What Is an Aortic Dissection? 7 Things to Know

An aortic dissection happens when a tear forms in the inner layer of the aorta, the body's main artery. Once that tear opens, blood pushes its way into the wall of the aorta and splits its layers apart. This creates a second, fake path for blood to travel, right next to the real one.

As blood keeps flowing through this fake path, it can cause serious harm. It can block blood from reaching important organs and make the aortic wall weaker. Without quick diagnosis and treatment, the wall can burst.

An aortic dissection is different from other problems that affect the aorta, like an aneurysm or a rupture.

An aortic aneurysm is a bulging or ballooning of the aortic wall. A person can live with an aneurysm that may never lead to dissection or rupture.
An aortic rupture is a full-thickness break in the aortic wall that causes massive internal bleeding. Rupture is often fatal within minutes.

1. What are the types of aortic dissection?

Doctors sort aortic dissections into different types. This helps them choose the best treatment for each person. The most common method they use is called the Stanford system.

Stanford Type A affects the ascending aorta. That's the part of the aorta that rises straight up from the heart. Type A is the most serious type. It has the highest risk of stroke, heart damage and a burst in the aortic wall. Because of this, it almost always requires emergency surgery.
Stanford Type B affects the descending aorta. That's the part of the aorta that runs downward, away from the heart. Doctors often treat Type B with medicine first. Some people still need an aortic repair, which is done through a small tube guided inside the blood vessels called stents.

Doctors also use the DeBakey system, which sorts dissections into three types. Type I starts in the ascending aorta and spreads past the aortic arch, the curved part at the top. Type II stays in the ascending aorta only. Type III starts in the descending aorta and spreads downward.

Any dissection that reaches the ascending aorta, whether Stanford A or DeBakey I or II, is more dangerous and usually needs immediate surgery. Dissections that stay in the descending aorta, whether Stanford B or DeBakey III, can often be treated without open surgery unless other problems come up.

Timing matters, too.

A sudden aortic dissection is one diagnosed within 14 days of the first symptoms. These need the fastest response. An aortic dissection found between 15 and 90 days after symptoms start falls into the next group.

For aortic dissection cases, care often focuses on controlling blood pressure, checking the aorta with regular imaging and doing a repair only when it's needed.

2. What causes aortic dissection and who is at risk?

Most aortic dissections happen in people who have high blood pressure. High blood pressure slowly weakens the wall of the aorta, making a tear more likely. Other things can raise your risk too, including:

Connective tissue disorders: These are conditions you're born with that affect the tissues holding your body together. Marfan syndrome, Loeys-Dietz syndrome and Ehlers-Danlos syndrome can all weaken the aortic wall.
Bicuspid aortic valve: Some people are born with a heart valve that has two flaps instead of the usual three. This puts extra strain on the aortic wall.
Atherosclerosis: This is a buildup of a fatty material called plaque inside the arteries. Over time, it makes the aorta stiffer and weaker.
Family history of aortic disease: If a close relative, like a parent, brother or sister, has had an aortic dissection or an aneurysm, your own risk goes up a lot.
Injury: A hard blow to the chest, such as one from a high-speed car crash, can trigger a dissection.
Past heart procedures: Surgery or other treatments involving the heart or aorta carry some risk of causing a tear.

Your risk also grows as you get older. Dissections happen more often in men, but, women can be at higher risk too, especially during pregnancy or in the weeks after giving birth. Women may also have symptoms that don't look like the usual warning signs, which makes it important to stay alert.

3. What are the warning signs of an aortic dissection?

The main warning sign of an aortic dissection is sudden, intense pain in the chest or upper back. An aortic dissection is a serious tear in the wall of the aorta, the body's largest blood vessel. Many people describe the pain as sharp, and it can feel like something is tearing or ripping inside them.

As the tear grows, the pain can spread to other parts of the body. You might feel it in your neck, jaw, belly or down your spine.

4. Is aortic dissection considered a heart attack?

There's one big difference between aortic dissection pain and the pain of a heart attack. A heart attack usually builds up slowly and gets worse over time. Aortic dissection pain is different. It often hits its worst point within just a few seconds.

