Aortic dissection

Aortic dissection is a life-threatening tear in the large artery that carries blood away from your heart.

Key points about aortic dissection

  1. If you have an aortic dissection, treatment is needed immediately. Early diagnosis and treatment can increase your survival rate. 
  2. The symptoms of aortic dissection are similar to a heart attack, so it can be difficult to know which you are experiencing. 
  3. A key symptom is sudden chest pain that feels like tearing, as well as other symptoms listed below. 
  4. If you have these symptoms, it's a medical emergency and you need help immediately.
  5. Having such a major medical event out of the blue can be shocking, and it takes time to recover physically and emotionally from it.
  6. After the initial treatment, there may be changes to your lifestyle that present challenges, so ongoing support is important.

If you or someone you care for has sudden chest pain along with the following symptoms, go to the nearest emergency department immediately or call 111 and ask for an ambulance:

  • shortness of breath
  • severe tummy pain 
  • fast onset of fever-like symptoms and sweating
  • fainting or dizziness
  • loss of consciousness
  • loss of vision or blurry vision
  • weakness of your arms or legs.

What are the symptoms of aortic dissection?

The symptoms of aortic dissection can be very similar to a heart attack. This can make it difficult to know if you are having an aortic dissection. 

Common symptoms of aortic dissection include:

  • chest pain that starts suddenly
  • chest pain that feels like tearing, ripping or shearing
  • chest pain that can spread to you neck or back
  • a fast onset of fever-like symptoms and sweating
  • severe tummy pain 
  • shortness of breath
  • fainting or dizziness
  • loss of consciousness
  • loss of vision or blurry vision
  • weakness of your arms or legs. 

What are the causes of aortic dissection?

The aorta is the largest blood vessel in your body. It comes directly from your heart to supply blood to the rest of your body.

Aortic dissection happens when the inner layer of the wall of your aorta tears, causing blood to flow between the inner and middle layer of your aorta, separating the layers. This causes reduced blood and oxygen supply to the rest of your body such as your brain, kidneys and heart. In more serious cases, your aorta can burst and cause death. 

Conditions that can weaken the wall of the aorta can increase your risk of getting aortic dissection. These include:

  • high blood pressure
  • aortic aneurysm (the wall of the aorta bulges like a balloon)
  • coronary artery disease or atherosclerosis
  • Marfan syndrome or Ehlers-Danlos syndrome 
  • heart valve disease involving the aortic valve
  • regular cocaine or amphetamine use 
  • extremely strenuous exercise such as weightlifting
  • severe traumatic injury to the chest.

Other general risk factors include:

  • smoking
  • a family history of aortic dissection
  • being male (men are 2 times more likely to get aortic dissection than women) 
  • being aged more than 60 years old
  • pregnancy.

What are the complications of aortic dissection?

Complications of an aortic dissection include:

  • stroke
  • damage to an organ, such as kidney failure
  • aortic valve damage
  • cardiac tamponade (accumulation of blood in the lining around your heart and putting pressure on your heart)
  • sudden death.

How is aortic dissection diagnosed?

Your doctor will do several tests to find out whether you have had an aortic dissection or rule out other similar conditions such as a heart attack.

These tests may include:

How is aortic dissection treated?

If you have an aortic dissection, treatment will be needed immediately to save your life. Surgery is usually needed to repair the damaged blood vessel. You may also be given a blood pressure-lowering medicine such as beta blockers to prevent the dissection from getting worse. 

After the surgery, you need to stay in hospital for a while until you recover enough to go home. You may also need to attend follow-up checks after your treatment to monitor your aorta and make sure you are recovering well. 

What is the outlook for someone with aortic dissection?

Aortic dissection is life threatening and often fatal if the aorta ruptures or if the condition is left undiagnosed and untreated. However, early diagnosis and treatment increases survival rates.

After your initial treatment, you may be advised that there are things you can no longer do in order to reduce the risk of long-term complications. For example, you may need to avoid strenuous physical activity and activities that involve heavy lifting because these can increase blood pressure and therefore stress on the aortic wall.

Normal daily activities such as 
cooking, bathing, driving, climbing stairs and mild aerobic exercise are usually fine, but contact sports are not recommended. You may also need to change your job, as sedentary jobs are often more appropriate for people who have had an aortic dissection.

There are sometimes complications that require further treatment. 

Having such a major medical event occur out of the blue is shocking and you need time and support to come to terms with it happening. There can also be physical and emotional challenges on the road to recovery. To help you recover, you may also need talking therapy and connection with other people who have been through the experience. 

How can I care for myself with aortic dissection?

There are a few things you can do to help manage your condition.

These include taking the following steps:

  • Controlling and managing your blood pressure – this can be achieved by a low-salt diet and blood pressure medicines. See your GP if you are unsure whether your blood pressure is well controlled. 
  • Quitting smoking if you are a smoker. 
  • Having a healthy balanced diet and maintaining a healthy weight.
  • Attending your cardiology follow-up appointments or cardiac rehabilitation after your surgery – ask your cardiologist or GP if this is available in your area. 

What support is available with aortic dissection?

Having an aortic dissection can be shocking. Many people with this condition go through a traumatic, often life-changing emergency event that affects you physically and mentally. As well as information to help you understand the condition, you may need help and support to come to terms with what you have experienced and the changes in your life as a result. 

Talk through your feelings with your family/whānau members or healthcare providers. You can also ask your doctor about where to get psychological help, or you can find a counsellor, psychologist or psychotherapist yourself. Read more about how to talk about your feelings and cognitive behavioural therapy (CBT).

You can also contact an aortic dissection survivor Pete Fleming through LinkedIn or the Heart Foundation website. Scroll down to the bottom of the page and leave a comment. 

How can I prevent aortic dissection?

You can reduce your risk of getting an aortic dissection by doing these things:

  • Controlling and managing your blood pressure – this can be achieved by a low-salt diet and blood pressure medicines. See your GP if you are unsure whether your blood pressure is well controlled. 
  • Quitting smoking if you are a smoker. 
  • Having a healthy balanced diet and maintaining a healthy weight.
  • Attending regular check-ups with your doctor or nurse if you are advised to have one, eg, if you have a family history of aortic dissection.  
  • Having regular exercise.

Learn more

The following links provide further information about aortic dissection. Be aware that websites from other countries may have information that differs from New Zealand recommendations.

Aortic dissection Heart Foundation, NZ
Healing hearts through friendship Heart Foundation, NZ   
Aortic dissection HealthInfo Canterbury, NZ
Aortic dissection Patient Info, UK

References

  1. Aortic dissection Heart Foundation, NZ
  2. Aortic dissection Patient Info, UK
  3. Juang D, Braverman AC, Eagle K. Aortic dissection Circulation. 2008;118:e507–e510.
Credits: Health Navigator Editorial Team. Reviewed By: Mr David McCormack, Consultant Cardiothoracic Surgeon, Waikato DHB; John Bleackley and Peter Fleming, consumer advisors