Chest and Back Pain: Is Aortic Dissection a Concern?

Chest pain and back pain?

Hello Doctor: I usually experience chest tightness and chest pain, but it is not severe discomfort; it simply feels like there is chest tightness and pain.
I have also experienced hyperventilation and anxiety, which are usually accompanied by pain in the upper left back.
Yesterday, I felt persistent pain in my upper left back all afternoon, similar to the soreness experienced when stretching too hard (it felt a bit achy).
I often have chest pain and tightness, but this morning when I woke up, the pain in my upper left back had significantly decreased and was no longer as intense as yesterday (although there is still some discomfort).
Today, I came across a news article stating that back pain could potentially indicate aortic dissection.
Doctor, could my symptoms be indicative of aortic dissection? What tests should I undergo to determine if it is indeed aortic dissection? P.S.
I have mitral valve prolapse, and my blood pressure and heart rate are normal.
My blood lipids and cholesterol levels are also normal, and I do not smoke or drink.
Thank you, Doctor!

Tony, 30~39 year old female. Ask Date: 2017/05/27

Dr. He Dongjin reply Cardiology

Hello, the back pain feels like muscle nerve pain, and both blood pressure and heart rate are normal, which does not resemble aortic dissection.
There is no need to worry.
Changhua Hospital cares about you.

Reply Date: 2017/05/27

More Info

A: Thank you for your detailed description of your symptoms. Based on what you've shared, it sounds like you are experiencing chest discomfort and upper back pain, which can understandably raise concerns about serious conditions such as aortic dissection. However, let's break down your symptoms and the associated risks.

Aortic dissection is a serious condition that occurs when there is a tear in the inner layer of the aorta, allowing blood to flow between the layers of the aortic wall. This can lead to severe complications, including rupture or decreased blood flow to vital organs. The classic presentation of aortic dissection includes sudden, severe chest pain that may radiate to the back, often described as a tearing or ripping sensation. Patients may also experience symptoms such as shortness of breath, fainting, or neurological deficits if blood flow to the brain is compromised.

In your case, you mentioned that your chest pain is not severe and is often accompanied by anxiety and hyperventilation. The pain in your upper back feels more like muscle strain rather than the acute, severe pain typically associated with aortic dissection. Additionally, you noted that your symptoms have improved since yesterday, which is a positive sign. Aortic dissection usually does not improve on its own and tends to worsen over time.

Given your medical history of mitral valve prolapse and the fact that your blood pressure and cholesterol levels are normal, the likelihood of aortic dissection may be lower, especially since you do not have the classic risk factors such as uncontrolled hypertension or connective tissue disorders. However, it is essential to consider that any persistent or concerning symptoms warrant further evaluation.

To assess whether aortic dissection is a concern, your healthcare provider may recommend several diagnostic tests. These could include:
1. Chest X-ray: This can help identify any widening of the aorta or other abnormalities.

2. CT Angiography: This is a highly sensitive and specific test for diagnosing aortic dissection. It provides detailed images of the aorta and can show the presence of a tear.

3. MRI: This can also be used to visualize the aorta and assess for dissection, although it is less commonly used in acute settings compared to CT.

4. Echocardiogram: This can evaluate the heart and aorta, especially if there are concerns about the mitral valve or other cardiac issues.

Given your symptoms and the fact that they have improved, it may not be an emergency situation, but it is crucial to discuss your concerns with a healthcare provider. They can perform a physical examination, review your symptoms in detail, and determine the appropriate tests based on your clinical presentation.

In conclusion, while your symptoms could be concerning, they do not strongly align with aortic dissection based on your description. However, it is always best to err on the side of caution when it comes to chest pain and back discomfort. Please consider scheduling an appointment with your physician to discuss your symptoms further and to determine if any diagnostic testing is necessary. Your health and peace of mind are important, and a thorough evaluation can help clarify your situation.

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