Aortic Dissection: Emergency Warning Signs, Types, Diagnosis & Treatment
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer: What Is an Aortic Dissection?
An aortic dissection is a medical emergency in which a tear in the inner layer of the aorta splits the artery wall layers apart; if blood escapes the artery, it is often deadly. The classic sign is sudden, severe tearing chest or upper back pain. Type A usually needs emergency surgery, while Type B often uses blood pressure medicines.
What the research says
Surgery is linked to far lower in-hospital mortality in Type A dissection. A registry analysis of 5,553 Type A patients in the International Registry of Acute Aortic Dissection (1996–2018) found in-hospital mortality of 19.7% overall — 16.1% after surgery versus 52.1% with medical management. Five-year survival was also higher after surgical repair, even in septuagenarians (57.0% vs 13.7%). (Hemli et al., Eur J Cardiothorac Surg, 2022) [3]
For uncomplicated Type B dissection, a 2025 meta-analysis favored stent-graft repair for survival — with a stroke trade-off. Across 12 studies (25,605 patients), thoracic endovascular aortic repair (TEVAR) was linked to lower all-cause mortality than optimal medical therapy (risk ratio 0.57, 95% CI 0.43–0.76) but a higher stroke risk (risk ratio 1.56, 95% CI 1.30–1.89). (Qazi et al., Future Cardiol, 2025) [4]
The best treatment for uncomplicated Type B is still debated. A separate 2025 meta-analysis of 25,650 patients (21,041 on medicine alone, 4,609 with TEVAR) found no significant difference in 30-day or in-hospital mortality, concluded there is no definitive evidence yet of a survival benefit, and called for randomized trials. (Jubouri et al., Ann Vasc Surg, 2025) [5]
Aortic Dissection at a Glance
Feature | Summary |
Definition | A tear in the inner layer of the aorta; blood rushes through and splits the inner and middle artery layers [1] |
Urgency | Medical emergency — if blood escapes the artery, it is often deadly [1] |
Typical patient | Men in their 60s and 70s [1] |
Key warning sign | Sudden severe chest or upper back pain with a tearing or ripping feeling [1] |
Types | Type A (ascending aorta — more dangerous, surgery) vs. Type B (descending aorta — often medicines) |
Main risk factors | High blood pressure, atherosclerosis, aortic aneurysm, bicuspid aortic valve, aortic coarctation, genetic connective tissue disorders [1] |
Diagnosis | Exam clues (unequal pulses, different arm blood pressures) plus chest X-ray, TEE, CT scan, or MRA [2] |
Treatment | Surgery with graft (Type A); medicines, or surgery with stents for complicated cases (Type B) [2] |
Aftercare | Lifelong blood pressure medicine and regular CT or MRI scans [2] |
What is an aortic dissection, and why is it a medical emergency?
The aorta is the body's main artery — the great vessel that carries blood out of the heart to every organ and limb. An aortic dissection happens when a tear forms in the inner layer of that artery wall [1].
Blood then rushes through the tear, forcing the inner and middle layers of the artery to split apart — that split is the dissection. If the blood breaks through and goes outside the artery, the result is often deadly [1].
A few facts put this in perspective:
Aortic dissection isn't very common — but it is one of the most dangerous cardiovascular emergencies that exists.
It usually happens in men in their 60s and 70s [1].
Its symptoms can mimic a heart attack or other heart conditions — and that mimicry often leads to delays in diagnosis [1].
Early diagnosis and fast treatment greatly improve the chance of survival [1]. Every minute counts.
Aortic dissection is closely linked to aortic aneurysm (a bulge where the aortic wall weakens). A thoracic aortic aneurysm occurs when a weak spot in the wall of the aorta begins to bulge — and having an aneurysm increases the risk of rupture or a tear in the aorta's lining (dissection) [1].
What are the six emergency warning signs of an aortic dissection?
Aortic dissection warning signs can feel like a heart attack, and any of them, such as sudden severe chest or back pain, means calling 911. Symptoms may include:
Sudden severe chest or upper back pain that spreads to the neck or back — the pain may feel like something is tearing or ripping [1].
Sudden severe stomach pain [1].
Loss of consciousness [1].
Shortness of breath that comes on suddenly [1].
Symptoms like those of a stroke — sudden vision problems, trouble speaking, and weakness or loss of movement on one side of the body [1].
Leg pain and trouble walking [1].
When to See a Doctor
This is not a "schedule an appointment" situation — it is a call-the-ambulance situation. Call 911 or your local emergency number if you have:
Severe chest or stomach pain
Sudden shortness of breath
Symptoms of stroke, such as sudden trouble seeing, speaking, or moving
What causes aortic dissection, and how do type A and type B differ?
An aortic dissection is caused by a weakened area in the aorta's wall [1]. Where that tear forms determines the type — and the type determines the treatment.
