Summary

• A medical emergency resulting from a tear in the aortic wall intima, which causes blood flow into a new false channel composed of the inner and outer layers of the media. May propagate in an antegrade or retrograde direction, or both.
• Typically presents in men older than 50, with sudden onset of severe ripping or tearing substernal or interscapular pain.
• May present with syncope, heart/renal failure, or mesenteric or limb ischaemia; O2/ALS protocol and haemodynamic support should be instituted without delay when the condition is suspected.
• Diagnostic modalities include CT scan, MRI, or trans-thoracic/trans-oesophageal echocardiography.
• Involvement of the ascending aorta and/or arch warrants urgent surgical repair. Dissections of the descending aorta are managed medically with beta blockade; surgery in this group is reserved for those with end-organ malperfusion, persistent pain, or rupture.
• Lifelong surveillance is needed with regular imaging to detect aneurysmal degeneration of the remaining aorta, which may later require surgery.