Diseases & Conditions

Aortic Dissecting Intramural Hematoma - Aortic Dissection


Overview, Causes, & Risk Factors

An aortic dissection is a tear in the inner layer of the wall of the aorta. The aorta is the largest artery in the body and is directly attached to the heart.

What is going on in the body?

The aorta and its branches carry all the blood from the heart out to the rest of the body. When there is a weakening of the wall of the aorta for any reason, blood flow can cause a tear in the wall. This tear forms a tube or canal within the wall of the aorta. Though the aorta goes down into the abdomen, this condition usually starts in the chest. In some cases, blood flowing within this canal can reenter the aorta or perforate into the body and cause massive bleeding and even death.

What are the causes and risks of the condition?

Common causes of aortic dissection include:

  • high blood pressure
  • trauma to the chest, such as a crush injury from a motor vehicle accident
  • hereditary diseases that weaken the wall of the aorta
  • congenital heart disease, or heart abnormalities present at birth
  • pregnancy
  • any disease that weakens or damages the wall of the aorta
  • surgery or other procedures, which may damage the aorta

  • Symptoms & Signs

    What are the signs and symptoms of the condition?

    The most common symptoms of aortic dissection include:

  • chest pain, which is usually severe and may go through to the back. The pain may also move around as the condition spreads to involve more of the aorta.
  • shortness of breath
  • weakness
  • fainting
  • paralysis, or not being able to move a body part, which is uncommon

  • Diagnosis & Tests

    How is the condition diagnosed?

    The history and physical exam may make a healthcare provider suspect aortic dissection. An ECG, or electrocardiogram, may reveal a pattern associated with high blood pressure. A chest X-ray may show an abnormally shaped aorta. The X-ray may also show fluid in the lungs, known as pulmonary edema, or around the heart, known as pericardial effusion.

    Special X-ray tests are used to confirm the diagnosis. A cardiac catheterization involves the insertion of a tube through the skin and into an artery. This tube can be threaded up into the aorta and injected with contrast agent. As the contrast agent moves through the aorta, pictures can be taken. If a dissection is present, it can be seen. Other types of special X-rays can also be used to make the diagnosis.


    Prevention & Expectations

    What can be done to prevent the condition?

    Treatment of any underlying disease, especially high blood pressure, can help prevent aortic dissection. In people with inherited diseases who are at high risk, high blood pressure should be treated before problems occur.

    What are the long-term effects of the condition?

    In many cases of aortic dissection, there are no long-term effects. Individuals are either treated successfully or die. Death may occur instantly in some cases. In other cases, permanent body damage can occur. For example, a person may become paralyzed or have a heart attack or stroke.

    What are the risks to others?

    Aortic dissection is not contagious, and poses no risk to others.


    Treatment & Monitoring

    What are the treatments for the condition?

    People with aortic dissection are treated in the hospital. Medical treatment is started to lower the blood pressure and make sure the heart does not pump with too much force. Surgery is needed for many people with this condition. People who have a dissection that is further from the heart are sometimes treated with medications instead of surgery. This is often done if the person is not well enough to withstand surgery. However, these people may need emergency surgery if the aorta starts to leak, gets bigger, or blocks off the blood supply to an organ or limb.

    What are the side effects of the treatments?

    All surgery carries the risk of infection and bleeding, but, in this case, there is also a very real chance of death. Heart and blood pressure medications may also cause side effects. These may include allergic reactions, stomach upset, or other side effects, depending on the medication used.

    What happens after treatment for the condition?

    If a person has surgery, the aortic dissection is often "cured." The problem area of the aorta may be cut out, fixed, or bypassed with an artificial graft, or man-made artery. People treated with medications are watched for blood pressure control or symptoms that may require surgery.

    How is the condition monitored?

    People who have surgery need a period of monitoring during recovery. This is done to make sure the heart and aorta are healing properly. People usually need close monitoring of their heart and blood pressure. Special X-ray tests may be used to follow up on people after surgery. Any new or worsening symptoms should be reported to the healthcare provider.


    Attribution

    Author:Eric Berlin, MD
    Date Written:
    Editor:Ballenberg, Sally, BS
    Edit Date:02/12/01
    Reviewer:Adam Brochert, MD
    Date Reviewed:07/27/01

    Sources

    Merck Manual, 1999

    Harrison's Principals of Internal Medicine, 1991

    Current Medical Diagnosis and Treatment, 1996