A preliminary exam found U.S. Senator Lindsey Graham died from an aortic dissection. It’s a tear in the inner lining of the aorta - the largest artery in the body – but it isn’t always fatal.
Dr. Michael Nazarian, a cardiothoracic surgeon at Texas Health Heart & Vascular Hospital Arlington, explains to KERA’s Sam Baker what could bring on such a condition.
Dr. Nazarian: Generally, high blood pressure is a major risk factor, and anything that causes damage to the aortic wall can potentially lead to an aortic dissection.
That includes high blood pressure - and it's important to control that - but also poorly controlled diabetes, smoking.
There's also a genetic risk factor that can also make somebody prone to a weak aortic well. and so, people need to know their family history. Knowledge of that can be critical here.
Baker: Is it an easy condition to miss in exams?
Dr. Nazarian: It is. A neurotic dissection is a sudden process, typically…
Baker: It's not something that builds over time…
Dr. Nazarian: …it generally doesn't start that way. Although the symptoms, once it happens, can be quite sudden, and they are sort of classically described as sudden chest pain or tearing pain that starts in the chest and may radiate to the back.
A clinical history and physical exam are helpful, but really the gold standard is getting the correct imaging done quickly. The most helpful test here is a CT angiogram of the chest that can usually identify the dissection flap and help make the diagnosis definitively.
Baker: And once you know it's an aortic dissection, how do you treat it?
Dr. Nazarian: Well, the treatment depends on the location of the tear in the aorta.
If the tear occurs in the ascending aorta, that's the part near the heart, the treatment is emergency surgery to prevent rupture or dissection of blood into the space around the heart.
If the tears occurs in more distal portions of the aortic, the treatment is typically medical to control blood pressure, and occasionally surgery may be needed if there's restricted blood flow to an organ or to an extremity.
Baker: What's the survival rate?
Dr. Nazarian: The survival rate is pretty good if folks get attention early.
The difficulty here is that with aortic dissections, time matters. In the first 24 to 48 hours, for every hour without treatment, there's an additional one to two percent risk of death.
The key is really to recognize the symptoms and seek medical attention early. Go straight to an emergency room or call 911. Don't delay here.
Baker: How often is aortic dissection misdiagnosed or mistaken for a heart attack or a stroke?
Dr. Nazarian: That's very common. And fortunately, aortic dissections are a rare occurrence. Only about three to four people out of 100,000 are affected yearly.
But the challenge is certainly that based off of the symptoms alone, and sometimes even the physical exam, it's hard to differentiate between a dissection, a heart attack, or some other potentially life-threatening condition.
Most of us in the medical community, certainly the frontline doctors, are usually attuned to this and jump to a definitive test such as a CAT scan with an angiogram to help make that diagnosis.
Baker: Who's at risk for aortic dissection?
Dr. Nazarian: Anybody can potentially get it, but aortic dissections are twice as likely to occur in men versus women.
Folks who have any of those underlying risk factors, especially high blood pressure, so hypertension is a major risk factor, diabetics and smokers, and there is that pool of people who have certain genetic risk factors that make them prone to having a weak aortic wall:
and Loeys-Dietz syndrome.
If you have a family history of that, that's something that you're going to want to share with your doctor.
Baker: Anything you can do to prevent such an occurrence?
Dr. Nazarian: Blood pressure control is certainly the most helpful here. I like to tell my patients to keep a log of their blood pressure at home and bring that with them to their doctor visit so that the doctors can see how they're doing, make adjustments to their medications and help them to really reduce their risk of having this potential complication.
RESOURCES:
National Library of Medicine - MedlinePlus: Aortic Dissection
