Aortic dissection natural history, complications and prognosis

The symptoms of aortic dissection usually develop in the fifth decade of life and start with symptoms such as sudden onset chest/back pain. If left untreated, patients with aortic dissection may progress to develop aortic regurgitation, myocardial ischemia, and cardiac tamponade. The complications of aortic dissection include but not limited to aortic rupture, pericardial tamponade, myocardial ischemia, compression of nearby organs and etc. Aortic dissection carries a poor prognosis. Mortality rate differs based on the type of dissection and is higher in type A compared to type B (25% versus 12%).

• The symptoms of aortic dissection usually develop in the fifth decade of life and start with symptoms such as sudden onset chest/back pain.^[1]
• If left untreated, patients with aortic dissection may progress to develop aortic regurgitation, myocardial ischemia, and cardiac tamponade.

The complications of aortic dissection include:^{[2][3][4][5][6][7]}

• Aortic rupture
• Pericardial tamponade
• Acute aortic regurgitation
• Myocardial ischemia
• Thoracic aortic aneurysm
• Renal ischemia
• Superior mesenteric artery dissection and resultant visceral ischemia
• Pleural effusion
• Claudication due to an extension of the dissection into the iliac arteries

• Ischemic cerebrovascular accident (CVA) due to dissection into the head vessels
• Hemiplegia due to dissection into the spinal arteries
• Hemianesthesia due to dissection into the spinal arteries

• Superior vena cava syndrome due to compression of the superior vena cava
• Horner syndrome (compression of the superior cervical ganglia)
• Dysphagia due to (compression of the esophagus)
• Stridor and wheezing (compression of the airway)
• Hemoptysis (compression of and erosion into the bronchus)
• Vocal cord paralysis and hoarseness (compression of the recurrent laryngeal nerve)

• Aortic dissection carries a poor prognosis.^[8]
• Mortality rate differs based on the type of dissection and is higher in type A compared to type B (25% versus 12%).

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