About 96% of individuals with<unk>  present with severe pain that had a sudden onset. The pain may be described as a tearing, stabbing, or sharp sensation in the chest, back, or abdomen. About 17% of individuals feel the pain migrate as the<unk>  extends down the aorta. The location of pain is associated with the location of the<unk> . Anterior chest pain is associated with<unk> s involving the ascending aorta, while interscapular back pain is associated with descending<unk> s. If the pain is pleuritic in nature, it may suggest acute pericarditis caused by bleeding into the sac surrounding the heart. This is a particularly dangerous eventuality, suggesting that acute pericardial tamponade may be imminent. Pericardial tamponade is the most common cause of death from<unk> . While the pain may be confused with that of a heart attack,<unk>  is usually not associated with the other suggestive signs, such as heart failure and ECG changes. Less common symptoms that may be seen in the setting of<unk>  include congestive heart failure (7%), fainting (9%), stroke (6%), ischemic peripheral neuropathy, paraplegia, and cardiac arrest. If the individual fainted, about half the time it is due to bleeding into the pericardium, leading to pericardial tamponade. Neurological complications of<unk> , such as stroke and paralysis, are due to the involvement of one or more arteries supplying portions of the central nervous system. If the<unk>  involves the abdominal aorta, compromise of one or both renal arteries occurs in 5–8% of cases, while ischemia of the intestines occurs about 3% of the time. Blood pressure People with<unk>  often have a history of high blood pressure. The blood pressure is quite variable at presentation with acute<unk> . It tends to be higher in individuals with a distal<unk> . In individuals with a proximal<unk> , 36% present with hypertension, while 25% present with hypotension. Proximal<unk>  tends to be associated with weakening of the vascular wall due to cystic medial degeneration. In those who present with distal (Stanford type B)<unk> , 60–70% present with high blood pressure, while 2–3% present with low blood pressure. Severe hypotension at presentation is a grave prognostic indicator. It is usually associated with pericardial tamponade, severe aortic insufficiency, or rupture of the aorta. Accurate measurement of blood pressure is important. Pseudohypotension (falsely low blood-pressure measurement) may occur due to involvement of the brachiocephalic artery (supplying the right arm) or the left subclavian artery (supplying the left arm). Aortic insufficiency Aortic insufficiency (AI) occurs in half to two-thirds of ascending<unk> , and the diastolic heart murmur of aortic insufficiency is audible in about 32% of proximal<unk> s. The intensity (loudness) of the murmur depends on the blood pressure and may be inaudible in the event of low blood pressure. Multiple causes exist for AI in the setting of ascending<unk> . The<unk>  may dilate the annulus of the aortic valve, preventing the leaflets of the valve from coapting. The<unk>  may extend into the aortic root and detach the aortic valve leaflets. Alternatively, following an extensive intimal tear, the intimal flap may prolapse into the left ventricular outflow tract, causing intimal intussusception into the aortic valve, thereby preventing proper valve closure. Myocardial infarction Heart attack occurs in 1–2% of<unk> s. Infarction is caused by the involvement of the coronary arteries, which supply the heart with oxygenated blood, in the<unk> . The right coronary artery is involved more commonly than the left coronary artery. If the myocardial infarction is treated with thrombolytic therapy, the mortality increases to over 70%, mostly due to bleeding into the pericardial sac, causing cardiac tamponade. Pleural effusion A pleural effusion (fluid collection in the space between the lungs and the chest wall or diaphragm) can be due to either blood from a transient rupture of the aorta or fluid due to an inflammatory reaction around the aorta. If a pleural effusion were to develop due to<unk> , it is more common in the left hemithorax rather than the right hemithorax.
Aortic dissection
Costochondritis
Aortic rupture
Tietze syndrome  Tietze syndrome  1
Acute aortic syndrome
Thoracic aortic aneurysm
Aortoenteric fistula
Myocardial rupture