Acute aortic dissection

Pathophysiology

• Intimal tear allows pressurized blood into aortic wall
• Propagation of dissection creates false aortic lumen
• Complications arise from extension into nearby structures

Risk factors

• Chronic hypertension (strongest overall risk factor)
• Underlying aortopathy (eg, Marfan syndrome)

Clinical presentation

• Sudden-onset, severe chest and/or back pain
• Hypertension usually present*
• Often a >20 mm Hg variation in SBP between arms
• Often a widened mediastinum on chest x-ray

*Hypotension on presentation suggests aortic rupture or other complication (eg, cardiac tamponade,
acute aortic regurgitation).

SBP = systolic blood pressure.