Aortic Dissection
- Fysiobasen
- Sep 8
- 5 min read
Aortic dissection is a life-threatening condition in which a tear develops in the innermost layer of the aorta (the body’s main artery). Blood enters through the tear and spreads between the layers of the vessel wall, causing the aorta to split along its length. If the blood breaks through all the vessel wall layers, it can lead to acute and often fatal bleeding¹. The condition requires immediate diagnosis and treatment.
Causes and Pathophysiology
Aortic dissection occurs when a weakness in the aortic wall gives way to the pressure from the blood flow. This results in a tear in the intima (the innermost layer of the aorta), after which blood is forced between the intima and the media (the middle layer). This creates a false channel (“false lumen”) that can block blood flow to vital organs or lead to rupture of the aorta¹.
There are two main types of aortic dissection, depending on where the tear occurs:
Type A: The tear is located in the ascending aorta, near the heart. This is the most dangerous type and can quickly lead to cardiac tamponade, heart failure, or death.
Type B: The tear is located in the descending part of the aorta (after the branches leave the aortic arch)².
An aortic aneurysm (outpouching) can increase the risk of dissection, as the weakened wall is more prone to rupture.
Risk Factors
Several conditions increase the likelihood of aortic dissection:
Untreated or poorly controlled high blood pressure (hypertension)
Atherosclerosis
Existing aortic aneurysm
Congenital valve defects (e.g., bicuspid aortic valve)
Congenital narrowing of the aorta (coarctation)
Hereditary connective tissue disorders such as Marfan syndrome, Ehlers-Danlos syndrome, Loeys-Dietz syndrome, and Turner syndrome³
Inflammatory conditions in blood vessels (e.g., giant cell arteritis)
Smoking
Cocaine use or other substance abuse
Older age (especially people over 60)
Male sex (more common than in women)
Pregnancy (rare, but increased risk in the third trimester)
Heavy, intense physical exertion (for example, heavy lifting or strength training)
Symptoms and Clinical Presentation
Symptoms of aortic dissection may vary but are dominated by:
Sudden, extremely intense and tearing/ripping chest pain, often radiating to the back, neck, or abdomen
Acute abdominal pain
Fainting or loss of consciousness
Shortness of breath or acute respiratory distress
Stroke-like symptoms: sudden vision loss, speech disturbances, paralysis, or loss of sensation on one side of the body
Weak or absent pulse in one arm or leg
Pain or weakness in the legs
Difficulty walking
The symptoms often resemble other serious conditions such as myocardial infarction, which can delay correct diagnosis².
Complications
Aortic dissection can rapidly lead to severe complications:
Acute, life-threatening bleeding into the chest or abdominal cavity
Damage to vital organs (for example, kidney failure, intestinal ischemia)
Stroke
Damage to the aortic valve (aortic insufficiency) or accumulation of blood around the heart (cardiac tamponade)
Death, especially with rupture or untreated dissection²
Diagnosis
The diagnosis is established through a combination of acute clinical assessment and imaging, such as CT of the aorta with contrast, ultrasound (TEE), or MRI. Blood tests are used to assess organ failure and rule out other causes.
Treatment
Aortic dissection is a medical emergency that requires rapid hospitalization and monitoring. Treatment varies depending on type and extent:
Type A dissection usually requires emergency surgery to repair or replace the damaged part of the aorta.
Type B dissection may in some cases be managed with blood pressure–lowering medications and close monitoring. Surgery or endovascular treatment (stent placement) is considered if complications or rapid deterioration occur.
Blood pressure is lowered quickly and carefully to reduce stress on the aortic wall. The patient is closely monitored with imaging and frequent clinical evaluations³.
Prevention
Risk reduction is essential:
Proper blood pressure control – use a home blood pressure monitor if needed
Smoking cessation and avoidance of cocaine or other drug use
Healthy diet with little salt, plenty of vegetables, fruit, and whole grains
Maintain normal weight and exercise regularly
Use a seat belt to prevent injuries in car accidents
Follow-up with a doctor in cases of hereditary connective tissue disease, family history of aortic disease, or known risk factors
Individuals with known genetic risk may receive preventive medication even with normal blood pressure⁴.
Prognosis and Follow-up
Early diagnosis and treatment are critical for survival. Untreated aortic dissection carries a high mortality rate, especially if rupture occurs. After treatment, patients must be closely monitored over time to detect new aneurysms, complications, or the need for further interventions.
Physiotherapy
Physiotherapy plays an important but highly specialized role in follow-up after aortic dissection. Most patients who have experienced this condition have undergone acute, life-threatening illness and often extensive surgery or stent treatment. Rehabilitation must therefore be individually tailored, with careful consideration of the aorta’s condition, blood pressure, and any restrictions given by the treating physician¹.
Goals and Considerations
The main goal of physiotherapy after aortic dissection is to restore function, strength, and endurance without increasing the risk of new dissection, elevated blood pressure, or complications. Activities must be dosed so that the strain on the heart and blood vessels does not become excessive.
The physiotherapist conducts a thorough assessment of the patient’s general condition, previous functional level, comorbidities, and any residual symptoms, such as pain, fatigue, or reduced endurance.
Interventions and Follow-up
Early mobilization: After medical clearance, physiotherapy often begins in the hospital with light mobilization to prevent complications such as blood clots and muscle weakness.
Gradual increase in activity: Activity and exercise are intensified step by step. Initially, the focus is on calm, short sessions of low to moderate intensity (e.g., walking, light bodyweight exercises, or simple arm and leg movements).
Blood pressure control: All activity is monitored regarding blood pressure and heart rate. Heavy lifting, sudden movements, intense strength training, or high-intensity exercise are discouraged in the first months, and further progression must always be cleared by a doctor.
Individual training plan: The plan is adapted to the patient’s course, surgical status, and any restrictions. Many will benefit from gradually increased endurance training (e.g., light cycling, uphill walking), but with frequent monitoring of blood pressure and symptoms.
Education: Patients are taught to recognize their own limits, pay attention to symptoms (e.g., chest pain, shortness of breath, dizziness), and avoid risky exertion that may cause acute blood pressure spikes.
Motivation and psychological support: The physiotherapist helps patients overcome fear of physical activity after severe illness and provides support in finding safe and meaningful activities in daily life.
Long-term follow-up: Many will require continued training and guidance in primary care or through cardiac rehabilitation programs. Follow-up also includes advice on weight reduction, smoking cessation, and diet.
Key Precautions
It is essential that all exercise and physical activity after aortic dissection be carried out in close collaboration with a physician, and that the physiotherapist has updated information on surgical type, restrictions, and medical status. Activities that cause sudden or significant increases in blood pressure must always be avoided, particularly heavy lifting, strength training to exhaustion, the Valsalva maneuver (holding one’s breath under strain), and competitive sports in the early phase.
References
Black JH III, et al. Clinical features and diagnosis of acute aortic dissection. https://www.uptodate.com/contents/search. Accessed May 11, 2021.
Black JH III, et al. Management of acute aortic dissection. https://www.uptodate.com/contents/search. Accessed May 11, 2021.
AskMayoExpert. Thoracic aortic aneurysm (adult). Mayo Clinic; 2020.
Ferri FF. Aortic dissection. In: Ferri's Clinical Advisor 2021. Elsevier; 2021. https://www.clinicalkey.com. Accessed May 11, 2021.
How to prevent heart disease at any age. American Heart Association. https://www.heart.org/en/healthy-living/healthy-lifestyle/how-to-help-prevent-heart-disease-at-any-age. Accessed May 11, 2021.
