Chest pain radiating to the back and interscapular region, with shock in presence of risk factors such as hypertension suggest a diagnosis of acute aortic dissection. Loss of pulses occurs when vessel orifices are obstructed by mobile intimal flaps and pulses may well be preserved if such obstruction does not occur. A pleural effusion (left sided) may also be present.

A pleural effusion (usually left sided) may also be present. The effusion is typically serosanguinous and does not indicate rupture unless accompanied by hypotension and falling haematocrit.  Pain may be localized to the front back of the chest, often in the interscapular region and typically migrates with propagation of lesion.

Severe pain from onset differentiates it from myocardial infarction. Sudden onset pain, severe, tearing associated with diaphoresis. Pulse deficits may be produced obstruction of the branches by compression of the true lumen by distended false lumen or by obstruction of the vessels orfice by mobile intimal flag. Peripheral pulses thus may be normal if the pathologic process does not compromise their orifices.

RISK FACTOR: Risk factor include old age (50-70 yrs), hypertension, females sex, pregnancy bicuspid or unicuspid aortic valve, Noonan or Turner's syndrome, cocaine abuse or connective tissue disorders such as Marfan's Ehler's Danlos syndrome, or arteritis such as Takayasu's or giant cell arteritis.

Homoeopathic treatment requires a deep constitutional analysis. The history of the disease, the family medical history, physical and mental characteristics of the patient, the likes and dislikes, medication details are all taken into consideration. This approach stands in consonance with the homoeopathic convention: Well selected Homoeopathic remedies are effective for aortic dissection treatment.

CACTUS. Sensation of constriction of the heart, feels as if it were compressed or squeezed by an iron hand. Heart pains come on slowly, gradually increase then gradually subside. Angina pectoris, with suffocation, cold sweat and ever-present iron band feeling. Blood clots. Pulse feeble, irregular quick, without strength. Melancholic, taciturn, sad, and ill humored. Worse < about noon, lying on the left side, walking, going upstairs. 11 a.m. and 11 p.m. Better > open air.

DIGITALIS. Sudden sensation that the heart stood still. Pulse very small, slow, feeble, intermitting every third, fifth and seventh beat. Feels as if the heart would stop beating if she moved. Blueness, coldness and suffocation. Despondency, fearful, anxious for the future. Worse < when sitting erect, after meals, music. Better > when stomach is empty, in open air.

KALMIA. Sharp, severe pains about heart taking way the breath with shooting down into stomach and abdomen with slow pulse and numb feelings in left arm. Pains often travel downward in heart attacks. Rapid and visible beating of the heat, paroxysms of anguish with great breathlessness, pains in limbs, stitching lower part of chest, right sided face ache. Worse < when bending over and better > by sitting erect.

LACHESIS Great loquacity jumps from on subject to another. Fits of suffocation and fainting, especially when moving, pulse weak, intermittent, stitches in left side of chest. Can’t bear anything tight around the neck or waist. Horrible, smothering feeling about the heart awaking him from sleep and compelling him to leave the bed, dread of going to sleep on account of marked aggravation. Pain begins on the left and extends to the right. The face is purple, mottled puffed. looks swollen and bloated. Worse < sleep, and on going to sleep, left side, and heat.

LACTRODECTUS MACTANS: The bite of this spider simulates a heart attack. Constriction of the chest muscles, with radiation to the back. Gasping breath. Violent, pericardial pain extending to the axilla down the arm and forearm to fingers with numbness of extremity. Pulse feeble and rapid. Skin as cold as marble. Fears losing his breath. Use this remedy if no other is specifically indicated.

LAUROCERASUS Sensation as if the heart would turn over, causing him to gasp for breath, worse when lying down. Spasmodic tickling cough in cardiac patients. Breathlessness worse < from lying down, motion, stooping, eating, drinking, or warmth.

NAJA. Sense of oppression in chest, as if a hot iron had been run into it and a big weight put upon it. Angina, threatened paralysis of the heart, body cold, pulse slow, weak, irregular and tremulous. Angina pains extending to the nape of neck, left shoulder and arm with anxiety and fear of death Cannot lie on left side, but has great > relief of pain and breathlessness when lying on right side. Worse < from stimulants. Better > walking of riding in open air.

SPIGELIA. Great breathlessness at every change of position. Breathlessness, must lie on right side with head high. Sharp, shooting pains from the heart to the back, radiating from the heart down the arm, over the chest, and down the spine. Great weakness of the body after walking, Great oppression or anxiety about the heart. Craving for hot water which > ameliorates. Fear of sharp pointed things such as needle and pins, afraid of injections and acupuncture. Worse < from touch, motion, noise, turning, washing, concussion. Better > lying on right side with head high, inspiring.