Although not common, aortic dissection is a medical emergency. It requires immediate diagnosis and treatment. Without quick action, it can lead to internal bleeding, stroke, kidney failure, or sudden death. It mostly affects older adults, particularly men between the ages of 60 and 80. However, it can also occur in younger people, especially those with high blood pressure, heart defects from birth, or certain genetic conditions.

The most frequent cause of aortic dissection is long-term high blood pressure. Over time, the constant pressure can weaken the walls of the aorta, making them more prone to tearing. Other risk factors include connective tissue disorders such as Marfan syndrome, Ehlers-Danlos syndrome, and Loeys-Dietz syndrome. These genetic conditions weaken the structure of the body’s blood vessels, including the aorta, increasing the risk of a tear. People with an abnormally shaped aortic valve or a family history of aortic disease are also at higher risk. In rare cases, aortic dissection can be triggered by trauma to the chest, such as from a car accident, or by extreme physical strain, such as heavy weightlifting.

What makes this condition so dangerous is that its symptoms often resemble those of a heart attack or other common illnesses. The most typical symptom is a sudden, severe pain in the chest or upper back. Many patients describe it as a tearing or ripping sensation. The pain can also move — starting in the chest and spreading to the neck, jaw, or down the back. Some people experience shortness of breath, fainting, numbness or weakness on one side of the body, or difficulty speaking. If the dissection affects the arteries supplying the brain, it may even cause stroke-like symptoms. Others may have abdominal pain, leg pain, or loss of pulse in the limbs, depending on where the dissection spreads.

Surviving an aortic dissection is just the beginning of a long road to recovery. Patients need to make lasting changes to their lifestyle and take medicines regularly to keep their blood pressure under control. Regular follow-up scans are also important to monitor the condition of the aorta and to catch any new problems early. Smoking must be stopped completely, and patients are advised to avoid heavy lifting or intense physical activity unless cleared by their doctor. A heart-healthy diet, stress reduction, and careful monitoring of cholesterol and blood pressure are part of lifelong management.

Some people are diagnosed with aortic dissection incidentally — meaning they had no symptoms, but the condition was discovered during a scan for another reason. These silent dissections are still dangerous. Even if the patient feels fine, the dissection could grow or rupture later. That’s why doctors may recommend frequent imaging tests and, in some cases, preventive surgery, even if there are no immediate symptoms.

In families where aortic dissection has occurred at a young age or in more than one relative, doctors often recommend genetic counselling. Inherited conditions like Marfan or Loeys-Dietz syndrome can be passed from one generation to the next. People who carry these genes may look completely healthy but be at high risk for serious heart and blood vessel problems. Screening of family members can help catch these risks early.

Recovery from aortic dissection can also affect a person’s mental health. After such a traumatic event, it’s common to feel anxious or depressed. Some patients may fear another dissection, or they may find it difficult to get back to everyday life. Cardiac rehabilitation programmes can be very helpful. These programmes guide patients through physical recovery, help manage anxiety, and offer practical advice for adjusting to a new lifestyle.

Public awareness of aortic dissection is still quite low, even though it can happen to anyone — from a retired man in his 70s to a young athlete in peak health. In recent years, the sudden deaths of public figures due to undiagnosed dissections have brought some attention to the condition, but more education is needed. Most people have heard of heart attacks and strokes. Far fewer know about aortic dissection. This gap in knowledge means that many people don’t recognise the symptoms, and even trained professionals may miss it in the early stages.

Advancements in medical technology are helping change this. Emergency rooms are now using faster CT scanners and Artificial Intelligence to detect dissections more quickly. Surgery has also improved, with better success rates and less invasive techniques. New medications are being tested to help protect the aorta from further damage in patients who are not surgical candidates. Despite these positive developments, awareness remains the most powerful tool.

It is essential for people, especially those with high blood pressure or a family history of heart and vascular disease, to take chest or back pain seriously. Sudden, severe, or unusual pain should never be ignored. Even if it turns out to be something less serious, it’s better to be cautious. When it comes to the aorta, every minute counts. Aortic dissection may lie hidden deep in the chest, but it is a condition that demands public attention and early action. Knowing the risks, recognising the symptoms, and seeking help right away can mean the difference between life and death.

This article is authored by Dr Niranjan Hiremath, senior consultant, cardiovascular and aortic surgeon and surgical lead, Indraprastha Apollo Hospital, New Delhi.