Type | Where the Tear Is | Key Facts |
Type A | The part of the aorta where it exits the heart, or in the upper (ascending) aorta; the tear may also spread into the stomach area [1] | |
Type B | The lower (descending) aorta only; may also spread into the stomach area [1] | Often treated with medicines; complicated cases may need surgery or stents [2] |
Risk Factors: Who Is Most at Risk?
Things that raise the risk of aortic dissection fall into three groups.
Heart and Blood Vessel Conditions
Risk Factor | What It Is |
High blood pressure (hypertension) | The single biggest driver — constant pressure weakens the aortic wall |
Atherosclerosis | A buildup of fats, cholesterol, and other substances in and on the artery walls [1] |
Aortic aneurysm | A bulge in the wall of the body's main artery |
Bicuspid aortic valve | An aortic valve with two flaps rather than the usual three [1] |
Aortic coarctation | A narrowing of the aorta present at birth [1] |
Genetic Conditions
Certain genetic diseases also raise the risk:
Turner syndrome — high blood pressure, heart conditions, and other health conditions may result [1].
Marfan syndrome — weakens the connective tissue that supports structures throughout the body. People with this disorder often have a family history of aortic aneurysms or aortic dissections [1].
Other connective tissue disorders — including Ehlers-Danlos syndrome (loose joints and fragile blood vessels) and Loeys-Dietz syndrome (twisted arteries, especially in the neck) [1].
Inflammation of the arteries — also called giant cell arteritis [1].
Other Possible Risk Factors
Sex assigned at birth — men are more likely to have an aortic dissection than women [1].
Age — more likely in people 60 and older [1].
Cocaine use — raises blood pressure for a limited time [1].
Pregnancy — dissections can happen in otherwise healthy people during pregnancy, though this doesn't occur often [1].
Intense weightlifting — strenuous resistance training raises blood pressure during the activity [1].
What are the complications of aortic dissection?
Aortic dissection can cause death from severe internal bleeding, organ damage such as kidney failure, stroke, aortic regurgitation and cardiac tamponade.
Death due to severe internal bleeding [1]
Organ damage, such as kidney failure or life-threatening damage to the intestines [1]
Stroke
Aortic regurgitation — backward flow of blood through the aortic valve [1]
Cardiac tamponade — poor blood flow caused by a buildup of fluid in the sac that surrounds the heart [1]
How is aortic dissection diagnosed?
Diagnosing an aortic dissection can be a challenge — its symptoms resemble many other heart conditions [2]. Healthcare professionals often diagnose it in an emergency setting, where a care team quickly examines you [2].
Exam Clues
Two quick physical findings can raise immediate suspicion:
Diagnostic Tests
Tests used to diagnose aortic dissection include:
Test | What It Shows |
Chest X-ray | Shows the condition of the heart and lungs; may show a widening of the body's main artery [2] |
Transesophageal echocardiogram (TEE) | Sound waves create pictures of the heart in motion — from inside the body; gives a clearer picture of the heart and aorta than a regular echocardiogram [2] |
CT scan of the chest | X-rays make cross-sectional images of the body; can confirm the diagnosis [2] |
Magnetic resonance angiogram (MRA) | A magnetic field and radio waves create images of the blood vessels [2] |
How is aortic dissection treated with surgery or medicines?
An aortic dissection is a medical emergency that needs treatment right away. Treatment may include surgery or medicines, depending on the area of the aorta involved [2].
Type A Aortic Dissection
Surgery — the surgeon removes as much of the damaged aorta as possible and stops blood from leaking into the aortic wall. A lab-made tube called a graft rebuilds the aorta [2]. If the aortic valve leaks as a result of the damaged aorta, it may be replaced at the same time, with the new valve placed within the graft.
Medicines — reduce the heart rate and lower blood pressure [2]. Lowering blood pressure can prevent the dissection from getting worse, and medicines may also control blood pressure before surgery.
Type B Aortic Dissection
After Treatment
Life after an aortic dissection requires vigilance:
What seven steps can lower your risk of aortic dissection?
You can lower your risk of an aortic dissection by preventing chest injury and taking steps to keep your heart healthy [1]:
Manage blood pressure, blood sugar, and cholesterol. If you have high blood pressure, get a home blood pressure measuring device to check your numbers. If you have high blood sugar or high cholesterol, work with your healthcare professional to bring your levels down.
Do not smoke. If you smoke, quit — and ask your healthcare team for help.
Eat a healthy diet. Cut back on sodium and table salt. Choose plenty of fruits, vegetables, and whole grains.
Stay active. Aim for 150 minutes of moderate physical activity or 75 minutes of vigorous activity each week — or a mix of both [1].
Manage weight. Eat healthy and exercise regularly; ask your team what a healthy weight is for you.
Get enough sleep. Try to get 7 to 9 hours of sleep a night [1].
Wear a seat belt. This lowers the risk of chest injury during a car accident [1].
Two additional steps for those with specific risks:
Tell your healthcare team if you have a family history of aortic dissection, a connective tissue disorder, or a bicuspid aortic valve. If you have a genetic condition that raises your risk, your care team may recommend medicines even if your blood pressure is healthy [1].
