About 10,000 people a year will experience an aortic dissection – a tear in the body’s biggest blood vessel. It can be life-threatening, but it’s also possible to survive and to avoid in some cases.
Dr. Mark Pool says the first sign of aortic dissection often - and oddly - comes at night.
“Patients will come to the E.R. because they woke up with severe pain,” said the cardiothoracic surgeon with Texas Health Dallas and with Texas Health Physicians Group. “Chest pain, back pain. They never had pain like that before and they immediately call 911.”
Pool says it’s not clear what causes the tear to begin with, and it’s mostly luck of the draw about who’ll have an aortic dissection – although family history can play a role. Medication can be a first line of treatment in some cases, but an operation’s usually needed at some point.
“If you don’t fix it with surgery, the person’s pretty much not going to make it. But when we get the person in the O-R before it ever tears, the risk might be one or two percent.”
What cause the aorta to tear: I think of it as there must be little tiny nano-tears normal to the human condition that just heal and you never know about it. But if the blood pressure’s very high at the moment when a little nano-tear occurs, then that can open into a larger tear and an aortic dissection occurs.
Two types of aortic dissection: Type A involves the portions directly arising from the heart. If that part’s involved, then that person needs immediate surgery. With type B, that the descending part, the part that’s more near the abdomen. If it tears, that’s a big problem, but typically those patients can be managed with medication first. Sometimes we go in later with what amounts to a really big stent to cover the tear and that’s ll that’s needed.
Who’s at risk: There can be some hereditary aspect to it, but that has a very strong genetic component. Other than that, there can be tendencies in families toward this. So knowing family history matters when it comes to aortic dissection. But there are a lot of patients who have aortic dissection with no family history whatsoever.
Steps to avoid aortic dissection:
- Don’t smoke cigarettes. Chemicals in cigarettes can weaken the proteins that make up the wall of the aorta.
- Control your blood pressure. If the patient’s blood pressure is high, we want to use medications to bring that down.
- Investigate any family history of aortic dissection. One of the first tests to get is an echocardiogram – an ultrasound of the heart. The bigger the aorta to begin with, the higher the risk that it could tear or burst. If it gets to a certain size, then we’d think about an elective surgery to replace that section of the aorta so it never tears to begin with.