This is a serious condition caused by a tear in the inner wall of the aorta at its most proximal part. The aorta is the largest blood vessel in the body.
The exact cause is unknown, but risk factors include fatty plaque build-up in the arteries, high blood pressure, smoking, aortic aneurysms, chest trauma, hereditary diseases, previous heart surgery, pregnancy and vasculitis.
It presents as a very severe chest pain (often described as a ripping pain) that can radiate to the back and shoulder blades. Pain may also occur in other parts of the body, such as the neck, arm, jaw, abdomen and/or hips. Other associated symptoms include: anxiety, feelings of impending doom, dizziness, fainting, nausea and vomiting, cold and clammy skin, a fast, weak pulse, asymmetric pulses, choking, abdominal pain and difficulty swallowing.
Diagnosis is made by taking a detailed history and performing a full physical examination. Palpation and assessment of pulses on both sides of the body are important to look for possible asymmetries. The diagnosis is confirmed by a CT-scan.
The definitive treatment is urgent surgery. Analgesics and antihypertensives should be used to control associated pain and hypertension.
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