Aortic dissection: symptoms, causes, diagnosis and emergency treatment

The British Heart Foundation (BHF) lists the symptoms of aortic dissection as sudden, severe pain across the chest, often felt in the back or between the shoulder blades; pain in the jaw, face, abdomen, back or lower extremities (hip, thigh, knee, lower leg, ankle and foot); feeling cold, clammy and sweaty; and fainting and shortness of breath.

The BHF says that if you experience any of these symptoms you should phone 999 immediately, because aortic dissection is a medical emergency and needs urgent treatment.

• Sudden, severe pain across the chest, often felt in the back or between the shoulder blades.

• Pain in the jaw, face, abdomen, back or legs.

• Feeling cold, clammy and sweaty.

• Fainting and shortness of breath.

The BHF explains that the aorta is the main artery in the body, carrying blood high in oxygen away from the heart to the rest of the body. Aortic dissection is when the weakened wall of the aorta tears, causing blood to leak between the layers that make up the wall. This can happen suddenly or slowly over time.

It is different from a ruptured aneurysm. The BHF describes aortic rupture as a significant tear in all the layers of the aorta wall where there is a large aneurysm, causing blood to leak out from the aorta, which leads to severe blood loss and is life threatening.

The BHF says to phone 999 immediately. The NHS says not to drive yourself to A&E, and that the person you speak to at 999 will give you advice about what to do.

The symptoms can overlap with those of a heart attack. The NHS lists chest pain that feels tight or like squeezing, chest pain spreading to the arms, neck or jaw, severe difficulty breathing, pale, blue or grey skin, and someone who has passed out and is not responding normally as reasons to call 999. The BHF says diagnosing aortic dissection can be difficult because the symptoms are similar to many other health conditions, which is why imaging is used.

The BHF says certain risk factors increase the chance of aortic dissection. High blood pressure is one of the most common and can weaken the wall of the aorta over time, making it more likely to tear under pressure. Others include atherosclerosis and aortic coarctation (narrowing of part of the aorta, present at birth). Conditions that weaken the aorta wall, like an aneurysm, can make aortic dissection more likely too.

Some people are born with conditions that cause the aorta wall to weaken. The BHF lists Marfan syndrome, Turner syndrome, Ehlers-Danlos syndrome, Loeys-Dietz syndrome and bicuspid aortic valve as uncommon examples.

The BHF says diagnosis can be difficult because symptoms resemble those of many other conditions. Imaging is the key: a CT scan, a magnetic resonance angiogram (MRA) or a transoesophageal echocardiogram (TOE), in which a probe is guided through the throat to image the heart and aorta.

The BHF says there are two types of aortic dissection, type A and type B. Each type is in a different area and the treatment and management of each is different.

The BHF says people who have had an aortic dissection, including those treated with surgery, usually take blood pressure medicines for the rest of their lives to reduce the stress on the aorta. Ask the specialist team what follow-up imaging and monitoring is planned in your case.

Because having an aneurysm raises the chance of dissection, aneurysm checks matter. The BHF says most people with an aneurysm have no symptoms, that one is sometimes picked up during CT, MRI or ultrasound tests for other conditions, and that there is a screening programme in the UK. The NHS says an ultrasound test is offered to all men when they turn 65, as they are most at risk of an abdominal aortic aneurysm.

The NHS says lifestyle changes such as quitting smoking and eating healthily may be recommended for a small aneurysm, along with medicines to lower blood pressure and cholesterol, and that surgery may be done if an abdominal aortic aneurysm is large (5.5cm or bigger), quickly getting bigger or painful. The BHF similarly says that if an aneurysm grows to more than around 5.5cm you may need surgery to prevent it from bursting.

Aortic dissection is always an emergency, treated through 999 and hospital emergency departments rather than a booked appointment. The BHF says treatment and management differ between the two types of dissection.

For the long term, the BHF says people will usually take blood pressure medicines for life. If you use private care for follow-up, ask who is overseeing your scans and blood pressure treatment and how they are in contact with the team that treated you.