Chest pain is one of the symptoms that people often associate with a heart attack. However, not every episode of chest pain is caused by a blocked heart artery. One of the less common but extremely serious causes is aortic dissection.

An aortic dissection occurs when a tear develops in the inner layer of the aorta, the body's main artery. Blood enters through the tear and separates the layers of the artery wall. The dissection can extend along the aorta and may reduce blood flow to vital organs. If the aorta ruptures, it can cause severe internal bleeding and become rapidly fatal.

Because its symptoms can resemble a heart attack and other cardiovascular emergencies, recognising the warning signs and getting an early diagnosis is extremely important.

What Is Aortic Dissection?

The aorta carries oxygen-rich blood from the heart to the rest of the body. Its wall has several layers that normally remain together. In an aortic dissection, the inner layer tears and blood flows between the layers.

This creates a false channel within the artery wall. As the dissection spreads, it can interfere with blood supply to the heart, brain, kidneys, intestines or limbs. It can also cause serious complications such as stroke, kidney injury, aortic valve problems, cardiac tamponade or internal bleeding.

Aortic dissection is broadly classified into two types:

• Type A: The dissection involves the ascending aorta, the section closest to the heart. It is a particularly dangerous form and generally requires emergency surgery.
• Type B: The dissection involves the descending part of the aorta. Depending on its severity and complications, it may initially be managed with medicines or may require an endovascular procedure or surgery.

Why Can It Be Mistaken for a Heart Attack?

Both conditions can cause sudden chest discomfort, breathlessness and other symptoms. This can make the initial diagnosis challenging.

However, there can be differences in the way the pain presents.

Aortic dissection may cause:

• Sudden, severe chest or upper-back pain
• Pain that reaches maximum intensity very quickly
• A tearing, ripping or sharp sensation
• Pain that may move from the chest towards the back or abdomen
• Sudden severe abdominal pain
• Fainting or shortness of breath
• Stroke-like symptoms such as difficulty speaking, vision problems or weakness on one side of the body

A heart attack more commonly causes pressure, heaviness, squeezing or discomfort in the chest. The discomfort may spread to the arm, shoulder, neck, jaw or back. However, symptoms can vary, so the nature of pain alone cannot confirm which condition is responsible.

Importantly, aortic dissection can sometimes affect the blood supply to the coronary arteries and cause complications that resemble or even result in a heart attack. This is why a person with sudden severe chest pain needs urgent medical assessment rather than attempting to identify the cause at home.

What Are the Warning Signs That Should Not Be Ignored?

The most important warning sign is sudden and severe chest or upper-back pain, particularly when it reaches maximum intensity at the beginning.

Other symptoms that need urgent attention include:

• Sudden chest, back or abdominal pain
• Pain spreading towards the back or abdomen
• Sudden breathlessness
• Fainting or loss of consciousness
• Sudden weakness
• Difficulty speaking or seeing
• Weakness or loss of movement on one side of the body
• Leg pain or difficulty walking

An important point is that aortic dissection does not always give a long warning period. It can occur suddenly, even when a person has not experienced previous symptoms.

Who Is at Higher Risk?

High blood pressure is an important risk factor because long-term pressure on the aortic wall can contribute to weakening of the artery.

Other factors associated with increased risk include:

• Aortic aneurysm
• Atherosclerosis
• Bicuspid aortic valve
• Certain congenital conditions affecting the aorta
• Marfan syndrome and other connective tissue disorders
• Family history of aortic aneurysm or dissection
• Smoking
• Certain forms of drug use that can cause a sudden rise in blood pressure

Age and sex also influence risk. Aortic dissection is more commonly seen in older adults and occurs more frequently in men, although it can occur in younger people, particularly when genetic or structural risk factors are present.

How Is Aortic Dissection Diagnosed?

Because the symptoms can overlap with a heart attack, pulmonary conditions and other emergencies, doctors need to assess the patient quickly.

Depending on the clinical situation, doctors may use:

• CT aortogram, which can show the tear and the extent of the dissection
• Echocardiography, including trans-oesophageal echocardiography in selected patients
• ECG and blood tests as part of the broader assessment

Imaging is particularly important because the treatment for aortic dissection is very different from the treatment for a typical heart attack.

Why Early Treatment Matters

Aortic dissection is a medical emergency. The treatment depends on where the dissection occurs, whether the aorta has ruptured and whether blood flow to vital organs has been affected.

For Type A dissection, emergency surgery is generally required to repair the affected section of the aorta.

For Type B dissection, treatment may involve close monitoring and medicines to control blood pressure and heart rate. If complications such as rupture or reduced blood flow to an organ develop, an endovascular procedure or surgery may be required.

The sooner the condition is recognised and treated, the better the opportunity to prevent life-threatening complications.

Can Aortic Dissection Be Prevented?

Not every case can be prevented, particularly when genetic conditions are involved. However, controlling cardiovascular risk factors can help reduce risk.

Key measures include:

• Keep blood pressure under control.
• Do not smoke.
• Manage cholesterol and blood sugar.
• Maintain a healthy weight.
• Stay physically active as advised by a healthcare professional.
• Follow up regularly if an aortic aneurysm has already been diagnosed.
• Tell your doctor about a family history of aortic aneurysm or dissection.
• If you have a known genetic condition affecting connective tissue or the aorta, follow recommended cardiac and aortic monitoring.

Do Not Ignore Sudden Chest Pain

Aortic dissection is uncommon compared with a heart attack, but its seriousness means it should not be overlooked. Sudden, severe chest or back pain, particularly when accompanied by fainting, breathlessness or neurological symptoms, requires immediate emergency medical attention.

It is not possible to reliably distinguish aortic dissection from a heart attack based only on symptoms. Do not wait for the pain to settle or try home remedies. Seek emergency care immediately. Rapid assessment, appropriate imaging and specialist treatment can be lifesaving.