Causes

There are two causes for a rupture of the aorta. In principle, accidents can cause the aorta to rupture, but this is extremely rare because the aorta is relatively protected inside the body. A much more common reason for a rupture of the aorta is an aortic aneurysm.

An aneurysm is an enlargement of a vessel. If the vessel wall is stretched more and more, it can rupture. Since several litres of blood flow in the aorta every minute, a person can bleed to death very quickly through a rupture of the aorta.

The causes of these aneurysms are different. An aneurysm can lead to a rupture of the aorta: But the biggest risk factor is atherosclerosis. However, if an aneurysm is present, it is very rare.

An aneurysm causes no pain and has very few symptoms. Most often it is found by chance during preventive medical checkups. In Germany there is no preventive examination for aneurysms, even though it has been available in the USA and in Great Britain for quite some time and has achieved good results and is quite cheap at only about 30 Euros.

Very high blood pressure (which exists for a long time)
Infections
Connective tissue diseases like the Ehlers-Danlos syndrome
Inflammations

If an aortic tear is caused by aortic dissection, there are various risk factors that are familial and hereditary. For example, one of the main risk factors is a weakness of the media, i.e. the middle layer in the wall structure of the aorta, and arteriosclerosis. Such a structural weakness of the media occurs, for example, in hereditary diseases such as Marfan syndrome or Ehlers-Danlos syndrome.

Elevated blood pressure (hypertension) is also considered a risk factor for aortic dissection. Genetic factors also play a role in arterial hypertension. Therefore, only a few risk factors can be found that have a family history or are hereditary and thus increase the risk of aortic dissection and possibly also of aortic rupture. In case of aortic rupture due to trauma or accident, no hereditary risk factors can be found.

Symptoms

The symptoms of an aortic tear differ depending on the type of tear. In the following, a distinction is made between a tear (rupture) that occurs as a result of aortic dissection and a traumatic injury to the aorta, for example as a result of an accident. If a rupture of the vessel wall occurs during an aortic dissection (a splitting of the wall layers of the aorta), an acute, sudden and usually stabbing pain dominates, which can radiate into the back region.

In addition, there is a massive loss of blood, with blood flowing into the abdomen or chest. This leads to a drop in blood pressure and the signs of hypovolemic shock. These are a systolic blood pressure (upper blood pressure value) of less than 100 mmHg up to less than 60 mmHg, barely palpable pulses, shallow and faster breathing up to the point of disturbance and loss of consciousness.

Death by bleeding to death can occur very quickly. If the rupture of the aorta as a result of an aortic dissection is covered, i.e. the blood cannot flow freely into the abdominal cavity, a pulsating and painful mass (tumour) occurs, which can also be palpated from the outside, depending on the patient. Here too, pain may predominate, which radiates into the back.

As a result of an aortic rupture, laxative vessels may be displaced or severed. This results in a reduced supply of other organs. This undersupply can also cause neurological deficits or a stroke.

Neurological deficits are manifested by paralysis or a loss of sensitivity, for example the perception of touch. This form of stroke is called an ischemic infarction because it occurs as a result of insufficient blood supply to the brain or parts of the brain. Likewise, abdominal pain (no supply of the relevant arteries to organs of the gastrointestinal tract) or acute renal failure (renal arteries no longer supply sufficient blood) can occur due to the reduced supply to organs.

Bleeding from the ruptured aorta can also lead to weakened or uneven pulses in the legs and feet or arms and hands. If the aortic tear lies very far in the upper part of the aorta, i.e. close to the outlet of the aorta from the heart, a tear may also involve the heart. The symptoms of aortic valve insufficiency (the aortic valve of the heart no longer closes properly) or pericardial effusion, which can lead to pericardial tamponade, dominate here.

Aortic valve insufficiency means that the ventricle is not sufficiently sealed to the aorta during the filling phase of the left heart ventricle, resulting in a backflow of blood from the aorta into the heart. Pericardial effusion is the accumulation of fluid (in this case blood) in the pericardium. This causes the heart in the pericardium to become constricted and it can no longer work properly (pericardial tamponade).

This can lead to shortness of breath and reduced performance. If an aortic tear occurs after a traumatic event such as an accident, the symptoms of the concomitant injuries usually dominate. Patients with a traumatic aortic rupture are usually polytraumatic patients, which means that they have several, usually life-threatening injuries.

Pain in the chest and abdominal area can also occur, but the polytraumatic injuries do not always necessarily mean that the aortic rupture has to be the result of the aortic rupture. Due to the massive loss of blood, in which, depending on the type of injury, blood can flow into the abdominal cavity or, in the case of open injuries, to the outside, a haemorrhagic shock can also occur here. This means a shock symptomatology due to the lack of volume caused by the blood loss.

The shock is dominated by tachycardia (increased pulse rate), hypotension (blood pressure values below 100/60 mmHg) and dyspnoea (difficult breathing until breathing difficulties). The first signs of an aortic rupture or dissection are sudden pain. This pain is usually classified as very extreme, described as stabbing and usually migrates from the tear location towards the back.

Due to the severe blood loss, corresponding symptoms can occur within a very short time. If, for example, the characteristic pain sets in and a very low blood pressure is measured a short time later, the interaction of these signs can be an indication of an existing aortic tear. The loss of blood can also be accompanied by a loss of consciousness because not enough blood reaches the brain.

In addition to open bleeding into the thorax or abdomen, where the symptoms rapidly worsen, the signs of a so-called covered aortic tear may be different. In this case, the bleeding is squeezed or at least limited by anatomical structures. In contrast to the continuous pain pattern of an open aortic tear, pulsating pain occurs.

The bleeding causes a mass of space, which can cause other symptoms in addition to local pain. If, in the case of corresponding pain, a growing structure is palpated in anatomical proximity to the aorta, this may be a sign of an aortic tear. This topic may also be of interest to you: Symptoms of Aortic Dissection