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An aortic rupture usually begins with an aortic dissection. An aortic dissection is when the different layers of the circumference of the aorta separate and blood begins to back up between the different layers. The layers become weak and rupture of the aorta ensues. The aorta begins at the left ventricle and arches up and over the heart to then descend through the chest and upper abdomen, ending at the iliac vessels in the pelvic area. The most common points of aortic rupture include at the ascending aorta, where the blood pressure is at its highest, and at the abdominal area, especially near the renal arteries. This is where an abdominal aortic aneurysm can occur. An abdominal aortic aneurysm is an enlargement of the abdominal aorta that weakens the wall and causes it to rupture.
An aortic rupture is a life threatening event. It can occur due to an aortic dissection, an aortic aneurysm or to a shear force placed on the aorta during a fall or motor vehicle accident. The sudden acceleration and deceleration injury to the aorta can shear the aorta from a fixed point to a relatively mobile point. It is most commonly occurring in the chest portion of the aorta but can occur in the abdominal aorta.
The main symptoms of an aortic rupture include shortness of breath, abdominal or chest pain, problems with swallowing and shock. The major symptoms of shock include low blood pressure, cold and pale skin and a decreased level of consciousness. An aortic rupture is fortunately extremely rare but should be suspected in any kind of high velocity motor vehicle accident or fall.
The major symptoms of shock due to aortic rupture include a blood pressure less than 60 mm Hg systolic and a rapid heartbeat of over 120 beats per minute. There can be trouble breathing and an inability to get a normal level of oxygen in the body. The breathing is often rapid and shallow and the skin is often pale. There can be excessive sweating, nausea and vomiting, severe weakness all over the body, a lack of urine output, which can be severe, confusion, lethargy, and low level of consciousness progressing to coma. The person can faint even when lying down or having the legs raised.
The diagnosis of aortic rupture depends on a complete history and physical examination. The character of the pain is important as is the recent history of trauma. A known aortic aneurysm can indicate the possible presence of an aortic rupture as can a history of Marfan syndrome, a genetic disease which predisposes a person to aortic dissection in the chest. The doctor will also look for the physical findings of aortic rupture, including shock-like symptoms and pain in the chest or abdomen, which often radiates to the back. Some patients only have back pain, which should make the doctor suspicious if there are other indicators of aortic tears or rupture. Bruising of the chest or abdomen can be a sign of aortic rupture and there can be a new onset of a harsh sounding systolic ejection murmur. Lung sounds can be diminished and there can be a difference in the blood pressure from the upper extremities and the lower extremities. Blood pressure can be elevated in just one arm. Overall, however, blood pressure is quite low and dropping readily. Rib fractures can be noted by a crunching sound on palpation of the rib cage or by x-ray.
Tests which can be done to prove the presence of the aortic rupture include a chest x-ray, which will show widening of the mediastinum and free blood in the chest cavity. A CT scan can show the same thing and an MRI exam, if available quickly, can show the tear or rupture. A CBC will be low due to blood loss. Kidney and liver shut down can be noted by blood testing. If available, an angiogram can show the presence of contrast leaking from a tear in the aortic wall.
An aortic tear or rupture needs emergency surgery. IV fluids and IV blood transfusions must be given to support the patient prior to and up until the surgery is done to repair the aorta. Conventional surgery can be done using a large chest incision. A more recent surgery involving stenting of the aorta can help in less serious cases. The surgery must be done urgentLAWYER HELPLINE: ☎ 1800 339 958
The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here