Aortic Rupture (Dissection) Symptoms and Emergency Intervention

Aortic dissection is one of the most urgent conditions in vascular surgery and one that requires us to act as fast as possible. In this article I will explain the symptoms of dissection and why we are racing against time.

Aortic Dissection Symptoms: Stabbing Pain in the Back

The most characteristic symptom of dissection is chest or back pain that begins suddenly, is extremely severe and is described as “tearing” or “like a knife being driven in”; the pain can typically radiate to the back, the neck or the abdomen. Unlike the pressure sensation of a heart attack, this pain begins abruptly at its most severe.

The Difference Between Type A and Type B Dissection

If the dissection involves the ascending aorta (the segment close to the heart) we call it Type A; this is a true surgical emergency that can be fatal within hours, and we take the patient to the operating room as soon as the diagnosis is made. If the dissection involves only the descending aorta we call it Type B; as long as it is uncomplicated we generally prefer medical treatment with strict blood pressure control, while in complicated cases we turn to angiographic treatment (TEVAR).

The Vital Importance of Emergency Surgical Intervention

In Type A dissection every passing hour increases the risk of death; large international registries show that in-hospital mortality is around 26% in patients who undergo surgery, while it can rise to 58% in patients who cannot be operated on. This difference clearly demonstrates how life-saving timely surgery is.

Frequently Asked Questions

How is aortic dissection distinguished from a heart attack? Pain that begins suddenly at its most severe and radiates to the back suggests dissection; the definitive diagnosis is made with emergency imaging (computed tomography, BT).

Does every dissection require surgery? No; while Type A dissection requires emergency surgery, uncomplicated Type B dissection can usually be managed with medication.

Who is at higher risk of dissection? The risk is increased in people with uncontrolled high blood pressure, in those with an inherited connective tissue disorder such as Marfan syndrome, and in those with a bicuspid aortic valve.

Conclusion

Aortic dissection is a true emergency in which minutes and hours are vitally important. If you notice sudden and severe chest or back pain, going to the emergency department without losing time is life-saving.

If you have experienced sudden and severe chest or back pain, we recommend that you go to the emergency department without losing time.

References

1. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): New Insights into an Old Disease. JAMA. 2000;283(7):897-903.
2. Isselbacher EM, Preventza O, Hamilton Black J 3rd, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease. Circulation. 2022;146(24):e334-e482.