Thoracic Aortic Dissection: Causes, Symptoms and Diagnosis

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The most important and largest vessel in the body that brings oxygenated blood from the heart to the rest of the body is the aorta. In an aortic dissection, the inner wall of the aorta tears, and the blood flow gets disturbed. This could lead to life-threatening bleeding and serious complications. A thoracic aortic dissection takes place in the aorta that passes through the chest cavity.

Causes

Aortic dissection is a rare condition and usually occurs in men in their 60s and 70s. The following conditions can raise the risk of dissection:

• High blood pressure: Hypertension, or high blood pressure, can damage the aorta’s inner lining, and make it weak and more likely to tear.
• Atherosclerosis: It refers to the “hardening of the arteries” and happens when plaque builds up in the artery wall. The plaque makes it more susceptible to tearing.
• Trauma to the chest: A car accident can cause a trauma to the chest leading to aortic dissection.
• Coarctation of the aorta: This is a birth defect in which a portion of the aorta is narrower than usual. Some babies have heart defects due to changes in their genes or chromosomes.
• Connective tissue disorders (CTD): CTDs such as Marfan syndrome or Ehlers-Danlos syndrome can cause weakness in the blood vessels, leading to aortic dissections, and ruptures.

Risk factors

Here is a list of things that can raise the risk of aortic dissection:

• Age: People who are 60 and above are more likely to develop aortic dissection
• Cocaine consumption: Cocaine-induced hypertension can cause complication like aortic dissection
• High-intensity weightlifting: This strenuous exercise can raise your risk of aortic dissection
• Pregnancy: Aortic dissections occur in otherwise healthy women during pregnancy
• Heart surgery or procedures
• Swelling of the blood vessels due to conditions like arteritis and syphilis is linked to aortic dissection
• Bicuspid aortic valve is associated with a high risk of aortic dissection

Symptoms

Some of the symptoms of aortic dissection are similar to those of a heart attack. Some of the common signs and symptoms include:

• Sudden severe chest or upper back pain
• Loss of consciousness
• Shortness of breath
• Sudden severe stomach pain
• Stroke like symptoms, including vision problems, difficulty in speaking, and weakness or loss of movement
• Leg pain
• Difficulty in walking
• Weak pulse in one arm or thigh in comparison to the other
• Mild neck, jaw, or chest pain
• Numbness, tingling, or pain in the toes or fingers
• Fever
• Fainting or dizziness
• Pale skin
• Nausea
• Heavy sweating

How to diagnose aortic dissection

For diagnosis, your doctor will ask about your symptoms, medical history, lifestyle, and family medical history. During the physical exam, your doctor may listen to your heart sounds with a stethoscope, take your pulse and evaluate your circulation. Other possible tests include:

• CT scan: A powerful test that uses rotating X-ray machines and computer technology to produce cross-sectional views of your aorta.
• MRI: This test uses strong magnetic fields and radio waves to create 3-dimensional detailed anatomical images of the organs and tissues within the body.
• Echocardiogram: This test gives a graphic outline of the heart’s movement. It finds how your heart’s chambers and valves are pumping blood through your heart.
• Transesophageal echocardiogram (TEE): This test uses echocardiography to check for an aneurysm. It also helps determine if there is a tear in the aorta lining.
• Chest X-ray: It makes use of invisible electromagnetic energy beams to make images of internal tissues, bones, and organs onto film.
• Arteriogram (angiogram): It uses X-rays and a special dye to see inside the blood vessels.

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Data Sources:

• https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=85&contentid=p08258
• https://www.mayoclinic.org/diseases-conditions/aortic-dissection/symptoms-causes/syc-20369496
• https://www.webmd.com/heart-disease/what-is-aortic-dissection

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