Aortic dissection


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Aortic dissection

Cardiovascular system

Vascular disorders

Arterial disease

Angina pectoris

Stable angina

Unstable angina

Myocardial infarction

Prinzmetal angina

Coronary steal syndrome

Peripheral artery disease

Subclavian steal syndrome


Aortic dissection


Behcet's disease

Kawasaki disease


Hypertensive emergency

Renal artery stenosis

Coarctation of the aorta

Cushing syndrome

Conn syndrome


Polycystic kidney disease


Orthostatic hypotension


Familial hypercholesterolemia



Chronic venous insufficiency


Deep vein thrombosis




Vascular tumors

Human herpesvirus 8 (Kaposi sarcoma)


Congenital heart defects

Truncus arteriosus

Transposition of the great vessels

Total anomalous pulmonary venous return

Tetralogy of Fallot

Hypoplastic left heart syndrome

Patent ductus arteriosus

Ventricular septal defect

Coarctation of the aorta

Atrial septal defect

Cardiac arrhythmias

Atrial flutter

Atrial fibrillation

Premature atrial contraction

Atrioventricular nodal reentrant tachycardia (AVNRT)

Wolff-Parkinson-White syndrome

Ventricular tachycardia

Brugada syndrome

Premature ventricular contraction

Long QT syndrome and Torsade de pointes

Ventricular fibrillation

Atrioventricular block

Bundle branch block

Pulseless electrical activity

Valvular disorders

Tricuspid valve disease

Pulmonary valve disease

Mitral valve disease

Aortic valve disease


Dilated cardiomyopathy

Restrictive cardiomyopathy

Hypertrophic cardiomyopathy

Heart failure

Heart failure

Cor pulmonale

Cardiac infections



Rheumatic heart disease

Pericardial disorders

Pericarditis and pericardial effusion

Cardiac tamponade

Dressler syndrome

Cardiac tumors

Cardiac tumors

Cardiovascular system pathology review

Acyanotic congenital heart defects: Pathology review

Cyanotic congenital heart defects: Pathology review

Atherosclerosis and arteriosclerosis: Pathology review

Coronary artery disease: Pathology review

Peripheral artery disease: Pathology review

Valvular heart disease: Pathology review

Cardiomyopathies: Pathology review

Heart failure: Pathology review

Supraventricular arrhythmias: Pathology review

Ventricular arrhythmias: Pathology review

Heart blocks: Pathology review

Aortic dissections and aneurysms: Pathology review

Pericardial disease: Pathology review

Endocarditis: Pathology review

Hypertension: Pathology review

Shock: Pathology review

Vasculitis: Pathology review

Cardiac and vascular tumors: Pathology review

Dyslipidemias: Pathology review


Aortic dissection


0 / 11 complete

USMLE® Step 1 questions

0 / 2 complete

High Yield Notes

6 pages


Aortic dissection

of complete


USMLE® Step 1 style questions USMLE

of complete

A 28-year-old man is brought to the emergency department after being involved in a high-speed motor vehicle collision. The patient was a restrained driver traveling on the highway when he suddenly slammed into the back of a stopped semi-truck. Upon arrival to the emergency department, the patient reports severe substernal chest pain radiating to his left shoulder blade. His temperature is 37.0°C (98.6°F), pulse is 104/min, respirations are 18/min and blood pressure is 185/100 mmHg. Physical examination shows bruising over the anterior chest wall, but no crepitus is felt on palpation. Shoulder examination shows full passive and active range of motion bilaterally. A chest X-ray is obtained (see below):  

Reproduced from: Radiopaedia  

Which of the following is the most likely location of injury?   

External References

First Aid








Aortic dissection p. 309

associations with p. 728

hypertension p. 306

Marfan syndrome p. 714

Marfan syndrome as cause p. 306

Bicuspid aortic valve

aortic dissection and p. 309

Cardiac tamponade p. 481

aortic dissection and p. 309

Connective tissue diseases

aortic dissection and p. 310


aortic dissection in p. 309

Hypertension p. 306

aortic dissection and p. 309, 728

Marfan syndrome

aortic dissection and p. 309


Content Reviewers

Rishi Desai, MD, MPH


Tanner Marshall, MS

Vincent Waldman, PhD

An aortic dissection is where part of the tunica intima (which is the endothelial, or the innermost layer of a blood vessel) of the aorta is ripped off. What happens is a tear in the tunica intima of the aorta forms, and the high-pressured blood flowing through the aorta begins to tunnel between the tunica intima and the tunica media, separating the two layers. This is widely accepted as an unideal situation.

Now as the high-pressured blood continues to shear more and more of the tunica intima off the tunica media, blood starts to pool between the two layers, increasing the outside diameter of the blood vessel. The area where blood collects between the tunica intima and the media is called a false lumen, and the true lumen is the regular lumen of the blood vessel.

Since high pressure is a cause of aortic dissection, it’s no surprise that the aorta is the prime target for this problem. So what causes aortic dissections? Well, chronic hypertension is the major cause, whether the hypertension is caused by stress or from increased blood plasma volume like in pregnancy. Blood vessel coarctation, which is the narrowing of a blood vessel, also can cause dissection.

Aortic dissections most often happen in the first 10 cm of the the aorta closest to the heart. In order for an aortic dissection to occur, an underlying condition usually has to exist that weakens the aorta’s wall. Connective tissue disorders like Marfan’s and Ehlers-Danlos syndrome can cause a dissection, as well as a decreased blood flow to the vasa vasorum. Aneurysms can be a cause of aortic dissection as well, and incidentally dissection can also cause aneurysms because again, the dissection weakens the blood vessel wall.


  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "Acute Type A Aortic Dissection" Cardiology Clinics (2017)
  5. "Aortic dissection: medical, interventional and surgical management" Heart (2016)
  6. "Acute aortic dissection: pathogenesis, risk factors and diagnosis" Swiss Medical Weekly (2017)

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