Symptoms:

The symptoms usually begin suddenly, and include severe chest pain. The pain may:

• Be described as sharp, stabbing, tearing, or ripping
• Be felt below the chest bone, then moves under the shoulder blades or to the back
• Move to the shoulder, neck, arm, jaw, abdomen, or hips
• Change position -- pain typically moves to the arms and legs as the aortic dissection gets worse

Other symptoms may include:

• Changes in thought ability, confusion, disorientation
• Decreased movement in any part of the body
• Decreased sensation in any part of the body
• Dizziness
• Dry mouth
• Dry skin
• Fainting
• Nausea and vomiting
• Pallor
• Profuse sweating (clammy skin)
• Rapid, weak pulse
• Shortness of breath -- difficulty breathing when lying flat (orthopnea)

Signs and tests:

The health care provider will take your family history and listen to your heart, lungs, and abdomen with a stethoscope. A "blowing" murmur over the aorta, a heart murmur, or other abnormal sound may be heard.

There may be a difference in blood pressure between the right and left arms, or between the arms and the legs.

There may be low blood pressure, bulging neck veins, or signs resembling a heart attack. There may be signs of shock, but with normal blood pressure.

Aortic dissection or aortic aneurysm may be seen on:

• Aortic angiography
• Chest x-ray -- may show chest widening or fluid in the lining of the lung (pleural effusion)
• Chest MRI
• CT scan of chest with dye
• Doppler ultrasonography (occasionally performed)
• Echocardiogram
• Transesophageal echocardiogram (TEE)