What are the main symptoms of aortic dissection

Aortic dissection is a relatively serious arterial disease. When it occurs, the patient will feel very painful and need to use analgesics to control the pain when necessary. Patients with aortic dissection will have certain symptoms in the early stages. Doctors usually decide on the corresponding medical treatment plan based on the patient's symptoms to help the patient recover.

(1) The intensity of pain is more characteristic than its location: the pain is extremely severe and unbearable from the beginning; the pain is pulsating, tearing, or cutting, and is often accompanied by vasovagal excitement, such as profuse sweating, nausea, vomiting, and syncope. (2) The location of pain helps indicate the starting point of separation: severe pain in the anterior chest often occurs in proximal dissections, while the most severe pain in the interscapular area is more common in dissections at the distal end of the starting point. Although proximal and distal dissections may cause pain in the anterior chest and back at the same time, if there is no pain in the interscapular area at the back, distal dissection can be ruled out, because more than 90% of patients with distal dissections have back pain. Pain in the neck, pharynx, forehead, or teeth often indicates that the dissection involves the ascending aorta or aortic arch.

(3) Migratory pain indicates that the scope of aortic dissection is expanding: the pain can move from the starting point to other parts, often along the path and direction of separation, causing pain in the head, neck, abdomen, waist or lower limbs. About 70% of patients have this feature. And due to the expansion of the scope of the dissection hematoma, it causes dysfunction of the adjacent organs of the aortic branches.

(4) The pain is often persistent: For some patients, the pain persists until death and is difficult to relieve with analgesics such as morphine. For some patients, the pain disappears because the distal intima ruptures and the blood in the dissection hematoma returns to the aortic lumen. If the pain disappears and then reappears, one should be alert to the risk of continued expansion of the aortic dissection and outward rupture. A small number of patients who do not experience pain often have syncope or coma in the early stages of the disease, which masks the pain symptoms.

(5) Hypertensive patients may appear to be in shock due to severe pain, and may be anxious, sweating, pale, and have an accelerated heart rate, but their blood pressure is often not low or may even be elevated. About 80% to 90% of distal dissections and some proximal dissections have hypertension. Many patients who already have hypertension experience pain that causes their blood pressure to rise even higher after the onset of the disease. Hypotension is often the result of cardiac tamponade, pleural or peritoneal rupture caused by dissection. When the dissection involves the brachiocephalic vessels and causes damage or occlusion of the limb arteries, blood pressure cannot be accurately measured and false hypotension occurs.

(6) Symptoms of dissection rupture or compression: Dissection hematoma compresses the surrounding soft tissues, affecting the major branches of the aorta, or ruptures into adjacent organs, causing damage to the corresponding organ systems, resulting in clinical manifestations of multi-system damage.