Aortic Dissection: Causes, Symptoms, and Treatment
Medically reviewed by Achuta Uppu, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Aortic Dissection?
A cardiovascular surgeon (a doctor who operates on the heart and blood vessels) treats aortic dissection, often with a cardiologist (a heart doctor) involved in care. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is aortic dissection?
The aorta is the major artery that carries blood out of the heart to the rest of the body. Aortic dissection is a serious condition in which the inner layer of the aorta wall tears. Blood then flows between the layers of the vessel wall, creating a second channel where blood stays still.
If the second channel gets bigger, it can push on branches of the aorta and narrow them, which reduces blood flow through them. A dissection can also lead to aortic rupture, which means the aorta bursts, or to decreased blood flow to organs. Aortic dissection is life threatening and needs treatment right away.
Symptoms
In most cases, symptoms begin suddenly. The most common one is severe chest pain that may feel like a heart attack. The pain is often described as sharp, stabbing, tearing, or ripping. It is felt below the breast bone and then moves under the shoulder blades or to the back. It can also move to the shoulder, neck, arm, jaw, abdomen, or hips. Other symptoms include:
- Fainting or dizziness.
- Heavy sweating with clammy skin.
- Nausea and vomiting.
- Shortness of breath.
- Pale skin and a rapid, weak pulse.
- Stroke symptoms or belly pain.
- Trouble swallowing from pressure on the esophagus, the tube that carries food to the stomach.
Causes and who gets it
The exact cause is unknown, but a tear or damage to the inner wall of the aorta usually starts it. In many cases, high blood pressure is likely the most direct cause. Common risks include aging and atherosclerosis, which is a hardening of the arteries. Blunt chest trauma, such as hitting a steering wheel in a car crash, can also cause it.
Other risks include pregnancy, heart surgery or procedures, and connective tissue disorders such as Marfan syndrome and Ehlers-Danlos syndrome. Illegal stimulant drugs such as cocaine are another risk. It most often occurs in men over age 60, but people with genetic risks can have dissections at younger ages. About 3 in 100,000 people get it each year.
How doctors diagnose it
A doctor takes a medical and family history and listens to the heart with a stethoscope. The exam may find a difference in blood pressure between the right and left arms. Imaging tests can show the dissection. These include a CT scan of the chest with dye, an echocardiogram (an ultrasound of the heart), chest MRI, chest X-ray, or aortic angiography. Blood tests check for a heart attack.
Treatment
Dissections in the part of the aorta that leaves the heart are treated with surgery. Dissections in other parts may be managed with surgery or medicines. Surgery can be standard open surgery through a cut in the chest or abdomen, or endovascular aortic repair, which is done without any major cuts.
Medicines that lower blood pressure may be prescribed. They may be given through a vein. Beta-blockers are the medicines of first choice. Strong pain relievers are very often needed. If the aortic valve is damaged, valve replacement is needed. People who survive need lifelong treatment of high blood pressure and CT scans every few months to watch the aorta.
When to see a doctor
Call 911 right away if you have sudden, severe chest or back pain, especially pain that feels sharp, tearing, or ripping. Call 911 too for fainting, trouble breathing, or stroke signs such as sudden weakness or trouble speaking. Do not wait to see if the symptoms pass. This condition is life threatening. It can be managed with surgery if it is done before the aorta ruptures. Less than half of people survive a ruptured aorta.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. This doctor can check your blood pressure, order screening imaging when you have a family history, and refer you to a heart specialist. After treatment, they can help manage blood pressure and coordinate follow-up scans with the surgeon.
Common questions
Is aortic dissection an emergency?
Yes. It is life threatening and needs treatment right away. Call 911 right away for sudden, severe chest or back pain or other symptoms of dissection.
What does the pain feel like?
It may feel like a heart attack. People describe sharp, stabbing, tearing, or ripping pain below the breast bone that moves to the back, shoulder blades, or arms and legs.
Can aortic dissection be prevented?
Many cases cannot be prevented. Keeping high blood pressure under control lowers risk, especially for people at risk of dissection. People with Marfan or Ehlers-Danlos syndrome should follow up with their doctor regularly.
Who is most at risk?
It most often occurs in men over age 60, and high blood pressure is likely the most direct cause in many cases. Smoking, atherosclerosis, cocaine use, pregnancy, and genetic conditions such as Marfan syndrome also raise risk.
Sources
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
