Spotting the signs of Aortic Dissection

Aortic dissection is a life-threatening medical emergency that needs urgent diagnosis and treatment, yet is still often misdiagnosed. It is often missed in younger patients or those not typically seen as high risk.

Sadly, it causes more deaths each year than road traffic accidents in the UK. Quick diagnosis can be the difference between life and death and so knowing what to look out for is vital. Rapid diagnosis and treatment is vital to avoid catastrophic outcomes, however aortic dissection is often misdiagnosed in emergency departments, leading to preventable deaths. Where there have been delays in diagnosing and treating aortic dissection, this may raise questions around whether a patient or their family has ground to pursue a medical negligence claim.

What is Aortic dissection?

The aorta is the largest artery in the human body. Aortic Dissection occurs when a separation (tear) occurs in the inner layers of the aorta. This allows blood to flow between the layers of the aortic walls, causing the layers of the artery to be forced apart. This  weakens the aorta and can potentially lead to rupture of blood flow to vital organs.

Under the Stanford classification, there are two types of dissection: Type A and Type B. Type A has a higher mortality risk, and accounts for around 60% of dissections.

Aortic dissection is more common in men over the age of fifty, but an aortic dissection can happen to anyone at any age.

Risk factors include:

• High blood pressure
• Connective tissue disorders such as Ehlers-Danlos syndrome or Loeys-Dietz syndrome
• Inflammation of the arteries
• Aortic aneurysm (a bulge in the aorta which restricts blood flow)

Common symptoms of aortic dissection

Symptoms can vary and may mimic other more common conditions like heart attacks or a stroke. Knowing what to look out for could save a life:

• Sudden, severe chest pain, often described as “ripping” or “tearing”
• Pain that moves to the neck, back, jaw, or abdomen
• Shortness of breath or trouble breathing
• Loss of consciousness or fainting
• Weakness or paralysis on one side of the body
• Sweating, nausea, or dizziness
• Low blood pressure or pulse differences between limbs

Notably, pain can be brief or migratory, and in some cases may subside before returning, misleading both patients and doctors.

Diagnosis of Aortic Dissection

Aortic dissection can only definitively be diagnosed through a CT scan. Tests such as chest X-Ray, blood tests, ultrasounds and MRI scans can be used to determine if there is a tear or rule out other causes, but a CT scan should always be used to confirm the diagnosis.

Treatment

 Treatment aims to reduce the strain on the aorta and to repair the damage. An untreated dissection is usually fatal. Surgery is the usual treatment. Surgical treatments include repairing the dissection by sewing in an artificial part of artery or inserting a stent. Prior to surgery, medication to reduce blood pressure and heart rate is used to reduce the strain on the aorta. Type A dissection almost always requires immediate surgery. Type B dissections do not always require immediate surgery. For some patients with a Type B dissection, blood pressure lowering medication may be sufficient to manage the dissection, with surgery used if medication fails to stabilise the dissection. Patients who suffered either type of dissection will usually need to take blood pressure lowering medication for the rest of their lives.

Outcomes

When a dissection is diagnosed and treated on time, the survival rate is over 80%. However, delays in diagnosis and treatment mean that the actual survival rate is much lower. 48% of patients do not make it to the hospital alive. Around half of patients with a Type A dissection will die within 24 hours if they do not receive treatment, with the risk of dying as high as 1-3% per hour until surgery is performed.

When diagnosis is delayed or missed

Around 30% of aortic dissections are linked to genetic conditions such as Marfan syndrome or vascular Ehlers-Danlos syndrome, affecting people at younger ages than typically expected. It’s also a leading cause of maternal cardiac death. Unfortunately, aortic dissection is still frequently overlooked in these groups.

If a diagnosis is missed, the consequences can be catastrophic. Blood tests, ECGs, and chest x-rays cannot rule it out. The gold standard is a CT angiogram or MRI of the entire aorta, which is why the guidance rule should be “THINK AORTA”.

Not every delay will meet the legal threshold for negligence, however a claim may be investigated in circumstances when:

• Symptoms suggestive of aortic dissection were not adequately considered
• Risk factors were not assessed
• A patient was discharged without receiving the appropriate investigations
• There were failures to escalate care
• There was a delay in obtaining a diagnosis or commencing treatment

What you can do

If you’ve experienced severe, sudden pain and were not given a CT scan, especially if symptoms persisted or returned, it’s important to seek specialist follow-up. If you believe that medical professionals failed to investigate your symptoms, or those of your familyproperly and this led to a delay in diagnosis or treatment, legal advice may help you understand your options.

We’re here to help. Our medical negligence team understands the complexities of aortic dissection cases and will guide you clearly through every step of the claims process.

Read our case study and find out more about how we can help: Aortic Dissection Medical Negligence Claims