Chest Pain Cause Cardiopulmonary Aortic Dissection

Aortic dissection is one of the rarer causes of chest pain. A serious and life-threatening medical emergency, aortic dissection occurs when the layers of the aorta separate, allowing blood to flood between the layers. Aortic dissection causes severe chest pain, shock and often death.

Aortic Dissection and Chest Pain

The aorta is the largest artery in the body. It transports oxygenated blood from the heart to the rest of the body. Aortic dissection can occur at any point along the aorta but is most likely to occur where blood pressure is highest. For this reason, most cases of aortic dissection occur in the ascending aorta, the section of the aorta closest to the heart.

When aortic dissection occurs, the inner and middle layers of the aorta separate. Blood pumped out of the heart forces its way between the two layers, tearing the two layers further apart and increasing the length of the aortic dissection.

Severe chest pain results from aortic dissection. Often described as “shearing” and “tearing,” chest pain associated with aortic dissection changes location as the aortic layers continue to tear apart.

The aortic tear typically rips down the ascending aorta into the next section of aorta, the descending aorta. From the descending aorta, the tear enters the aorta’s main branches. Although uncommon, it is possible for an aortic dissection to tear upward toward the heart.

Blood flow between the two layers of the aorta can rupture the aorta’s outer layer. If this occurs, blood gushes into the chest cavity. When the aorta ruptures, death is generally inevitable.

Aortic Dissection and Other Causes of Chest Pain

The characteristic tearing and movement of aortic dissection chest pain distinguishes the condition from most other causes of chest pain. As with many causes of chest pain, pain from an aortic dissection can radiate down the back. Aortic dissection chest pain develops suddenly and is severe from the moment of onset.

Aortic Dissection Symptoms

Severe chest pain is often accompanied by additional aortic dissection symptoms, including a sudden cold sweat. The presentation of other aortic dissection symptoms depends on where in the aorta the dissection originates, the artery branches involved and the degree of compression the dissection places on surrounding organs.

It is not unusual for aortic dissection symptoms to resemble those of two other serious causes of chest pain: heart attack and pulmonary embolism. All three conditions can cause fatigue, weakness and shortness of breath.

Aortic Dissection Causes and Risk Factors

High blood pressure, or hypertension, is one of the major causes of aortic dissection. Other causes of aortic dissection include medical conditions and complications from medical procedures. In rare circumstances, massive trauma to the chest causes aortic dissection.

Aortic dissection risk factors include a range of cardiovascular, genetic and connective tissue disorders. The list of aortic dissection risk factors includes:

  • aortic aneurysm (a bulge in the wall of the aorta)
  • atherosclerosis (in which fatty deposits build up in the arteries)
  • bicuspid aortic valve (a condition in which the aortic valve has only two cusps rather than the normal three)
  • Ehlers-Danlos syndrome (a genetic disorder that causes a defect in collagen synthesis)
  • Marfan syndrome (a disorder of the connective tissue)
  • Turner syndrome (a condition in which a female is lacking an X chromosome)
  • uncontrolled high blood pressure.

In addition, otherwise healthy women can develop aortic dissection during the third trimester of pregnancy, although the incidence rate is very low. Cocaine use, which causes a sudden spike in blood pressure, should also be listed among aortic dissection risk factors.

Aortic Dissection Treatment

Aortic dissection treatment must begin as soon as possible to prevent further aortic tearing and to reduce the risk of aortic rupture. Medications that relax the heart muscle and slow the heart rate are administered as initial aortic dissection treatment. Beta blockers and sodium nitroprusside are often used at this stage in aortic dissection treatment.

In most cases, aortic dissection treatment requires surgical intervention. During surgery, the damaged portion of the aorta is removed and is replaced with a metal or plastic graft. Any remaining dissection is blocked to prevent the flow of blood between the aortic layers.

Follow up after initial aortic dissection treatment is life-long. Blood pressure-lowering medication must be taken on a regular basis to lower the risk of a second aortic dissection. Every six to 12 months, survivors of aortic dissection must have a CT scan or MRI to monitor and evaluate the aorta’s integrity.

Resources

American Heart Association. (n.d.). Aortic Dissection. Retrieved November 7, 2007, from the American Heart Association Web site: www.americanheart.org/presenter.jhtml?identifier=3005390.

Mayo Foundation for Medical Education and Research. (n.d.) Aortic Dissection. Retrieved November 7, 2007, from the Mayo Web site: www.mayoclinic.com/health/aortic-dissection/DS00605.