Aortic dissection requires immediate attention

U.S. Senator Lindsey Graham’s sudden death on Saturday from an aortic dissection has brought attention to a life-threatening condition that requires immediate medical attention.

“The mortality for aortic dissection is very high and requires emergent surgery,” said Cape Cod Hospital cardiac surgeon Frederick Y. Chen, MD, PhD. “The mortality is 1 to 2 percent per hour, and so probably 50 percent of patients never make it to the hospital.”

Those that do make it to the hospital, usually must undergo emergency surgery, he said, where the torn aorta is replaced with a polyester graft. That surgery, itself, is quite high-risk, with a mortality of about 20 to 30 percent, he said.

Since aortic dissections are so deadly, Dr. Chen cautioned that anyone experiencing symptoms should immediately call 911 or get to the closest emergency department.

“The symptom of an aortic dissection is deep pain and a sense that something is really wrong,” he said.

Aortic Dissection

The aorta is the main blood pipe from the heart to the body, Dr. Chen explained. The heart pumps blood through that main artery in a similar manner to a water main to a house, he said. When that blood pipe becomes injured because of high blood pressure or wall thickness due to atherosclerosis or being stretched, it can shred or tear, which causes the brain, the heart and parts of the body to be deprived of oxygenated blood.

According to the American Heart Association, an aortic dissection is a tear in the inner layer of the aorta, the body’s largest artery. Blood surges through the tear, causing the layers of the aortic wall to dissect or separate. Symptoms, according to the AHA, include:

• Sudden, severe chest pain.
• Back pain.
• Neck or jaw pain.
• Feeling faint, weak or short of breath.
• Symptoms can mimic other cardiovascular emergencies, making rapid diagnosis essential.

The only instance where surgery may not be needed is if the tear is on the part of the aorta that feeds the body instead of the heart, downstream of the head vessels, Dr. Chen said. In that case, treatment could be medication only. That kind of torn aorta is usually not immediately deadly. But if the tear occurs near the heart, surgery is always required.

“Senator Graham most likely had an acute dissection of the aorta near the heart, which led to his untimely passing before he could reach the hospital,” he said.

Who is at Risk?

One risk factor for an aortic dissection is a genetic predisposition to an enlarged aorta. That enlargement, or aneurysm, causes tissue stretching and weakness. That, plus high blood pressure and heavy lifting, can cause that weak spot to tear, Dr. Chen said. Anyone with a family history of sudden death or an aortic dissection should consider being screened; first with an ultrasound of the heart and then with a CT or MRI scan if the ultrasound shows a problem. Those with an enlarged aorta should have their blood pressure strictly controlled and avoid lifting heavy objects or bearing down inside.