Severe pain is the #1 symptom. Seek immediate emergency medical care for a sudden onset of severe pain in the chest, stomach, back, or neck. The pain is likely to be sharp, tearing, ripping, moving, or so unlike any pain you have ever had that you feel something is very wrong.

Aortic dissection can mimic heart attack. Heart attacks are far more common than aortic dissection. But if a heart attack or other important diagnosis is not clearly and quickly established, then aortic dissection should be quickly considered and ruled out, particularly if a patient has a family history or features of a genetic syndrome that predisposes the patient to an aortic aneurysm or dissection.

Aortic dissections are often preceded by an enlargement of the first part of the aorta where it comes out of the heart, called an aortic aneurysm. If you have an aneurysm, you are at increased risk for an aortic dissection. 

A personal or family history of thoracic aortic disease puts you at risk. If you or a family member is living with an aneurysm or if you have a family member who has had an aortic dissection, you are at an increased risk for thoracic aortic dissection. You and your other family members should be evaluated to determine if a predisposition for aortic aneurysm and dissection is running in the family. 

Certain genetic syndromes put you at risk. These genetic syndromes greatly increase your risk for thoracic aortic disease and a potentially fatal aortic dissection: Marfan syndrome, Loeys-Dietz syndrome, Turner syndrome, and Vascular Ehlers-Danlos syndrome. Bicuspid aortic valve disease puts you at risk. If you have a bicuspid aortic valve (two leaflets instead of the typical three), or have had a bicuspid aortic valve replaced, you need to be monitored for thoracic aortic disease.

Lifestyle and trauma can trigger aortic dissection. It is possible to trigger an aortic dissection through injury to the chest, extreme straining associated with body building, illicit drug use, poorly controlled high blood pressure, or by discontinuing necessary blood pressure medications. Rarely, pregnancy can trigger an aortic dissection. However, women with aortic aneurysms and connective tissue disorders who are pregnant are at higher risk of aortic dissection during late pregnancy and delivery and should be carefully monitored by a cardiovascular specialist.