rupture causing extreme blood loss
- Aortic valve incompetence: failure of the aortic valve leading to rapid heart failure
- Coronary artery dissection: loss of blood from the coronary arteries to the heart muscle causing a heart attack (myocardial infarction)
- Cardiac tamponade: accumulation of blood in the pericardium (the sac that contains the heart) leading to an inability of the heart to pump blood.
- Stroke: interruption of blood flow to the brain may cause a debilitating or fatal stroke
Aortic dissection can also cause a process known as malperfusion syndrome. Because blood flows in the walls of the aorta rather than through the vessel itself, not enough blood may reach its intended destination. This condition may cause organ failure, most frequently involving the kidneys and intestines. The result may be temporary or permanent kidney failure and intestinal injury, which may necessitate extensive bowel resection.
Learn about treatment of aortic dissection type A.
Learn about treatment of aortic dissection type B.
