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Health condition · Clinically reviewed

Aortic dissection, a time-critical tear that needs a hospital, fast.

Sudden severe tearing chest or back pain is an emergency. This guide explains Stanford Type A and B, how the diagnosis is made and how modern UK cardiothoracic teams treat it.

If you or someone with you has sudden severe tearing chest or back pain, call 999 now. This page is for information, not for a live emergency.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a UK-registered clinician before publication.

  • 02

    Sourced from guidance

    Checked against ESC, AHA/ACC, IRAD and NICE-aligned UK cardiothoracic pathways.

  • 03

    Current for 2026

    Reflects modern practice including TEVAR for complicated Type B and lifelong imaging surveillance.

Key facts

Aortic dissection at a glance.

The essentials in plain English: what it is, the Stanford and DeBakey classifications, the biggest risk factor and the classic story.

  • What it is

    A tear in the inner lining (intima) of the aorta allowing blood to dissect into the media and create a false lumen alongside the true one.

  • Stanford Type A

    Involves the ascending aorta (around 60 percent of cases). Surgical emergency with untreated mortality of roughly 1 to 2 percent per hour.

  • Stanford Type B

    Distal to the left subclavian (around 40 percent). Uncomplicated cases are managed medically; complicated cases need TEVAR.

  • DeBakey system

    Type I involves ascending, arch and descending aorta. Type II is ascending only. Type III is descending only.

  • Biggest risk factor

    Long-standing hypertension. Also connective tissue disease (Marfan, Loeys-Dietz, vascular Ehlers-Danlos), bicuspid aortic valve and cocaine use.

  • Classic presentation

    Sudden, severe tearing chest or interscapular back pain often described as the worst pain of life, sometimes with a blood pressure difference between arms.

Why this guide matters

Time is aorta.

Aortic dissection is uncommon but ferociously time-critical. The three points below shape everything else on this page.

  • Suspicion saves lives

    Every hour without treatment adds roughly 1 to 2 percent to mortality in Type A dissection. Early suspicion is the single biggest survival factor.

  • Imaging is fast and definitive

    CT angiography of the whole aorta answers the question in minutes. TOE is the bedside answer for the unstable patient.

  • Two very different pathways

    Type A is a cardiothoracic surgical emergency. Type B is medical unless complicated, when TEVAR takes over.

How the diagnosis is made

From first suspicion to a treatment plan.

The steps a UK emergency and cardiothoracic team will normally follow, in order, so you know what to expect and why.

  1. 01

    Assessing

    Rapid clinical suspicion

    Sudden tearing chest or back pain, especially with hypertension, connective tissue disease or a family history of aortic disease.

  2. 02

    Assessing

    Focused examination

    Blood pressure in both arms (a difference above 20 mmHg is a clue), pulse deficits, new aortic regurgitation murmur and neurology.

  3. 03

    Assessing

    ECG and chest X-ray

    ECG helps exclude STEMI (which dissection can mimic). Chest X-ray shows a widened mediastinum in roughly 60 percent of cases.

  4. 04

    Confirming

    CT angiography (gold standard)

    Urgent CTA of the arch, thoracic and abdominal aorta confirms the tear, classifies it and maps branch vessel involvement.

  5. 05

    Confirming

    Transoesophageal echo (TOE)

    Bedside option for the unstable patient. Excellent for the ascending aorta, aortic valve and pericardial fluid.

  6. 06

    Confirming

    MRA in selected cases

    MR angiography is an alternative when radiation or contrast concerns dominate and time allows.

  7. 07

    Preparing

    Bloods and crossmatch

    Baseline FBC, U and E, clotting, troponin, D-dimer where pre-test probability is low, plus group and save with 6 units crossmatched.

Typical timeline: door to CT to theatre in under two hours in a specialist centre.

Symptoms

What aortic dissection actually looks like.

The classic mix of tearing chest and back pain, blood pressure differential and branch vessel malperfusion, plus the features that mean 999 now.

  • Sudden tearing chest pain

    The classic story: an abrupt, severe, ripping or tearing pain in the chest at the very moment it starts.

  • Interscapular back pain

    Pain radiating between the shoulder blades is highly suggestive, especially with descending (Type B) dissection.

  • Blood pressure differential

    A systolic difference of more than 20 mmHg between arms, or absent peripheral pulses, points to branch involvement.

  • New aortic regurgitation

    A new early diastolic murmur in Type A dissection where the aortic valve is disrupted by the tear.

  • Malperfusion syndromes

    Stroke, limb ischaemia, spinal cord ischaemia, mesenteric ischaemia or acute kidney injury from occluded branch vessels.

  • Syncope or collapse

    Loss of consciousness can reflect tamponade, severe hypotension or cerebral malperfusion.

  • Cardiac tamponade

    Blood tracks into the pericardium in Type A dissection, causing muffled heart sounds, raised JVP and hypotension.

  • Red flag - sudden collapse

    Sudden death is a real outcome in untreated Type A dissection. Any suggestive presentation is a blue-light emergency.

Treatment

How aortic dissection is treated in the UK.

Immediate blood pressure and heart rate control first, then emergency open surgery for Type A or medical care with TEVAR for complicated Type B, followed by lifelong medication and imaging.

  • Immediate blood pressure control

    IV labetalol or esmolol first (beta-blocker), targeting systolic BP under 120 mmHg and heart rate under 60. Add sodium nitroprusside if needed.

  • Pain control

    IV opioid analgesia (morphine or fentanyl) reduces sympathetic drive and helps lower blood pressure and heart rate.

  • Type A - emergency surgery

    Open cardiothoracic replacement of the ascending aorta, often with aortic valve replacement (Bentall) and coronary reimplantation.

