About 72 to 80 of individuals who present with an aortic dissection have a previous history of hypertension.

The ascending aorta (1) and aortic arch (2) are not involved in this image.

Specialty Vascular surgery, cardiothoracic surgery Symptoms severe chest or back pain, vomiting, sweating, lightheadedness 1 2 Complications Stroke, mesenteric ischemia, myocardial ischemia, aortic rupture 2 Usual onset Sudden 1 2 Risk factors High blood pressure, Marfan syndrome, Turner syndrome, bicuspid aortic valve, previous heart surgery, major trauma, smoking 1 2 3 Diagnostic method Medical imaging 1 Prevention Blood pressure control, not smoking 1 Treatment Depends on the type 1 Prognosis Mortality without treatment 10 (type B), 50 (type A) 3 Frequency 3 per 100,000 per year 3.

The pain may be described as a tearing, stabbing, or sharp sensation.

About 17 of individuals feel the pain migrate as the dissection extends down the aorta.

The location of pain is associated with the location of the dissection.

Anterior chest pain is associated with dissections involving the ascending aorta, while interscapular back pain is associated with descending aortic dissections.

If the pain is pleuritic in nature, it may suggest acute pericarditis caused by bleeding into the sac surrounding the heart.

This is a particularly dangerous eventuality, suggesting that acute pericardial tamponade may be imminent.

Pericardial tamponade is the most common cause of death from AD.

Less common symptoms that may be seen in the setting of AD include congestive heart failure (7), fainting (9), stroke (6), ischemic peripheral neuropathy, paraplegia, and cardiac arrest.

If the individual fainted, about half the time it is due to bleeding into the pericardium, leading to pericardial tamponade.

Neurological complications of aortic dissection, such as stroke and paralysis, are due to the involvement of one or more arteries supplying portions of the central nervous system.

The blood pressure is quite variable at presentation with acute AD.

It tends to be higher in individuals with a distal dissection.

In individuals with a proximal AD, 36 present with hypertension, while 25 present with hypotension.

In those who present with distal (Stanford type B) AD, 60-70 present with high blood pressure, while 2-3 present with low blood pressure.

It is usually associated with pericardial tamponade, severe aortic insufficiency, or rupture of the aorta.

Pseudohypotension (falsely low blood-pressure measurement) may occur due to involvement of the brachiocephalic artery (supplying the right arm) or the left subclavian artery (supplying the left arm).

The intensity (loudness) of the murmur depends on the blood pressure and may be inaudible in the event of low blood pressure.

The dissection may dilate the annulus of the aortic valve, preventing the leaflets of the valve from coapting.

The dissection may extend into the aortic root and detach the aortic valve leaflets.

Alternatively, following an extensive intimal tear, the intimal flap may prolapse into the left ventricular outflow tract, causing intimal intussusception into the aortic valve, thereby preventing proper valve closure.

Infarction is caused by involvement of the coronary arteries, which supply the heart with oxygenated blood, in the dissection.

The right coronary artery is involved more commonly than the left coronary artery.

If the myocardial infarction is treated with thrombolytic therapy, the mortality increases to over 70, mostly due to bleeding into the pericardial sac, causing cardiac tamponade.

Vasculitis ( inflammation of an artery) is rarely associated with aortic dissection.

Causes Of Radiofemoral Delay