If you have an aortic aneurysm, find out how often you need checkups and whether surgery is needed to repair it [1].
Frequently Asked Questions
What is an aortic dissection?
An aortic dissection is a medical emergency in which a tear forms in the inner layer of the aorta — the body's main artery. Blood rushes through the tear, splitting the inner and middle layers of the artery wall. If blood escapes outside the artery, aortic dissection is often deadly.
What does aortic dissection pain feel like?
The classic symptom is sudden, severe chest or upper back pain that spreads to the neck or back and may feel like something is tearing or ripping. Other symptoms include sudden severe stomach pain, loss of consciousness, sudden shortness of breath, stroke-like symptoms, and leg pain with trouble walking. Because symptoms can mimic a heart attack, call 911 immediately rather than waiting.
What is the difference between Type A and Type B aortic dissection?
Type A involves a tear where the aorta exits the heart or in the upper (ascending) aorta — it is the more common and more dangerous type and typically requires emergency surgery. Type B involves a tear only in the lower (descending) aorta and can often be treated with blood pressure-lowering medicines; complicated cases may need surgery or stents.
What causes an aortic dissection?
Aortic dissection is caused by a weakened area in the aorta's wall. The strongest risk factor is high blood pressure, followed by atherosclerosis, aortic aneurysm, bicuspid aortic valve, and aortic coarctation. Genetic conditions such as Marfan syndrome, Turner syndrome, Ehlers-Danlos syndrome, and Loeys-Dietz syndrome also raise the risk.
How is an aortic dissection diagnosed?
An aortic dissection is often diagnosed in the emergency room based on exam clues — a weaker pulse in one arm or thigh or different blood pressure between the arms — and confirmed with imaging tests: a chest X-ray, transesophageal echocardiogram (TEE), CT scan of the chest, or magnetic resonance angiogram (MRA).
Can an aortic dissection be prevented?
You cannot eliminate the risk entirely, but you can lower it: control blood pressure, blood sugar, and cholesterol; don't smoke; eat a healthy diet; stay active; manage weight; get enough sleep; and wear a seat belt to prevent chest injury. If you have a family history of aortic dissection, a connective tissue disorder, or a bicuspid aortic valve, tell your healthcare team — you may need medicines even with healthy blood pressure.
What happens after treatment for aortic dissection?
After treatment, you may need to take blood pressure medicine for life and have regular CT scans or MRI scans to check your heart and blood vessels. Ongoing monitoring is essential to catch any new aneurysm or vascular problem early.
Conclusion
The main lessons from this guide are:
Aortic dissection is a tear in the aorta's inner layer — a life-threatening emergency most common in men in their 60s and 70s, and one that is frequently delayed because its symptoms mimic other heart conditions.
The warning signs are unmistakable in hindsight: sudden severe chest or upper back pain with a tearing or ripping feeling, sudden shortness of breath, stroke-like symptoms, or loss of consciousness. Call 911 — do not wait.
Treatment works best when it is fast: Type A dissections need emergency surgery with a graft; Type B dissections can often be managed with blood pressure medicines. And after treatment, lifelong monitoring keeps the heart and blood vessels under control.
We hope this complete guide has given you a clear understanding of what aortic dissection is, how to recognize it, and how risk can be managed.
Disclaimer: This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you are experiencing a medical emergency — including sudden severe chest or back pain — call 911 or your local emergency number immediately.
Related Reading
Open Aneurysm Surgery: Procedure, Recovery and Outlook explains open aneurysm surgery.
Learn more in our guide to CT Angiogram (CTA): What It Shows, How to Prepare and What to Expect.
References
Mayo Clinic. Aortic dissection — Symptoms & causes. Accessed October 12, 2026. https://www.mayoclinic.org/diseases-conditions/aortic-dissection/symptoms-causes/syc-20369496
Mayo Clinic. Aortic dissection — Diagnosis & treatment. Accessed October 12, 2026. https://www.mayoclinic.org/diseases-conditions/aortic-dissection/diagnosis-treatment/drc-20369499
Hemli JM, Pupovac SS, Gleason TG, et al. Management of acute type A aortic dissection in the elderly: an analysis from IRAD. Eur J Cardiothorac Surg. 2022;61(4):838-846. PMID 34977934. https://doi.org/10.1093/ejcts/ezab546
Qazi SU, Zaide DB, Fatima U, et al. Long term outcomes of thoracic endovascular repair versus optimal medical therapy for uncomplicated Stanford type B aortic dissection: a systematic review and meta-analysis. Future Cardiol. 2025;21(12):1071-1079. PMID 40923587. https://doi.org/10.1080/14796678.2025.2557765
Jubouri M, Surkhi AO, Alsarayrah AI, et al. TEVAR versus optimal medical therapy for uncomplicated type B aortic dissection: a systematic review & meta-analysis. Ann Vasc Surg. 2025;120:272-284. PMID 40582458. https://doi.org/10.1016/j.avsg.2025.06.020
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