Sudden severe chest or upper back pain are possible signs of an aortic dissection. Your first thought might be "heart attack" but an aortic dissection is very different.
Vascular and cardiac surgeons are well aware of the dangers associated with an aortic dissection, a tear in the main artery of the heart.
"The [death] rate for an aortic dissection is about 1% an hour for the first 48 hours, making every second count," said Dr. Ali Azizzadeh, director of vascular surgery at Cedars-Sinai Smidt Heart Institute in Los Angeles. "Equally as important is seeking care, whenever possible, at a medical center with specialized, comprehensive services in treating aortic dissections."
Even some physicians and nurses frequently mistake an aortic dissection for a heart attack, which can delay diagnosis and eventual life-saving surgery.
"Aortic dissections are often referred to as 'the great masquerader' because symptoms may be mistaken for other conditions such as a heart attack or stroke," Azizzadeh said in a Cedars-Sinai news release. "If you experience severe chest or back pain, it's imperative you go to the emergency department for a complete workup that screens for aortic dissection."
The aorta originates from the heart's left ventricle, the primary chamber that pumps oxygen-rich blood out of the heart. When blood seeps through a tear in the inner layer and into the middle layers of the aorta, it causes them to separate, or dissect. This may deprive important organs of blood supply.
"Better than treating an aortic dissection, however, is preventing it," said Dr. Michael Bowdish, vice chair of the cardiac surgery in the Smidt Heart Institute. "Using advanced imaging techniques, we can predict which patients are at highest risk of developing an aortic dissection -- then monitor and treat them appropriately."
When an aortic dissection cannot be prevented, however, there are lifesaving treatment options available.
"The way we surgically treat aortic dissections today is vastly different than how we treated them 10 years ago, or even five years ago," Bowdish said in the release. "We now have minimally invasive approaches -- both for endovascular and open-heart procedures -- that can get patients back home within a few short days."
The use of minimally invasive endovascular stent grafts is one of these alternative treatment options.
Despite recent breakthroughs in therapy, aortic dissections lead to more American deaths than motor vehicle accidents.
Azizzadeh and Bowdish say the best way to avoid the condition is to know the risk factors. They include a personal or family history of thoracic disease, bicuspid aortic valve disease, and certain genetic syndromes like Marfan syndrome, Loeys-Dietz syndrome, vascular Ehlers-Danlos syndrome or Turner syndrome.
An aortic dissection can also stem from the extreme straining that comes with bodybuilding, using illegal drugs, or having uncontrolled high blood pressure. In rare cases, aortic dissection occurs in pregnancy, especially in women with aortic aneurysms and connective tissue disorders.
Azizzadeh said the best thing to do if you have severe chest, back, or stomach pain is to go to the emergency room and ask the doctors to test for an aortic dissection.
The Mayo Clinic talks about symptoms and risk factors for an aortic dissection.
SOURCE: Cedar-Sinai Health System, news release, Sept. 16, 2022