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hat is aortic dissection? Your aorta is the main artery that carries oxygen-rich blood away from your heart to the rest of your body. The wall of your aorta is made up of three tissue layers — an inner layer (intima), middle layer (media) and outer layer (adventitia). An aortic dissection begins abruptly when a tear occurs in the inner layer of a weakened area of your aorta. Blood surges through the tear, causing the inner and middle layers to separate (“dissect”). As diverted blood flows between the tissue layers, the normal blood flow to parts of your body may be slowed or stopped, or the aorta may rupture completely. Aortic dissection is a life-threatening condition that can cause sudden death if it is not recognized and quickly treated. Aortic dissection is a separation between the inner and middle layers of the aortic artery wall. Blood pours through a tear in the inner layer, causing a bulge and weakness in that area of the aortic artery. Where is the aorta? The aorta runs throughout your torso. It begins at the main pumping chamber of your heart (the left ventricle), extends up through the front middle of your chest, arches from front to back under the base of your neck, then travels downward along the front of your spine — through your chest (thoracic aorta) and abdomen (abdominal aorta) — before branching just below your navel to two other arteries called the right and left common iliac arteries. Are there different types of aortic dissection? There are two main types: Stanford Type A Aortic Dissection: This type of dissection occurs in the first part of the aorta, closer to the heart, and can be immediately life-threatening. It usually requires emergency open chest surgery to repair or replace the first segment of the aorta where the tear started (ascending aorta +/- the arch and/or aortic valve). This is a more common type of dissection than Type B, and the dissection of the aorta usually extends through the entire length of the aorta. Stanford Type B Aortic Dissection: This type of tear begins farther down the aorta (descending aorta beyond the arch), and farther from the heart. Like the type A dissection, this usually extends from the descending aorta into the abdominal segment (abdominal aorta), but doesn’t involve the first part of the aorta in the front of the chest. Surgery may or may not be needed immediately, depending on exactly where the dissection is located and if it is or isn’t cutting off blood flow to your organs. These operations usually can be performed with a stent-graft device inserted into the aorta. Another classification system (DeBakey Classification) defines dissection by three types. Type 1 originates in the ascending aorta and extends through the downstream aorta. Type 2 originates and is limited to the ascending aorta (both would be considered Stanford Type A). Type 3 originates in the descending aorta and extends downward (similar to Type B). What’s the difference between aortic aneurysm, aortic rupture and aortic dissection? An aortic aneurysm is a bulge — like a bubble or a balloon — in a weakened area of the wall of the aorta or across an entire segment of the aorta. Aortic aneurysm can lead to aortic rupture and aortic dissection. An aortic rupture is a complete tear through all three layers of the aorta — like a rip or a hole — in the wall of the aorta. Blood bursts through the hole into the surrounding body cavity. SYMPTOMS AND CAUSES Common signs and symptoms include: Sudden severe, sharp pain in your chest or upper back; also described as a tearing, stabbing or ripping feeling. Shortness of breath. Fainting or dizziness. Low blood pressure; high suspicion when there’s a 20 mmHg pressure difference between arms. Diastolic heart murmur, muffled heart sounds. Rapid weak pulse. Heavy sweating. Confusion. Loss of vision. Stroke symptoms, including weakness or paralysis on one side of your body, trouble talking. What causes aortic dissection? Aortic dissection happens because there is an underlying, slow breakdown of the cells that make up the walls of your aorta. The breakdown has likely been going on silently for many years before the weakened area of the aortic wall finally gives way, resulting in a tear, which leads to the aortic dissection. What factors can increase the risk of developing aortic dissection? Factors that can increase your risk for developing aortic dissection include: Ongoing high blood pressure (hypertension). This is the most important risk factor. Stroke. Aortic valve damage. Damage to internal organs. Fluid buildup between the heart muscle itself and the sac covering the heart. This condition, called cardiac tamponade, puts pressure on the heart and prevents it from working properly. Death.