Aortic Dissection: Warning Signs, Emergency, and What to Do

Aortic dissection is a medical emergency where the inner layer of the aorta tears abruptly. Blood pushes between the layers of the artery wall, which can rupture without warning. The main symptom is sudden, severe chest or upper back pain that feels like tearing. This requires 911/emergency services immediately. With fast treatment, many people survive.

In plain words

Aortic dissection is a life-threatening emergency where the main blood vessel from your heart tears. The aorta carries blood from your heart to your body. When it tears, blood can flow between the layers, forcing them apart. This causes sudden, severe chest or back pain that feels like tearing. It requires immediate emergency care. Without quick treatment, it can be deadly. Many people survive with fast medical help.

What is Aortic Dissection: Warning Signs, Emergency, and What to Do?

Symptoms

Early symptoms

Sudden severe chest pain: Often described as a tearing or ripping sensation that starts abruptly. This is different from a heart attack's squeezing pressure. The pain may migrate as the dissection spreads. (1) (4)
Pain radiating to the upper back: The intense pain may shift between the shoulder blades or down the back. Some people feel it mostly in the back rather than the chest. (1) (2)
Difficulty breathing or shortness of breath: Breathing problems can develop as the dissection affects blood flow. This may feel like you can't get enough air or are gasping. (4) (6)
Dizziness or lightheadedness: Feeling faint or unsteady can happen when blood flow is disrupted. Some people collapse from the sudden drop in blood pressure. (2) (4)

Serious or emergency symptoms

Chest pain with signs of shock: Cold sweat, pale clammy skin, rapid weak pulse, and extreme weakness suggest internal bleeding. This is a dire emergency that needs a 911 call immediately. Call emergency services right away. Do not try to drive yourself. (2) (6) (3)
Loss of consciousness: Fainting along with chest/back pain means the dissection may be cutting off blood flow to the brain or heart. Every minute counts for survival. This is a 911-level emergency. Begin CPR if they stop breathing while waiting for help. (4) (5)
Unequal blood pressure between arms: A systolic blood pressure difference of 20 mmHg or more between arms can signal dissection. This is checked in the ER but should prompt immediate medical attention if noted. Get emergency evaluation even if other symptoms seem mild. (3) (6)

Causes

Primary causes

High blood pressure (hypertension): Chronic high pressure strains the aorta's walls. Over years, this can set the stage for a tear. Up to 75% of dissections happen in people with high blood pressure. (4) (5)
Genetic conditions affecting connective tissue: Marfan syndrome, Ehlers-Danlos syndrome, and similar disorders weaken the aorta's structure. Even mild strains can trigger dissection in affected people. (5) (7)
Trauma to the chest: Car accidents, falls from height, or other major impacts can tear the aorta immediately or start damage that leads to later dissection. (4)

Risk factors

Uncontrolled high blood pressure

Having BP consistently above 140/90 mmHg, especially if untreated, dramatically raises the risk. This is the most common preventable factor. (4) (7)

History of aortic aneurysm

An existing bulge in the aorta can develop a tear more easily. Rupture risk increases with aneurysm size over 5 cm. (7)

Family history of aortic disease

If a close relative had dissection or aneurysm, your risk is higher. Some families have undiscovered genetic predispositions. (4)

Diagnosis

Emergency doctors use imaging tests to confirm dissection quickly. A CT scan with contrast dye is most common. They may also order an MRI or transesophageal echocardiogram. Blood tests help rule out heart attack. The team works rapidly because delay raises mortality risk. Tell them about any chest/back pain symptoms and risk factors like high BP.

CT angiogram

Detailed X-ray images with contrast dye show the tear's location and blood flow between aortic layers. This is the gold standard test. (3)

MRI of the aorta

Provides clear images without radiation but takes longer than CT. Used when radiation must be avoided or for complex cases. (3)

Transesophageal echocardiogram (TEE)

Ultrasound probe down the esophagus gives close-up heart/aorta views. Often used during surgery planning. (3)

Treatment

Medication options

IV blood pressure medications

These rapidly lower blood pressure and heart rate to prevent further tearing. Given through an IV in intensive care while preparing for potential surgery. (3) (5)

Pain control medications

Severe pain stresses the body and can worsen blood pressure. Pain relief helps the medical team stabilize the patient. (5)

Lifestyle and self-care

Blood pressure management after recovery: Lifelong BP control is critical. Your doctor will recommend diet, exercise, and often medications to keep pressure below 120/80 mmHg if possible. (5)
Regular imaging follow-up: Even after successful treatment, scans every 6-12 months check for new aneurysms or dissection in other areas of the aorta. (4)
Avoid heavy lifting/strenuous activity: Physical straining raises BP suddenly. Your care team will advise safe activity levels during recovery and long-term. (2)

Always discuss dosing and treatment changes with your own prescriber.

Possible complications

Aortic rupture: The dissection can cause complete bursting of the aorta, leading to massive internal bleeding. This is often fatal unless treated emergently. (2) (4)
Organ damage from blocked blood flow: If the tear blocks arteries to kidneys, intestines, or legs, those tissues can die from lack of oxygen. This may require additional surgeries. (4)
Stroke or spinal cord injury: Reduced blood flow to the brain or spinal cord can cause paralysis or brain damage. Quick treatment improves outcomes. (4)

When to see a doctor

Routine follow-up

Schedule regular check-ups if you have high blood pressure, a family history of aortic disease, or genetic conditions like Marfan syndrome. Early detection of aortic enlargement can prevent dissection. (4) (7)

Seek emergency care

Call 911 immediately for sudden severe chest or upper back pain that feels like tearing or ripping, especially with breathing trouble or fainting. Do not drive yourself to the hospital. (2) (6)
Seek emergency care even for milder symptoms if you have risk factors. Early intervention before rupture greatly improves survival. (5)

Frequently asked questions

Is Aortic Dissection an emergency?

Yes, it's a dire emergency requiring immediate hospital care. The mortality rate rises about 1% per hour without treatment. Calling 911 at the first symptom saves lives. (2) (6)

What are the warning signs of Aortic Dissection?

Key signs are sudden severe chest/back pain (often described as tearing), difficulty breathing, fainting, or signs of shock like cold sweaty skin. These demand immediate 911 response. (1) (4)

What should I do if Aortic Dissection happens?

Call emergency services immediately. Do not eat, drink, or take medications unless directed. Stay as still as possible while waiting for help to avoid worsening the tear. (2) (6)

How quickly do I need help for Aortic Dissection?

Within minutes to hours. The risk of death increases sharply after the first 24 hours without treatment. Even with treatment, mortality can be 10-30%, so time is critical. (4) (6)

What happens at the hospital for Aortic Dissection?

You'll have urgent imaging (CT/MRI), IV medications to lower blood pressure, and likely emergency surgery to repair the aorta. The team acts quickly because delays raise complication risks. (3) (5)

References

CDC — Aortic Aneurysm and Dissection: Symptoms and Causes source 1
NHS — Aortic Dissection source 2
MedlinePlus — Aortic Dissection source 3
Mayo Clinic — Aortic Dissection source 4
Cleveland Clinic — Aortic Dissection source 5
American Heart Association — Aortic Dissection source 6
WHO — Cardiovascular Diseases source 7