Aortic Dissection

Overview

Aortic dissection occurs when a tear in the intima allows blood to enter the media and create a false lumen.

It can rapidly compromise major branch vessels or cause aortic rupture.

Clinical Features

The classic presentation is sudden severe chest or back pain, although symptoms can vary depending on the location and affected vessels.

Pulse deficits, neurological findings, acute aortic regurgitation, or shock may occur.

Sudden severe chest pain with pulse or blood-pressure asymmetry should raise concern for aortic dissection.

Investigation

CT angiography is commonly used in stable patients, while transesophageal echocardiography is useful in selected urgent settings.

Management

Immediate management includes pain control and reduction of aortic shear stress with appropriate medical therapy.

Proximal dissections generally require urgent surgical management, while selected distal dissections may be managed medically or interventionally depending on complications.

Clinical Pearls