Aortic Dissection – Diagnosis and Treatment

Diagnosis

Aortic dissection often appears with sudden, intense chest pain that may feel like tearing or ripping.

Doctors also check for signs such as different blood pressure readings in each arm or a widened aorta on a chest X-ray. These signs help raise suspicion for this serious condition, but diagnosis relies on further testing.

Common Tools Used for Diagnosis:

• Transesophageal Echocardiogram (TEE):
  The doctor guides an ultrasound probe through the esophagus, allowing close views of the heart and aorta. This helps the doctor spot an intimal tear, a false lumen, or blood flow disruptions.

• Computed Tomography Angiography (CTA):
  A CT scan of the chest provides detailed, cross-sectional images showing the aorta and can identify tears, aneurysms, and other problems.

• Magnetic Resonance Angiogram (MRA):
  MRA uses magnets and radio waves to make images of blood vessels. This test detects the location of the dissection and any areas where blood flow is blocked.

Doctors use these imaging tests, often along with a physical exam and questions about symptoms, to confirm a diagnosis and determine if the ascending aorta, aortic arch, or descending aorta is affected.

Common Symptoms Noted:

• Sudden chest or back pain
• Shortness of breath
• Weak pulse in one arm or leg

Treatment

Care for Acute Dissection Involving the Ascending Aorta

When the tear occurs in the part of the aorta closest to the heart, the medical team must act urgently.

Surgeons usually perform open surgical repair, removing the damaged section and replacing it with a synthetic graft. If the aortic valve is also affected, a surgeon may replace it during the same operation, sometimes using a valve placed inside the graft.

Medications play a vital role before and after the operation. Doctors prescribe beta blockers and other drugs to lower blood pressure and slow the heart, reducing strain on the vessel wall and limiting further injury.

Blood pressure management remains important, often for life, to help prevent new complications.

Key points:

• Surgeons use open surgical repair as the standard treatment.
• Synthetic grafts rebuild the aorta.
• Surgeons may perform valve replacement if there is valve damage.
• Medications control blood pressure and heart rate.

Approach for Tears in the Descending Aorta

When the dissection affects the section further from the heart, clinicians begin care with medications. Blood pressure control plays a crucial role and can be enough if there are no signs of serious complications.

Physicians often prescribe beta blockers or other drugs that keep the blood pressure within a safe range.

If the patient experiences ongoing problems or develops complications, clinicians may recommend endovascular techniques, such as placing a stent graft inside the aorta.

This approach is less invasive than open surgery and helps seal the tear and support the blood vessel.

Management steps:

• The first goal is to reduce blood pressure.
• Surgeons perform surgery or endovascular repair with a stent graft in complicated cases.
• Clinicians provide long-term follow-up with medical therapy and regular imaging for monitoring.