What is Aortic Rupture (Dissection)?

Aortic rupture (dissection) is a serious condition in which a tear occurs in the inner layer of the body’s main artery (aorta). Blood flows through the tear, causing the inner and middle layers of the aorta to split (rupture). Aortic dissection is often fatal if blood passes through the outer wall of the aorta.

Aortic aneurysm and aortic dissection

A thoracic aortic aneurysm occurs when a weak spot in the aortic wall begins to bulge, as shown in the image to the left. The presence of an aneurysm increases the risk of rupture or tear (dissection) in the aortic membrane, as shown in the image at right.

Aortic dissection is relatively rare. It usually occurs in men in their 60s and 70s. The symptoms of aortic dissection can mimic those of other diseases and often cause delays in diagnosis. However, when aortic dissection is detected early and treated promptly, the chances of survival are greatly increased.

Symptoms

Aortic dissection symptoms may be similar to other heart problems, such as a heart attack. Typical signs and symptoms include:

• Sudden severe chest or upper back pain radiating to the neck or back, often described as a tearing or ripping sensation
• Sudden severe stomach pain
• loss of consciousness
• Shortness of breath
• Symptoms similar to those of a stroke, such as sudden vision problems, difficulty speaking, and weakness or loss of movement on one side of your body (paralysis).
• Weak pulse in one arm or thigh compared to the other
• leg pain
• difficulty walking

Reasons

Aortic dissection is caused by a weakened area of ​​the aortic wall.

Aortic dissections are divided into two groups depending on which part of the aorta is affected:

• A: This more common and dangerous type involves a tear in the part of the aorta where it exits the heart. The tear can also occur in the upper aorta (ascending aorta), which can extend into the abdomen.
• B: This type involves a tear only in the lower aorta (descending aorta), and this tear may extend into the abdomen.

Risk factors

Some of the things that may increase your risk of aortic dissection include:

• Uncontrolled high blood pressure (hypertension)
• Hardening of the arteries (atherosclerosis)
• Weakened and swollen artery (aortic aneurysm)
• Aortic valve defect (bicuspid aortic valve)
• Narrowing of the aorta at birth (aortic coarctation)

Some genetic diseases increase the risk of aortic dissection:

• Turner syndrome: High blood pressure, heart problems, and other health problems can be the result of this disorder.
• Marfan syndrome: This is a condition in which the connective tissue that supports various structures in the body is weak. People with this disorder often have a family history of aneurysms in the aorta and other blood vessels or a family history of aortic dissection.
• Other connective tissue disorders: This includes Ehlers-Danlos syndrome, a group of connective tissue disorders that involves loose joints and fragile blood vessels, and Loeys-Dietz syndrome, which causes twisting of the arteries, especially in the neck.

Inflammation of the arteries (giant cell arteritis) may also increase your risk of aortic dissection.

Other potential risk factors for aortic dissection include:

• Sexual intercourse: Men are more likely to have an aortic dissection than women.
• Age: Aortic dissection is more likely in people aged 60 and over.
• Prohibited substance use: This medication temporarily increases blood pressure.
• Pregnancy: Rarely, aortic dissections occur in healthy women during pregnancy.
• High intensity weightlifting: This and other strenuous resistance training can increase your risk of aortic rupture by increasing blood pressure during activity.

Complications

Possible complications of aortic dissection include:

• Death due to severe internal bleeding
• Organ damage, such as kidney failure or life-threatening intestinal damage
• Paralysis
• Aortic valve damage (aortic regurgitation) or rupture of the membrane around the heart (cardiac tamponade)

Prevention

You can reduce your risk of aortic rupture by preventing chest injury and taking steps to keep your heart healthy.

• Check blood pressure: If you have high blood pressure, get a home blood pressure monitor to help monitor your blood pressure.
• Do not smoke: If you smoke, take steps to stop.
• Maintain your ideal weight: Follow a low-salt diet with plenty of fruits, vegetables and whole grains, and exercise regularly.
• Fasten your seat belt: This reduces the risk of chest injury during a car accident.
• Work with your doctor to: Tell your doctor if you have a family history of aortic dissection, connective tissue disorder, or bicuspid aortic valve. If you have an aortic aneurysm, find out how often you need monitoring and whether surgery is necessary to repair your aneurysm.
  If you have a genetic condition that increases your risk of aortic rupture, your doctor may recommend medication even if your blood pressure is normal.

Diagnosis

Aortic dissection can be difficult to detect because the symptoms are similar to those of many other health problems. Your doctor may think you have an aortic dissection if:

• Sudden tearing or tearing chest pain
• Blood pressure difference between right and left arm
• Enlargement of the aorta on chest x-ray

Tests to diagnose aortic dissection include:

• Transesophageal echocardiogram (TEE): This test uses sound waves to create pictures of the heart in motion. A transesophageal echocardiogram (TEE) is a special type of echocardiogram in which an ultrasound probe (transducer) is passed through your esophagus and placed near your heart. This test gives your doctor a clearer picture of your heart and aorta than a regular echocardiogram.
• Chest computed tomography (CT) scan: X-ray is used to produce cross-sectional images of the body. Chest computed tomography (CT) can confirm the diagnosis of aortic dissection.
• Magnetic resonance angiogram (MRA). Magnetic resonance angiography (MRA) uses a magnetic field and radio wave energy to create images of your blood vessels.

Treatment

Aortic dissection is a medical emergency that requires immediate treatment. Treatment may include surgery or medication, depending on the area of ​​the aorta involved.

Type A aortic dissection

Treatment of type A aortic dissection may include:

• Operation: Surgeons remove as much of the dissected aorta as possible and prevent blood from leaking into the aortic wall. A synthetic tube (graft) is used to reconstruct the aorta. It is also possible to replace the aortic valve if it leaks as a result of damage to the aorta. The new valve is placed inside the graft.
• Medicines: Medications are given to reduce heart rate and lower blood pressure, which can prevent aortic dissection from worsening. They may be given to people with type A aortic dissection to control blood pressure before surgery.

Type B aortic dissection

Treatment of type B aortic dissection may include:

• Medicines: The same medications used to treat type A aortic dissection can be used without surgery to treat type B aortic dissections.
• Operation: The procedure is similar to that used to correct type A aortic dissection. Sometimes stents (small wire mesh tubes that act as a type of scaffolding) can be placed in the aorta to repair complex type B aortic dissections.

After treatment, you may need to take medication to control your blood pressure for the rest of your life. You may need regular CT scans or MRI scans to monitor your condition.