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Acute Aortic Dissection: Emergency Approach

Time-critical diagnosis and rapid intervention in a life-threatening cardiovascular emergency

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Acil Servis department. Book Appointment →

What is Acute Aortic Dissection: Emergency Approach?

Acute aortic dissection is a separation of the aortic wall layers due to an intimal tear that allows blood to flow into the media, creating a false lumen.

The Stanford classification divides dissection into Type A (involving the ascending aorta) and Type B (descending aorta only); Type A is a surgical emergency.

Mortality increases approximately 1-2% per hour in untreated Type A dissection, making rapid diagnosis the cornerstone of survival.

CT angiography of the entire aorta is the gold-standard imaging study and should be obtained within minutes of clinical suspicion.

Symptoms

Sudden, severe, tearing or ripping chest or interscapular back pain that is maximal at onset
Migration of pain as the dissection propagates along the aorta
Differential blood pressure or pulse deficit between extremities
New aortic regurgitation murmur, syncope, or focal neurologic deficit from branch vessel involvement
Signs of cardiac tamponade, acute heart failure, or limb ischemia in advanced cases

Risk Factors

Long-standing uncontrolled hypertension
Connective tissue disorders such as Marfan, Loeys-Dietz, or Ehlers-Danlos syndrome
Bicuspid aortic valve, coarctation, and previous aortic surgery
Cocaine or amphetamine use, pregnancy in the third trimester, and intense isometric exertion
Family history of aortic disease and advanced age with atherosclerosis

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Immediately call emergency services (112) for any sudden severe chest or back pain, especially with tearing quality
  • Apply for urgent care if there is a pulse difference between arms, neurologic symptoms, or syncope alongside chest pain
  • Consider dissection in any patient with chest pain plus connective tissue disease history or known thoracic aneurysm
  • Re-evaluate any post-discharge patient with recurrent or migrating pain following recent aortic intervention

Treatment Methods

01
Initial management focuses on aggressive blood pressure and heart rate control with intravenous beta blockers (esmolol, labetalol) targeting systolic BP 100-120 mmHg and HR <60
02
Type A dissection requires emergent open surgical repair, usually replacement of the ascending aorta with or without arch reconstruction
03
Type B dissection without complications is managed medically; complicated Type B benefits from thoracic endovascular aortic repair (TEVAR)
04
Pain control with intravenous opioids and avoidance of vasodilators that cause reflex tachycardia
05
Long-term follow-up with serial imaging and lifelong antihypertensive therapy is essential to prevent late complications

Which Department to Visit?

You can visit our Acil Servis department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.