Aortic dissection

It’s often difficult to spot the signs of when an aortic dissection is going to happen. Some of the immediate and sudden symptoms can be a pain that people often describe as sharp, tearing or ripping, and it’s usually felt in the chest, back or between the shoulder blades.

The symptoms can move around the body when the tear occurs and affects other organs, causing pain in the tummy, shoulders, neck and jaw, with weakness and numbness in the limbs. The change in normal blood flow in the body can cause dizziness, weakness, difficulty breathing and clamminess, as well as nausea and vomiting. The body can quickly go into shutdown, where you may lose consciousness and requires immediate life-saving treatment so you need to call 999.

It’s not clear exactly why it happens but certain conditions can weaken the blood vessels, putting them at more risk of aortic dissection. The most common cause is high blood pressure over a prolonged period, but also aortic aneurysm, injuries to the chest, atherosclerosis (where fatty material sticks to the inner wall of the aorta) and smoking. More rare conditions like Marfan’s syndrome or bicuspid aortic valve can also weaken the vessel wall over time and if you take drugs such as cocaine or amphetamines these can also increase your risk.

Aortic dissection is rare under the age of 40, usually affecting men in their 50s and 60s. Only around 30 people in a million will have one in a year.

Prevention is always better than cure, so addressing any potential risk factors is the most effective way of avoiding an aortic dissection occurring. Maintaining good control of your blood pressure and stopping smoking are essential for many health reasons, the risk of aortic dissection being one of them.

Aortic aneurysms are part of a screening process for those most at risk – in England, it’s offered to all men at 65, and if any bulge is found in the aorta wall this may be repaired if it’s a certain size to reduce the risk of it rupturing.

The mainstay of management once you have an aortic dissection is emergency surgery to repair the aorta and there are two types of aortic dissection, depending on where in the aorta the tear occurs.

Open heart surgery is required for the first type of aortic dissection (type A,) which involves a tear in the ascending aorta, the first part of the vessel stemming from the heart. Sometimes a prosthetic application may be placed to support the tear in the aorta.

The second type of dissection (type B) involves the descending aorta, further down the vessel, where it passes through the chest and abdomen. This is managed with endovascular surgery, where a stent (an open tube) is placed within the vessel to support the vessel wall and repair the leak – this is less invasive than opening the chest for open heart surgery.

As blood is diverted through the tear (like water going through a burst dam) it builds up in the chest or abdominal cavity, and fails to reach all the most vital organs of the body – the heart, lungs, brain and kidneys, which work to keep you alive.

Without treatment, aortic dissection almost always causes death. Type A is more often fatal than Type B, with 1 out of 2 people not making it to hospital alive. Complications are likely and if the aorta vessel ruptures, the mortality is as high as 90% after that. Surgery greatly increases the chance of survival, although surgery comes with its own risks.

After surgery you usually need to take medication for the rest of your life to keep your blood pressure and cholesterol levels well controlled, and you’ll need regular checks with a heart specialist to check the aorta in case any further problems develop.