16 Known Causes of Aortic Dissection

2. Turner Syndrome

Turner syndrome is a genetic condition that affects females. It occurs when one X chromosome is missing or partly missing. This change begins at conception and is usually not inherited. Many girls with Turner syndrome have short height and underdeveloped ovaries, and they may not go through puberty without hormone treatment.

Some are born with kidney differences, a webbed neck, or swelling of the hands and feet. Heart problems are also common. About one-third to one-half of affected females are born with a heart defect, most often involving the aorta, the large artery that carries blood from the heart to the rest of the body. Because of underlying structural differences in the aortic wall, the vessel may gradually stretch and weaken over time.

As the wall becomes more fragile, the risk of an aortic aneurysm increases. If pressure inside the artery continues to rise, a tear can form in the inner layer of the vessel. Blood may then push between the layers of the aortic wall, creating a separation known as an aortic dissection. High blood pressure further increases strain on the weakened aorta and raises the likelihood of this complication.

3. Marfan Syndrome

Marfan syndrome is a genetic disorder that affects the body’s connective tissue. Connective tissue provides strength and structure to blood vessels, bones, eyes, and heart valves. When this tissue is weakened, the wall of the aorta can lose its normal support and elasticity. The aorta carries blood from the heart to the rest of the body.

In people with Marfan syndrome, the weakened aortic wall is more likely to stretch under normal blood pressure. Over time, this stretching can cause the aorta to enlarge, a change known as an aneurysm. As the vessel widens and the wall becomes thinner, the risk of a tear in the inner layer increases. If a tear forms, blood can move between the layers of the artery, leading to an aortic dissection.

Heart changes can further increase strain on the aorta. The aortic root may widen, and the aortic valve may leak, which alters normal blood flow and adds pressure to the vessel wall. Many people with Marfan syndrome are tall and thin, with long arms, legs, and fingers. A curved spine and eye problems, such as a displaced lens or severe nearsightedness, are also common. These physical features often help doctors recognize the condition early.

4. Aortic Coarctation

Aortic coarctation is a congenital heart defect present at birth. It occurs when a section of the aorta, the artery that carries oxygen-rich blood from the heart to the rest of the body, is narrower than normal. This narrowing restricts blood flow beyond the tight segment.

To overcome the blockage, the heart must pump with greater force to move blood through the narrowed area. The increased pressure raises blood pressure in the upper body, especially in the arms, while pulses in the legs may feel weaker. Over time, the persistent high pressure places extra strain on the aortic wall.

Continuous stress can weaken the vessel and make it more vulnerable to complications. If the wall becomes fragile enough, a tear may develop in the inner layer, allowing blood to push between the layers of the artery. This separation can lead to an aortic dissection.

Many people with aortic coarctation also have other structural heart differences, such as a bicuspid aortic valve, which has two flaps instead of three. This valve change can alter blood flow patterns and add further stress to the aorta. Even after repair, long-term high blood pressure may continue to strain the vessel wall.

5. Bicuspid Aortic Valve

A bicuspid aortic valve is a congenital condition in which the aortic valve has two flaps instead of the usual three. The aortic valve regulates blood flow from the heart into the aorta, the main artery that carries blood to the body. Because the valve has only two flaps, it may not open or close as smoothly as it should.

Over time, this difference can cause the valve to become narrowed or begin to leak. When the valve does not function normally, the heart must pump harder to move blood forward. The increased force of blood flow and added workload place extra stress on the wall of the aorta. With ongoing strain, the aorta may gradually stretch and weaken.

As the vessel wall loses strength, the risk of a tear in its inner layer rises. If a tear forms, blood can move between the layers of the artery, leading to an aortic dissection. Many people with a bicuspid aortic valve have no symptoms for years.

6. Ehlers-Danlos Syndrome

Ehlers-Danlos syndrome is a group of inherited disorders that affect connective tissue. Connective tissue provides strength and structure to the skin, joints, and blood vessel walls. In this condition, changes in certain genes disrupt the formation of collagen, a key protein that gives this tissue its durability and elasticity.

When collagen is weakened, the walls of arteries lose some of their normal strength. Some types of Ehlers-Danlos syndrome mainly cause loose joints and stretchy skin. Other types, especially the vascular form, directly affect the blood vessels. In these cases, the arterial walls can become thin and fragile.

