Aortic Dissection: 5 Common Signs and When to See a Doctor

Aortic Dissection: 5 Common Signs and When to See a Doctor

An aortic dissection is a life-threatening medical emergency involving a tear in the inner layer of the aorta—the body’s main artery.

As blood forces its way through the tear, it separates (dissects) the layers of the arterial wall. This can cut off blood flow to vital organs or cause the aorta to rupture.

Because every hour counts, recognising the signs early is critical for survival.

5 Common Signs of Aortic Dissection

Aortic dissection is often called “the great masquerader” because it can look like a heart attack, but its hallmark signs are distinct:

1. Sudden, “Tearing” Pain The most classic symptom is an abrupt onset of excruciating pain. Patients often describe it as a tearing or ripping sensation rather than the “pressure” associated with a heart attack. This pain usually starts in the chest and radiates to the neck or down the back between the shoulder blades.

2. Blood Pressure Discrepancy If the tear affects the branches of the aorta, you may have a significant difference in blood pressure between your right and left arms (typically a difference of >20 mmHg). You might also notice a “pulse deficit,” where the pulse in one wrist feels much weaker than the other.

3. Stroke-like Symptoms or Fainting If the dissection limits blood flow to the brain, it can cause sudden fainting (syncope), confusion, or focal neurological issues like weakness on one side of the body or difficulty speaking.

4. Severe Hypertension (High Blood Pressure) Most patients presenting with a dissection have dangerously high blood pressure. However, if the aorta begins to leak or rupture, blood pressure may suddenly plummet (hypotension), which is a sign of shock.

5. Signs of Poor Circulation (Malperfusion) Because the aorta feeds the entire body, a tear can block blood to various areas. This may show up as sudden, severe abdominal pain (gut), sharp “loin” pain (kidneys), or a cold, pale, and painful leg (limb ischemia).

When to See a Doctor

Aortic dissection has an extremely high mortality rate—increasing by roughly 1–2% every hour if left untreated. Seek emergency medical care immediately if:

• You feel sudden “ripping” chest or back pain: Do not wait to see if it passes. This is the primary red flag.

• You have known risk factors: If you have high blood pressure, a bicuspid aortic valve, or a connective tissue disorder (like Marfan syndrome or Ehlers-Danlos) and experience any chest discomfort.

• You experience a “thunderclap” sensation: Pain that is at its maximum intensity the very second it starts is highly suspicious for a dissection.

Diagnosis & Treatment

If a doctor suspects a dissection, they will prioritise a CT Aortogram (the gold standard for diagnosis) and an ECG to rule out a heart attack.

• Type A (Ascending Aorta): This is a surgical emergency requiring immediate open-heart surgery to prevent rupture or heart failure.

• Type B (Descending Aorta): These are often managed in the ICU with aggressive blood pressure medication (like IV beta-blockers) or minimally invasive stent-grafting.

The Bottom Line: Aortic dissection is a “race against the clock.” If you suspect you or someone else is experiencing one, call emergency services immediately. Long-term prevention focuses heavily on strict blood pressure control and smoking cessation.