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Aortic dissection


Alternative Names:

Aortic aneurysm - dissecting

Symptoms:

The symptoms usually begin suddenly, and include severe chest pain. The pain may feel like a heart attack, and can:

  • Be described as sharp, stabbing, tearing, or ripping
  • Be felt below the chest bone, then move under the shoulder blades or to the back
  • Move to the shoulder, neck, arm, jaw, abdomen, or hips
  • Change position -- pain typically moves to the arms and legs as the aortic dissection gets worse

Symptoms are caused by a decrease of blood flowing to the rest of the body, and can include:

Other symptoms may include:

  • Pain in the abdomen
  • Stroke symptoms
  • Swallowing difficulties from pressure on the esophagus
Signs and tests:

The health care provider will take your family history and listen to your heart, lungs, and abdomen with a stethoscope. The examinatinon may find:

  • A "blowing" murmur over the aorta, heart murmur, or other abnormal sound
  • A difference in blood pressure between the right and left arms, or between the arms and legs
  • Low blood pressure
  • Signs resembling a heart attack
  • Signs of shock, but with normal blood pressure

Aortic dissection or aortic aneurysm may be seen on:

Blood work to rule out a heart attack is needed.

Treatment:

Aortic dissection is a life-threatening condition and needs to be treated right away.

  • Dissections that occur in the part of the aorta that is leaving the heart (ascending) are treated with surgery.
  • Dissections that occur in other parts of the aorta (descending) may be managed with surgery or medications.

Two different techniques may be used for surgery:

  • Standard, open surgery -- a surgical cut is made in the chest or abdomen
  • Endovascuar aortic repair -- surgery is done without any major surgical cut

Drugs that lower blood pressure may be prescribed. These drugs may be given through a vein (intravenously). Beta-blockers are the first drugs of choice. Strong pain relievers are usually needed.

If the aortic valve is damaged, valve replacement is needed. If the heart arteries are involved, a coronary bypass is also performed.

Expectations (prognosis):

Aortic dissection is life threatening. The condition can be managed with surgery if it is done before the aorta ruptures. Less than half of patients with a ruptured aorta survive.

Those who survive will need lifelong, aggressive treatment of high blood pressure. They will need to be followed up with CT scans every few months to monitor the aorta.

Complications:

Aortic dissection may decrease or stop the blood flow to many different parts of the body. This may result in short-term or long-term problems, or damage to the:

  • Brain
  • Heart
  • Intestines or bowels
  • Kidneys
  • Legs
Calling your health care provider:

If you have symptoms of aortic dissection or severe chest pain, call 911 or your local emergency number, or go to the emergency room as quickly as possible.

Prevention:

Proper treatment and control of hardening of the arteries (atherosclerosis) and high blood pressure may reduce your risk of aortic dissection. It is very important for patients at risk for dissection to tightly control their blood pressure.

Take safety precautions to prevent injuries, which can cause dissections.

Many cases of aortic dissection cannot be prevented.

If you have been diagnosed with Marfan or Ehler syndrome, make sure you regularly follow-up with your doctor.

References:

Isselbacher EM. Diseases of the aorta. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 78.


Review Date: 6/7/2012
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, University of Washington School of Medicine; and Shabir Bhimji, MD, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided byVeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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