When examined, about two thirds of people with aortic dissection have diminished or absent pulses in their arms and legs. A dissection that's moving backward toward the heart may cause a murmur that can be heard through a stethoscope. Blood may accumulate in the chest. Chest x-rays show widened aortas in 90 percent of people with symptoms. Ultrasound scans can usually confirm the diagnosis even when the aorta isn't enlarged.
Death can occur a few hours after an aortic dissection begins.
Therefore, as soon as possible, doctors give drugs to reduce the heart rate and blood pressure to the lowest level that will maintain a sufficient blood supply to the brain, heart, and kidneys. Soon after drug therapy begins, a doctor must decide whether to recommend surgery or to just continue the drug therapy. Doctors almost always recommend surgery for dissections that involve the first few inches of the aorta closest to the heart, unless complications of the dissection make the risk of surgery too great. In these cases, surgery is necessary. During surgery, the surgeon removes the greatest possible area of dissected aorta, prevents blood from entering the false channel, and rebuilds the aorta with a synthetic graft.