If the aorta is involved, it may not tolerate normal blood pressure as well as it should. Ongoing pressure against a weakened wall increases the risk of a tear in the inner layer of the vessel. Once a tear develops, blood can force its way between the layers of the aortic wall, leading to an aortic dissection.

7. Loeys-Dietz Syndrome

Loeys-Dietz syndrome is a rare genetic disorder that affects connective tissue. This tissue helps support and strengthen blood vessels, bones, skin, and joints. When gene changes weaken it, the walls of major arteries lose strength and flexibility. The aorta is especially vulnerable. As blood flows through it under constant pressure, a weakened wall may gradually stretch and lose its normal shape.

This enlargement can form an aneurysm. If the inner layer of the aortic wall tears, blood can push between the layers of the vessel, leading to an aortic dissection. The condition can also affect other arteries throughout the body. Some vessels may twist, widen, or become fragile, which raises the risk of tears in different parts of the vascular system.

Loeys-Dietz syndrome follows an autosomal dominant pattern, meaning a child needs only one altered gene from a parent to develop the condition. Because vascular changes may appear early, regular imaging of the aorta and other arteries is often used to monitor vessel size and detect enlargement before complications develop.

8. Behcet’s Disease

Behcet’s disease is a rare inflammatory disorder that affects blood vessels throughout the body. It is a type of vasculitis, meaning it causes inflammation in both arteries and veins. It often begins in young adults and usually follows a pattern of flare-ups and quiet periods. The inflammation directly targets the vessel wall and can involve vessels of different sizes.

When arteries become inflamed, their structure can weaken over time. In more serious cases, large vessels such as the aorta may be affected. Repeated or long-standing inflammation increases stress on the arterial wall. As inflammation continues, the aortic wall can lose strength and elasticity.

A weakened area may stretch outward and form an aneurysm. Ongoing injury to the inner lining of the artery can create areas of fragility. If a tear develops, blood can enter between the layers of the vessel wall, leading to an aortic dissection.

9. Atherosclerosis

Atherosclerosis is a disease in which fatty deposits, called plaque, build up inside the arteries. Over time, this buildup makes the artery walls thicker, stiffer, and less flexible. When the process affects the aorta, it changes how the vessel responds to normal blood flow.

The aorta must expand and recoil with each heartbeat to handle the force of blood leaving the heart. Plaque reduces this elasticity. As blood pushes against a stiffened and sometimes narrowed area, pressure concentrates along the inner lining of the vessel. This added mechanical stress can damage the lining and increase the risk of a small tear.

If a tear develops, blood can enter between the layers of the aortic wall and lead to an aortic dissection. High blood pressure further increases this strain by forcing blood more strongly against an already hardened wall. When plaque-related weakening combines with elevated pressure, the likelihood of dissection rises.

10. Aortic Aneurysm

An aortic aneurysm is a weakened, bulging area in the wall of the aorta, the main artery that carries blood from the heart to the rest of the body. When part of the wall loses strength, it stretches outward under the constant force of circulating blood.

As the aneurysm grows, the vessel wall becomes thinner and more fragile. With each heartbeat, pressure continues to act on this weakened area. Over time, the inner layer of the aortic wall may tear. If a tear occurs, blood can move between the layers of the artery, leading to an aortic dissection. Aneurysms can develop in different parts of the aorta.

Those in the chest are called thoracic aneurysms, while those in the lower portion are known as abdominal aneurysms. Abdominal aneurysms are more common in older adults, especially men over age 65. Smoking, high blood pressure, and certain inherited conditions can further weaken the vessel wall and increase the risk.

11. Smoking Tobacco

Smoking tobacco is a major risk factor for aortic dissection because it directly damages blood vessels, including the aorta, the main artery that carries blood from the heart to the body. Chemicals in tobacco smoke injure the inner lining of the artery.

Repeated exposure triggers inflammation and structural changes that weaken the aortic wall and reduce its elasticity. As the wall becomes less flexible, it is less able to handle the force of blood moving through it. Smoking also raises blood pressure. Each heartbeat then pushes blood against the aorta with greater force.

When high blood pressure combines with a weakened vessel wall, stress on the artery increases. Over time, this stress can cause a tear in the inner layer. If a tear happens, blood can move between the layers of the wall and lead to an aortic dissection. Smoking also raises the risk of an aortic aneurysm, which is a bulging area caused by a weak vessel wall.

