What are the symptoms and treatment of aortic dissection?

From the Guidelines

Aortic dissection is a life-threatening condition that requires immediate medical attention, and treatment depends on the location of the dissection, with type A dissections typically requiring emergency surgery and type B dissections often being managed medically with aggressive blood pressure control. The symptoms of aortic dissection include sudden, severe chest or back pain often described as tearing or ripping, which may radiate to the neck, shoulders, or abdomen, as well as shortness of breath, fainting, stroke symptoms, weak pulse in one arm compared to the other, and signs of shock like pale skin and rapid heartbeat 1. The management of aortic dissection involves controlling pain and reducing systolic blood pressure to values between 100 and 120 mmHg, with beta-blockers being the first line treatment, and vasodilators such as nitroprusside being used in combination with beta-blockers to control blood pressure 1. Some key points to consider in the management of aortic dissection include:

• The importance of prompt diagnosis and treatment, as mortality rates increase significantly with delays, particularly for type A dissections where mortality increases by 1-2% per hour without intervention 1
• The use of imaging studies such as computed tomography angiogram (CTA), transesophageal echocardiogram (TEE), transthoracic echocardiogram (TTE), and magnetic resonance angiogram (MRA) to confirm the presence of aortic dissection and classify its location 1
• The need for long-term management, including oral antihypertensive medications, regular imaging follow-ups, and lifestyle modifications, to prevent further complications and improve outcomes 1. It is also important to note that the treatment of aortic dissection should be individualized based on the specific characteristics of the patient and the dissection, and that a multidisciplinary approach involving cardiologists, cardiothoracic surgeons, and other specialists may be necessary to ensure optimal care 1.

From the Research

Symptoms of Aortic Dissection

• Severe chest pain is a common symptom of aortic dissection, often described as tearing or ripping in nature 2, 3
• Hypertension is a major risk factor for aortic dissection, and patients often present with high blood pressure 2, 4
• Aortic dissection can also cause symptoms such as aortic regurgitation, pericardial effusion, and organ malperfusion 2, 5

Treatment of Aortic Dissection

• Medical therapy with aggressive blood pressure lowering is recommended for patients with acute aortic dissection, especially those with Stanford type B dissection 5
• Emergency surgery is often necessary for patients with type A aortic dissection, while those with type B dissection may be treated with thoracic endovascular aortic repair (TEVAR) if complications arise 5, 3
• Controlling heart rate and blood pressure is crucial in the initial management of acute aortic dissection, with a goal of reducing systolic blood pressure to 100-120 mmHg and heart rate to 60-80 beats/min 3, 4
• Parenteral antihypertensive agents, such as sodium nitroprusside and beta-blockers (e.g., esmolol), are used to control blood pressure and prevent target organ damage 4, 6