Aorta is the main artery that carries the blood from the heart to other parts of the body. Blood that is carried leaves the heart through the aortic valve and then the aorta. It is the largest blood vessel in the body.

A swelling or bulging at any point of the aorta resulting in a tear and rupture of that weakened point of the aorta is aortic rupture. Aortic rupture is a very rare and extremely dangerous condition. The most common cause of this type of rupture is an abdominal aneurysm. Aortic rupture is different from aortic dissection. This can be classified according to the cause, like traumatic aortic rupture and aortic rupture secondary to an aortic aneurysm.

What Are the Causes of Aortic Rupture?

Aortic rupture occurs due to the underlying, slow breakdown of cells that makes up the walls of the aorta. The breakdown goes silently for many years, and the weak areas of the aortic wall finally fail, resulting in aortic rupture. Aortic rupture can occur by an underlying vulnerability that is inherited. Constant high blood pressure and stress on the aortic wall can weaken the aorta wall and rupture. Aortic rupture in ascending aorta is nearly twice as common as in descending aorta. The highest stressed areas of the aorta resulting in tears in the aorta.

What Are the Symptoms of Aortic Rupture?

The common characteristic of aortic rupture is an abrupt start, which can happen at any place and time, at rest, even while sleeping, or not doing any activity. Common symptoms include

Shortness of breath.
Dizziness or fainting.
Heavy sweating.
Sharp severe pain in the upper back and chest may feel like a ripping, stabbing, or tearing feeling.
Confusion.
Loss of vision.
Rapid and weak pulse.
Symptoms of stroke include paralysis of one side of the body.
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Diastolic heart murmur, muffled heart sounds.
Low blood pressure.

Aortic rupture is a life-threatening condition. Around 40 % of patients die immediately due to a complete rupture and bleeding caused by it. The risk of death is more than one to three percent till the individual receives treatment.

What Factors Are Capable of Increasing the Risk of Developing Aortic Rupture?

Factors that have the capacity to increase the risk of developing aortic rupture are:

Hypertension (high blood pressure) directly damages the layers of the aortic wall and increases wall stiffness. It is one of the most critical risk factors.
Aortic valve disease (the valve between the aortic wall chamber and the main artery of the aorta does not work properly).
Aortic aneurysm (abnormal enlargement of the aortic wall).
Atherosclerosis (plaque buildup in the arteries due to high cholesterol and smoking).
Connective tissue disorders, Marfan syndrome, and Ehler- Danlos syndrome.
Vasculitis (specifically in aortitis, which is a rare condition that occurs due to inflammation of the blood vessels, restricts blood flow, and damages organs).
If an individual suffers from a family history of aortic rupture.
Congenital heart conditions like bicuspid aortic valve or turner syndrome.
Hereditary conditions primarily affect genetic causes.
Any type of traumatic injury to the chest.
Pregnant women having hypertension (high blood pressure) during delivery.
Age between 50 to 65 years increases the risk of getting cardiac disease.
Extended periods of high blood pressure can increase risk along with administration of drugs like Cocaine, and Amphetamine can also lead to more risk.
Strenuous powerlifting increases the speed of development of aneurysms or ruptures in susceptible people.

What Are the Complications That Result Due to Aortic Rupture?

Aortic rupture can lead to:

Aortic valve damage.
Stroke.
Damage to internal organs like lungs, liver, and kidney.
Cardiac tamponade - Fluid buildup between the heart muscle itself, pressuring the heart and preventing it from working properly.
Death - Nearly 40 % of the population has a life-threatening condition due to rupture or bleeding from the aorta.

How Is Aortic Rupture Diagnosed?

Aortic rupture must be diagnosed immediately, and immediate surgery is needed. The healthcare team needs to determine aortic rupture and conditions associated with stroke and heart attack. Other tests include

Chest X-ray: Small amount of radiation is used to create an image of structures in the chest, including lungs, heart, and blood vessels.
CT Scan: Computed tomography is the best view to detect aneurysm and dissection. For aortic imaging, intravenous contrast may be needed.
Transthoracic Echocardiogram: Uses ultrasound to provide pictures of chambers, heart valves, and the first portion of the aorta.
Transesophageal Echocardiogram (TEE): Heart valves and chambers in thoracic echocardiogram provide a better view of the thoracic aorta. An ultrasound probe is used through the mouth, which is directly behind the heart and in the descending aorta.
MRI (Magnetic Resonance Imaging): Radio waves and large magnets are used to produce detailed images of organs and structures of the body, like the valves and chambers and blood flow.

What Is the Treatment for Aortic Rupture?

Treatment of aortic rupture is mostly done by open aortic surgery or using EVAR (endovascular therapy.

Open Aortic Surgery - A surgery where the thoracic, retroperitoneal, and abdominal incision is used to visualize and control the aorta as a part of treatment.
EVAR (Endovascular Therapy) - Regardless of the cause, non-ruptured aortic aneurysms are repaired.

In some cases, an aortic occlusion balloon is used to be placed to prevent further blood loss before induction of anesthesia. Medications can be given to reduce heart rate and lower blood pressure, and help prevent and worsen aortic rupture.

How Is Aortic Rupture Prevented?

Factors that are capable of increasing the risk of developing aortic rupture cannot be changed. Connective tissue disorders, heart conditions, and genetic triggers have a family history of aortic rupture. Changing the risk factors can help prevent the condition:

Quitting smoking or tobacco.
Maintaining a healthy weight.
Lowering high blood pressure with dietary changes and medications.
Wearing a seat belt to prevent chest injury in case of an accident.
Regularly scheduled checkups can help in preventing the conditions.

Conclusion:

Aortic ruptures are catastrophic emergencies, and surviving such an injury is rare. The mortality rate of aortic rupture is 90 %. Around 65 to 75 % of patients die before they reach the hospital, and up to 90 % die before they reach the operating room. Screening for the disease of the aorta can help in preventing aortic rupture. Treatments like open repair or EVAR can limit the risk of aortic rupture.