Acute aortic dissection is a catastrophic cardiovascular emergency representing one of the most dangerous acute conditions the heart can experience. This life-threatening disorder occurs when the inner wall of the aorta (intima) tears, allowing blood to force into the middle layer (media), creating a false channel within the aortic wall. Livasa Hospital provides 24x7 emergency management with rapid diagnostic capabilities and surgical expertise to handle acute aortic dissection with optimal outcomes.

Understanding Acute Aortic Dissection

The aorta is the large artery carrying blood from the heart to the rest of the body. Aortic dissection occurs when a tear develops in the innermost layer, allowing blood to enter and separate the layers of the aortic wall. This is classified into two types based on location and involvement:

Type A Dissection:

• Involves the ascending aorta (first segment leaving the heart)

• More common (approximately 60% of cases)

• Requires urgent surgical intervention

• Higher mortality if untreated

Type B Dissection:

• Involves the descending aorta (beyond the left subclavian artery origin)

• Accounts for approximately 40% of cases

• May be managed medically in uncomplicated cases

• Requires careful monitoring and imaging surveillance

Risk Factors

Conditions significantly increasing dissection risk include:

• Hypertension – Most common risk factor; chronic high blood pressure damages the aortic wall

• Connective tissue disorders – Marfan syndrome, Ehlers-Danlos syndrome

• Atherosclerosis – Degenerative aortic wall disease

• Inflammatory aortitis – Takayasu arteritis, other vasculitides

• Pregnancy-related – Pregnancy increases dissection risk, particularly third trimester

• Cocaine abuse – Acute blood pressure elevation

• Trauma – Major blunt chest trauma

• Post-surgical – Following cardiac or aortic procedures

Clinical Presentation

Acute aortic dissection typically presents with sudden, severe symptoms:

• Severe chest pain – Most common presenting symptom; sudden onset, tearing or ripping quality

• Back pain – Between shoulder blades or lower back

• Abdominal pain – If dissection extends into abdominal aorta

• Syncope – From acute hypotension or pericardial tamponade

• Stroke symptoms – If carotid artery involvement occurs

• Acute heart failure – If aortic regurgitation develops

Symptoms may be atypical or minimal, causing diagnostic delays that increase mortality risk.

Emergency Diagnostic Approach

At Livasa Hospital's emergency department:

• Immediate ECG – Rules out acute myocardial infarction

• Chest X-ray – Widened mediastinum may be present

• Computed tomography (CT) angiography – Gold-standard diagnostic test providing definitive diagnosis and anatomical detail

• Transoesophageal echocardiography – Rapid bedside imaging when CT unavailable

• Blood pressure and extremity pulses – Assessment for perfusion deficits

Emergency Management Protocols

Acute aortic dissection management at Livasa Hospital includes:

Immediate Stabilisation:

• Rapid vascular access and continuous monitoring

• Aggressive blood pressure control (systolic target <120 mmHg)

• Heart rate control (target <60 bpm) with beta-blockade

• Pain relief and anxiolysis

• Preparation for urgent intervention

Type A Dissection:

• Emergency surgical evaluation by cardiothoracic surgery

• Usually requires urgent operative repair

• Operative approach depends on extent and involvement

Type B Dissection:

• Initial medical management in uncomplicated cases

• Careful haemodynamic monitoring

• Serial imaging to detect complications

• Surgical intervention if complications develop

Surgical Management

Surgical repair of Type A dissection involves:

• Opening the aorta and identifying the dissection plane

• Resecting the intimal tear and stabilising the dissection

• Reconstruction of the aortic wall

• Aortic valve assessment and repair or replacement if needed

• Restoration of coronary blood flow if involved

Long-Term Management

Post-acute phase management includes:

• Continued strict blood pressure control

• Regular imaging surveillance (CT or MRI at regular intervals)

• Management of underlying conditions

• Assessment for aortic aneurysm formation

• Long-term follow-up by aortic specialists

Why Choose Livasa Hospital?

• 24x7 emergency cardiology and cardiothoracic surgery services

• Advanced diagnostic imaging (CT angiography, TOE)

• Experienced cardiothoracic surgeons with aortic expertise

• Rapid decision-making and surgical capability

• Comprehensive post-operative critical care

NAP – Contact Details

Livasa Hospital Mohali
Sector 71, Sahibzada Ajit Singh Nagar (SAS Nagar)
Mohali, Punjab – 160071
Phone: +91-80788 80788 (24/7 Emergency)
Website: www.livasahospitals.com

If you suspect acute aortic dissection, call +91-80788 80788 immediately for emergency evaluation at Livasa Hospital.