Additional aortic dissection symptoms include:

Shortness of breath
Fainting or near-fainting
Sweating
A feeling of impending doom
Unequal blood pressure or pulses between arms
A new heart murmur

Some people experience unusual symptoms such as abdominal pain, stroke-like symptoms, limb weakness, hoarseness or decreased urine output.

If sudden severe chest or back pain occurs, especially with fainting, shortness of breath or an unsteady pulse, call 911 immediately and tell responders you are concerned about aortic dissection.

5. How is aortic dissection diagnosed?

To find an aortic dissection, your care team will ask about your symptoms and health history. Then they will do a physical exam.

They will check your blood pressure in both arms. If the numbers are different, that can be an early clue that something is wrong with the aorta.

Next, doctors will use imaging to get a clear look inside your body and confirm the diagnosis. They may use:

CT angiography (CTA): This is a special X-ray scan that uses a dye to make your blood vessels show up clearly. It's the most common tool because it's fast, easy to find in most hospitals and very accurate. A CTA shows where the tear is, how blood is moving through the real path and the fake one and whether the tear reaches any smaller vessels branching off the aorta.
Transesophageal echocardiography (TEE): This test uses sound waves to make pictures of the heart and aorta. A thin, flexible tube goes down the throat to get a close view from the inside. It's a great choice for people who are too sick to be moved, because doctors can do it right at the bedside. A TEE also checks how well the heart and the aortic valve are working.
MRI: This scan uses magnets and radio waves to create detailed pictures, and it doesn't use radiation. It shows the aorta clearly, but it takes longer and isn't always available, so it's less useful in an emergency.
Chest X-ray: This quick scan may show a widened area in the middle of the chest, called the mediastinum, the space between the lungs that holds the heart and major vessels. A chest X-ray can hint at a problem, but it can't confirm or rule out a dissection on its own.
Blood tests: A test called D-dimer, along with other lab work, can give doctors helpful clues. Still, these tests should never slow down imaging when doctors strongly suspect a dissection.

6. How is aortic dissection treated?

Treatment has three goals: keep the aorta from bursting, stop the tear from spreading and get blood flowing to your organs the way it should. The right treatment depends on where the tear is and how serious it is. Treatment for different types of dissection include:

Stanford Type A dissection: This type needs emergency surgery right away. Surgeons replace the torn part of the aorta and fix the heart valve if needed. Every hour without surgery raises the risk of dying.
Stanford Type B dissection: When there are no serious complications, doctors treat this type with medicine. The goal is to lower blood pressure and heart rate to reduce strain on the aorta.
Complicated Type B dissection: If the tear causes ongoing pain, uncontrolled blood pressure or poor blood flow to an organ, doctors use a procedure called TEVAR. A surgeon places a small tube inside the aorta to seal the tear and restore normal blood flow, without open surgery.

7. What does recovery from aortic dissection look like?

Recovery right after surgery includes close ICU monitoring, pain control and getting up and moving as soon as it is safe. Long-term care is equally important and includes:

Lifelong blood pressure management: Keeping blood pressure controlled reduces the risk of progression and recurrence
Regular surveillance imaging: CTA or MRI at intervals determined by the care team tracks any changes in the aorta over time
Lifestyle modifications: Quitting smoking , heart-healthy eating, maintaining a healthy weight and avoiding heavy isometric lifting all support aortic health
Cardiac rehabilitation: Physician-guided rehabilitation helps patients rebuild stamina safely after surgery or a hospitalization
Genetic counseling and family screening: People with connective tissue disorders benefit from specialized aortic clinics, and first-degree relatives may warrant screening

Staying consistent with medications and keeping all follow-up imaging appointments are essential components of long-term survival.

Expert aortic care at the Ochsner Aortic Center

For patients in the Gulf South region, the John Ochsner Heart and Vascular Aortic Center in New Orleans, Louisiana, provides complete expert care for aortic diseases, including aortic dissection.

The Ochsner Aortic Center brings together a coordinated multidisciplinary team who review every case together and builds a treatment plan made just for you. This means you get the combined expertise of an entire specialty team, from your first diagnosis through long-term follow-up. The center cares for the full range of aortic diseases.

People can survive aortic dissection with quick recognition and the right care. It is important to act quickly. If you or someone nearby develops sudden, severe chest or back pain, particularly with fainting, unequal pulses or neurological symptoms, call 911 without delay.

Learn more about the Ochsner Aortic Center.