Symptoms of aortic dissection may begin gradually or abruptly (acute aortic dissection). However, it is important to note that women experience different symptoms. In both sexes, chest pain is the primary symptom, but the intensity and type of chest pain may not be the same. This may cause women to delay in seeking treatment, which might be a reason more women than men die from aortic dissection. In the future, symptoms peculiar to women may be defined, which may improve women's survival rates.

Classic chest pain symptoms associated with aortic dissection are described as sharp, ripping, tearing or stabbing. It has been described as most intense at the onset of the symptom. This is in contrast to a heart attack, where the pain and discomfort typically intensifies gradually.

The location of pain is usually reported in the front of the chest below the sternum (breast bone) or on the back under the shoulder blades. Occasionally, pain is also reported in the abdomen or radiating to the neck, jaw, arm, shoulder, abdomen or hips. If the location of the pain changes, it may be a sign that the dissection is getting worse.

Other symptoms may include:

Weakness in one or both legs may occur if the aorta is blocked. In rare cases, stroke-like symptoms may occur (e.g., visual disturbances).

The signs physicians look for when diagnosing an aortic dissection in individuals are the five Ps: pain, paleness, pulselessness, paresthesia (numbness, tingling or heightened sensitivity in an area of the body) and paralysis (inability to move part of the body). The patient may also run a fever. In addition, patients with aortic dissection often have marked differences in their pulses from one arm to the other.