Aortic Dissection

About Aortic Dissection

Aortic dissection is a life-threatening cardiovascular emergency characterized by a tear in the intimal layer of the aorta, allowing blood to flow between the vessel wall layers. This condition requires immediate recognition and treatment as it can rapidly progress to rupture, cardiac tamponade, or organ malperfusion with extremely high mortality rates.

Pathophysiology

The dissection begins with an intimal tear that allows blood to enter the medial layer, creating a false lumen that propagates along the aortic wall. Hypertension, connective tissue disorders, and aortic wall degeneration are primary risk factors that weaken the vessel structure and increase wall stress, leading to the initial tear.

Clinical Reasoning

Patients typically present with sudden-onset, severe chest or back pain described as tearing or ripping, often migrating as the dissection extends. The clinical approach focuses on rapid imaging with CT angiography or TEE to confirm diagnosis and classify the dissection type, as Stanford Type A dissections involving the ascending aorta require emergency surgical repair while Type B dissections may be managed medically with aggressive blood pressure control.