12. Obesity

Obesity is a chronic condition marked by excess body fat. It develops when a person consistently takes in more calories than they burn. Diet, low physical activity, genetics, and certain health conditions can all contribute to this imbalance.

As body weight increases, the heart must work harder to supply blood to a larger body mass. This added workload raises blood pressure over time. Persistently high pressure inside the arteries places continuous force on the wall of the aorta. Under this strain, the vessel wall can gradually weaken, making it more vulnerable to a tear.

If a tear forms in the inner layer, blood can move between the layers of the artery and lead to an aortic dissection. Excess body fat also promotes long-term inflammation throughout the body. Chronic inflammation can damage blood vessels and reduce their structural strength. Over time, these changes may further compromise the integrity of the aortic wall.

13. Car Accidents

Car accidents can cause sudden and severe injury to the chest. During a high-speed collision, the vehicle may stop abruptly, but the body continues moving forward. This rapid deceleration creates powerful internal forces within the chest. The aorta, which sits deep in the chest, is still vulnerable to these forces.

As the body slows down suddenly, different parts of the aorta move at slightly different speeds. This uneven motion places intense stress on the vessel wall, especially near the curved portion in the upper chest. That area is particularly prone to injury because it is relatively fixed in position compared to other segments. A direct blow from a steering wheel, seat belt, or airbag can add further pressure to the chest.

When the stress exceeds the strength of the inner layer of the aortic wall, a tear can form. People who survive the initial crash may develop severe chest pain, back pain, or shortness of breath. Because a tear in the aorta can worsen quickly, rapid medical evaluation and treatment are critical to prevent life-threatening complications.

14. Lack of Early Treatment

Aortic dissection often begins with sudden chest or back pain. Many people delay seeking medical attention because they mistake the pain for muscle strain, heartburn, or stress. This delay allows the initial tear in the aortic wall to extend and become more dangerous.

High blood pressure plays a major role in this process. If it is not treated early, the constant force of blood slowly weakens the aortic wall. Continued strain can cause a small tear to grow into a full dissection. Without proper blood pressure control, stress on the artery stays high and the risk of tearing increases.

Some individuals show warning signs before a complete dissection occurs. An aortic aneurysm, or bulging area in the vessel wall, may develop first. If not regularly monitored or repaired, a weakened area can split under pressure, causing dissection or rupture.

15. Lifestyle Risk Factors

Daily habits can slowly weaken the aorta by raising blood pressure or damaging blood vessel walls. As stress on the artery builds over time, the risk of a tear increases. Long-term high blood pressure is one of the main contributors. When blood constantly pushes too hard against the artery wall, it creates ongoing strain. Uncontrolled blood pressure can weaken the aortic wall, making it more susceptible to dissection.

Smoking speeds up this damage. It injures the inner lining of the arteries and promotes hardening of the vessel walls. As elasticity decreases and structural damage builds, the aorta becomes less able to handle normal pressure.

Poor diet and lack of exercise can lead to high cholesterol and plaque buildup. Plaque stiffens the arteries and reduces flexibility. Stiffer vessels transmit more force to the aortic wall with each heartbeat, increasing mechanical stress.

Some behaviors cause sudden spikes in blood pressure. Cocaine and other stimulant drugs sharply raise heart rate and pressure, which can trigger a tear in a weakened aorta. Heavy weight lifting without proper technique can also cause abrupt pressure surges. Repeated spikes add extra strain, especially in people with other risk factors.

16. Complications

Aortic dissection can quickly become life-threatening because the tear in the aortic wall may continue to spread. As blood pushes between the layers of the vessel, the weakened wall can widen or split further. If the outer layer ruptures, severe internal bleeding can occur, leading to shock or death within minutes.

As the dissection extends, it can block blood flow to vital organs. Narrowing or blockage of branches of the aorta can reduce oxygen-rich blood to the brain, kidneys, or intestines. This loss of blood supply can cause permanent organ damage.

If the tear affects the part of the aorta near the heart, it may involve the aortic valve. Valve damage can allow blood to leak backward into the heart, increasing its workload. Over time, this added strain can lead to heart failure.

Blood may also collect in the sac surrounding the heart. When fluid builds up in this space, it can compress the heart and limit its ability to pump effectively. This is a dangerous complication that requires urgent care.