FAAQs — Frequently Asked Aortic Questions
The aorta is the main artery that sends blood away from the heart to the rest of the body. It is shaped like a candy cane and is typically as wide as a garden hose (2.5-3.5 cm). When blood is pumped by the heart, it first travels through the aorta. The thoracic aorta is the part of the aorta that is in the chest. The most important parts of the thoracic aorta to know are the aortic root, which is where the aortic valve opens and closes to let blood out of the heart, the ascending aorta, the arch, or curved top part of the candy cane, and the descending aorta.
The aorta is made up of three layers. An aortic dissection happens when the blood tears through the inner layer of the aorta, and then starts to flow in the thick middle layer of the aorta, leading to blood flowing through the true lumen and a false lumen formed by the blood entering the wall.
An aortic dissection is a medical emergency and can cause sudden death, but these deaths are preventable with early diagnosis and management.
A thoracic aortic aneurysm is a balloon-like bulge in the aorta that can occur in the first part of the aorta and involve the root of the aorta or the ascending aorta, or both. As an aneurysm enlarges, it increases the risk for an aortic dissection.
Thoracic aortic disease is an aneurysm, dissection, or rupture of any part of the aorta in the chest.
A heart attack happens when there is a blockage in one of the arteries that supplies blood to the heart (the coronary arteries). This blockage slows or can completely block blood flow. An aortic dissection is a tear in the inner lining of the aorta. The aorta is the large artery that is attached to heart that supplies blood to the rest of your body. Although the primary symptom – chest pain – is the same for both a heart attack and aortic dissection, the risk factors, diagnostic tests, and treatment are different.
Most aneurysms have no symptoms until they dissect or get extremely large. They are typically diagnosed incidentally after imaging was done for another reason, or through screening due to a known family history of aortic disease. Early diagnosis and appropriate management of a thoracic aortic aneurysm reduce the chances of an aortic dissection.
Most people who have aortic dissections have a thoracic aortic aneurysm that was undiagnosed. The most common symptom of aortic dissection is sudden onset severe chest pain, described as sharp or tearing.
Individuals at risk for thoracic aortic disease can be tested or screened through imaging of the aorta. Screening involves imaging of the thoracic aorta with an appropriate type of scan; echocardiogram, a computed tomography angiogram (CTA), or a magnetic resonance angiogram (MRA).
Early diagnosis and management of a thoracic aortic aneurysm can prevent an aortic dissection. Treatment involves routine imaging and medications to decrease the rate of growth of the aneurysm. When an aneurysm reaches the size that it is at risk for dissecting, surgical repair of the aneurysm is recommended. This treatment plan is highly effective for preventing aortic dissection.
Sadly, 50% of individuals will lose their lives to the condition. With prompt diagnosis and treatment, survival rate is over 80%.
The most significant way survival rate can be improved is through early identification and treatment prior to a dissection. Screening of individuals who have a family history of aortic disease, appropriate management of individuals who have been diagnosed with thoracic aortic aneurysms, and early identification of those with a genetic aortic condition are the best ways we can prevent dissections and associated deaths. Reducing missed diagnosis or misdiagnosis of aortic dissection in emergency settings is also important in increasing the survival rate. Currently, 1/4 of patients are misdiagnosed at the first presentation to a medical provider. We believe tools and strategies to reduce this problem should be approached through research, with measurable outcomes and assessment of evidence. In 2022, we partnered with the American College of Emergency Physicians to work together on this problem and develop evidence-based tools to improve outcomes.
Yes, if someone is experiencing cardiac arrest (their heart has stopped beating) CPR should be performed. In a patient experiencing an aortic dissection, CPR can keep you alive long enough for you to get to the operating room for an aortic repair.