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Aortic dissection symptoms often begin without warning, most commonly with sudden, severe tearing pain in the chest, back, or abdomen. The pain may become intensely severe within minutes, or feel like it is tearing through the chest into the back. At that moment, many people assume they are having a heart attack. However, an aortic dissection requires a completely different diagnostic approach and treatment, making early recognition of its symptoms critically important.
Aortic dissection and a heart attack can both cause sudden, severe chest pain. They may also cause shortness of breath, sweating, fainting, or pain that spreads beyond the chest. Because the symptoms can feel so similar, it is often difficult to tell the difference without medical tests.
Although they share many of the same symptoms, the underlying causes are completely different. A heart attack occurs when blood flow to the heart muscle is blocked, while an aortic dissection begins with a tear in the wall of the aorta. As a result, doctors use different methods of investigation to confirm the diagnosis and choose the right treatment.
Key differences between aortic dissection and a heart attack include:
| Aortic Dissection | Heart Attack |
| Pain often spreads to the back, neck, or abdomen | Pain more commonly spreads to the left arm, shoulder, or jaw |
| Pain may feel tearing, ripping, or unusually severe | Pain often feels like pressure, tightness, squeezing, or heaviness |
| May cause a weaker pulse or different blood pressure between the arms | Pulse differences between the arms are uncommon |
| May cause sudden weakness, difficulty speaking, or weakness in one leg | Neurological symptoms are less common |
| Emergency imaging helps doctors locate the tear | Heart examinations help doctors identify blocked coronary arteries |
Aortic dissection can cause more than sudden chest or back pain. As the tear in the inner layer of the aorta affects blood flow to different parts of the body, other symptoms may appear quickly, including fainting, shortness of breath, sudden weakness, numbness, difficulty speaking, or vision changes.
The exact aortic dissection symptoms depend on where the tear occurs in the aorta and which blood vessels it affects. In some cases, one arm may have a weaker pulse or a different blood pressure reading than the other.
The primary warning signs may include:
Any sudden, severe chest or back pain deserves immediate medical attention, especially if it begins without warning or becomes much worse within a few minutes. Even if you are unsure whether it is a heart attack or an aortic dissection, do not wait to see if the pain improves on its own.
Getting medical care as soon as possible gives doctors the best chance to identify the cause and start the right treatment. Because an aortic dissection can worsen quickly, calling emergency medical services is usually safer than driving yourself.
A tear in the inner layer of the aorta allows blood to flow between the layers of the artery wall. This creates a false channel that can reduce blood flow to vital organs and weaken the aorta. The tear may develop when the aortic wall has been weakened over time, or it may occur after severe trauma to the chest.
Doctors classify aortic dissection into two main types based on where the tear begins. Diagnosing the type helps determine how urgently treatment is needed and which approach is most suitable.
| Topic | Type A Aortic Dissection | Type B Aortic Dissection |
| Location | Begins in the ascending aorta, the part closest to the heart | Begins in the descending aorta, which carries blood away from the heart |
| Urgency | A life-threatening emergency that usually requires immediate surgery | May be managed with medication unless complications develop |
| Treatment | Emergency surgery | Blood pressure medication, an endovascular procedure called TEVAR, or surgery |
The risk of aortic dissection หis higher in people with conditions that weaken the aortic wall or place extra stress on it over time. Identifying these risk factors is essential for doctors to decide who may need closer monitoring.
People at higher risk are those with:
Once doctors suspect an aortic dissection, acting quickly to stabilize the patient and confirm the diagnosis becomes crucial. The medical team may monitor blood pressure and heart rate, provide medication to reduce stress on the aorta, and arrange urgent imaging tests to locate the tear and assess its extent.
A CT angiogram is often the first imaging test used in an emergency. It can quickly show where the tear begins, how far it extends, and whether blood flow to vital organs has been affected.
A transesophageal echocardiogram, or TEE, uses ultrasound to create detailed images of the heart and aorta. Doctors may use it when a CT scan is not suitable or when they need a closer view of the area near the heart.
MRI can provide detailed images of the aorta without using radiation. It is useful for stable patients or for follow-up care, but it usually takes longer than a CT scan.
Treatment for aortic dissection depends on where the tear begins, how far it extends, and whether it is affecting blood flow to vital organs. Doctors also consider the patient’s overall condition and whether complications such as internal bleeding, reduced organ perfusion, or aortic rupture have developed.
Type A aortic dissection usually requires immediate surgery because the tear involves the ascending aorta near the heart. During the operation, the surgeon removes or repairs the damaged section of the aorta and replaces it with a synthetic graft. Additional procedures may be needed if the dissection has affected the aortic valve or nearby arteries.
Uncomplicated Type B aortic dissection may initially be treated with medication. The main goal is to lower blood pressure and reduce the force placed on the aortic wall. Doctors closely monitor the patient and repeat imaging tests to check whether the dissection is changing.
TEVAR may be considered when a Type B dissection causes complications or does not respond well to medication. During this minimally invasive procedure, doctors guide a stent graft through a blood vessel and place it inside the aorta to cover the tear and redirect blood flow through the normal channel.
Open surgery may be necessary when the dissection cannot be treated safely with TEVAR or when the aorta has ruptured. The surgeon repairs the damaged section and restores blood flow as quickly as possible.
The treatment plan may change depending on how the dissection progresses. Continued blood pressure control and regular imaging remain important after the initial treatment to reduce the risk of future complications.
Sudden, severe chest or back pain should never be ignored. Even when symptoms seem similar to a heart attack, only prompt medical evaluation can determine whether an aortic dissection or another life-threatening condition is responsible.
At Vejthani International Hospital, the Cardiac Center provides advanced cardiovascular imaging, experienced cardiac and vascular specialists, and comprehensive emergency care. From rapid diagnosis to complex surgical and endovascular treatment, every stage of care is coordinated to help patients receive the right treatment as quickly as possible.
An aortic dissection occurs when a tear develops in the inner layer of the aorta, allowing blood to flow between the layers of the vessel wall. Long-standing high blood pressure is the most common risk factor because it places continuous stress on the aortic wall. Other causes and contributing factors include an aortic aneurysm, inherited connective tissue disorders such as Marfan syndrome, a bicuspid aortic valve, previous heart or aortic surgery, and severe chest trauma.
Aortic dissection treatment depends on the type and severity of the condition. Type A aortic dissection usually requires emergency surgery because it involves the ascending aorta near the heart. Type B aortic dissection may initially be treated with medications to control blood pressure and heart rate. If complications develop, minimally invasive procedures such as thoracic endovascular aortic repair (TEVAR) or open surgery may be recommended.
The survival rate depends on the type of aortic dissection, how quickly treatment begins, and the patient’s overall condition. Without prompt treatment, the risk of life-threatening complications increases rapidly, particularly in Type A aortic dissection. Early diagnosis, emergency surgery when indicated, and ongoing blood pressure control significantly improve the chances of survival and long-term recovery.
Cardiac Center, Vejthani International Hospital
Call: (+66)2-734-0000 Ext. 5300
English Hotline: (+66)85-223-8888
