Thoracic Aorta Dissection

Your Path

  • Thoracic aorta dissection


  • Type A: ascending aorta (2x as common as type B)
  • Type B: distal to left subclavian

Risk Factors

  • Htn
  • Dm
  • Smoking
  • Hyperlipidemia
  • Prior aneurysms
  • Known atherosclerosis
  • Connective tissue dz (e.g. Marfan Syndrome)


  • Acute onset, tearing/ripping type chest pain
  • Radiation of pain to back, neck
  • Stroke sx if involves carotids
  • Sob, new AI murmur if dissects to aortic valve/pericardium
  • Angina if involves coronaries
  • Abdominal pain if dissection extends distally and involves mesenteric vessels
  • Arm and/or leg ischemic sx if decreased flow to limbs

Physical Exam Findings

  • Sometimes asymmetry in strength of pulse (or loss of pulse entirely) of affected radial artery
  • Sometimes asymmetry in BP, with lower readings on affected arm
  • Stroke findings if involves carotids
  • Arm and/or leg findings of arterial insufficiency (e.g. cool, pale, decreased capillary refills, decreased and asymmetric distal pulses) if impaired arterial flow to limb(s)
  • Aortic insufficiency murmur (early diastolic along left sternal border), findings of pericardial effusion (diminished heart sounds, low bp, tachycardia) w/some type A dissections