  • Arch and complex reconstruction

    Selective arch replacement with MDT input when the tear extends into the arch or great vessels.

  • Type B uncomplicated - medical

    Tight blood pressure control, pain relief, close monitoring in HDU/ITU and serial imaging in the acute phase.

  • Type B complicated - TEVAR

    Thoracic endovascular aortic repair for malperfusion, rupture, refractory pain or rapid aortic growth.

  • Long-term medication

    Lifelong beta-blocker plus ARB (losartan is preferred in Marfan syndrome), targeting systolic BP under 120 mmHg for life.

  • Surveillance and genetics

    Regular CT or MRI surveillance, genetic testing where a heritable disorder is suspected, and cascade screening of first-degree relatives.

What this guide is based on

The sources behind every claim on this page.

International and UK guidance current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

If you have sudden severe tearing chest or back pain, call 999. Your cardiologist or cardiothoracic team knows your case and can tell you which parts of this guide apply to you.

  • European Society of Cardiology (ESC). Guidelines for the diagnosis and treatment of aortic diseases.

  • AHA/ACC. Guideline for the diagnosis and management of aortic disease.

  • International Registry of Acute Aortic Dissection (IRAD). Outcomes and management data.

  • NHS England. Adult cardiothoracic surgery service specification and aortic dissection pathway.

Red flags

When suspicion becomes emergency.

Aortic dissection is a diagnosis you make by suspecting it. These are the situations that must trigger immediate imaging or a 999 call.

  • Suspected Type A dissection

    Any sudden severe chest or back pain with suggestive features is a blue-light emergency needing immediate cardiothoracic assessment.

  • Haemodynamic instability

    Hypotension, tachycardia or shock in this setting suggests rupture, tamponade or severe aortic regurgitation. Resuscitate and escalate at once.

  • New neurological deficit

    Stroke, paraplegia or altered consciousness point to malperfusion of the head, spinal cord or brain and change surgical urgency.

  • Limb or mesenteric ischaemia

    Cold, pulseless limb or severe abdominal pain out of proportion to examination signals branch vessel occlusion.

  • Pregnancy in connective tissue disease

    Third-trimester and early postpartum women with Marfan syndrome are a highest-risk group. Any chest or back pain warrants urgent imaging.

  • Family history of aortic events

    Sudden death, aortic aneurysm or dissection in a first-degree relative under 60 raises suspicion sharply.

  • Cocaine or stimulant use

    Acute surge in blood pressure with cocaine, amphetamine or methamphetamine use can precipitate dissection.

  • Recent cardiac intervention

    New pain after cardiac catheterisation, valve surgery or aortic surgery may reflect iatrogenic dissection.

  • Progressive false lumen expansion

    Growth of the residual dissected aorta on surveillance imaging is a hard indication for intervention.

Living with it

A serious condition, with a clear long-term plan.

Four things make the biggest difference after dissection: pressure control, daily medication, sensible activity limits and never missing a surveillance scan.

A quiet reminder

Consistency beats intensity, every time.

Small, steady habits kept up for years do more for a dissected aorta than any short burst of effort.

  1. 01 Pressure

    Keep systolic BP under 120 mmHg

    Consistent, lifelong blood pressure control is the single most important thing you can do after any dissection.

  2. 02 Medication

    Take the beta-blocker every day

    Beta-blockers reduce the force each heartbeat puts on the aortic wall. Losartan is often added, especially in Marfan.

  3. 03 Activity

    Avoid heavy isometric strain

    No maximal lifting, no competitive contact sport. Steady aerobic activity is encouraged; a cardiologist will personalise limits.

  4. 04 Follow-up

    Never miss a surveillance scan

    CT or MRI at set intervals is not optional. Dissected aortas can grow silently and need intervention before they rupture.

Frequently asked

Everything we get asked about aortic dissection.

Quick answers on Type A versus Type B, imaging, TEVAR, surgery and prevention.

  • What is aortic dissection?

    It is a tear in the inner lining of the aorta that allows blood to force its way into the middle layer of the aortic wall, creating a false lumen. It is a life-threatening emergency and one of the most catastrophic vascular events in medicine.

  • What is the difference between Type A and Type B?

    Stanford Type A involves the ascending aorta and needs emergency cardiothoracic surgery because untreated mortality is roughly 1 to 2 percent per hour. Stanford Type B starts distal to the left subclavian artery and is usually managed medically with blood pressure control, unless it is complicated by malperfusion, rupture, refractory pain or rapid growth, when TEVAR is offered.

  • What does the pain feel like?

    People typically describe a sudden, severe tearing or ripping pain in the chest or between the shoulder blades that is maximal at the moment it starts. Many call it the worst pain of their life. Any such pain, especially with high blood pressure or a connective tissue disorder, needs a 999 call.

  • How is aortic dissection diagnosed?

    CT angiography of the arch, thoracic and abdominal aorta is the gold standard and confirms the diagnosis, classifies the tear and maps branch vessel involvement. Transoesophageal echocardiography is a bedside alternative in unstable patients. ECG and chest X-ray help exclude mimics such as STEMI.

  • What is TEVAR?

    Thoracic Endovascular Aortic Repair is a keyhole procedure in which a covered stent-graft is deployed inside the descending aorta to cover the tear entry, depressurise the false lumen and restore flow to occluded branches. It is the standard intervention for complicated Type B dissection.

  • Can dissection be prevented?

    Not always, but the risk drops sharply with lifelong blood pressure control, avoiding cocaine and stimulant use, treating aneurysms before they reach threshold size, and genetic testing plus cascade screening in families with heritable aortic disease. If you have Marfan, Loeys-Dietz or vascular Ehlers-Danlos, dedicated aortic surveillance is essential.

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