Our Take: Beacon Kalamazoo surgeon explains risks, causes of aortic dissection
Dr. Jerry Pratt, Beacon Kalamazoo
The sudden death of U.S. Senator Lindsey Graham has put a spotlight on aortic dissection, a condition that can strike with little to no warning, even in people who seem perfectly healthy. It’s the same condition that killed actor John Ritter in 2003. To help us understand the risks, causes and treatment, Dr. Jerry Pratt, a cardiothoracic surgeon at Beacon Kalamazoo, answered our questions about aortic dissection.
- What is an aortic dissection, and why can it be fatal so quickly?
An aortic dissection is a tear that occurs in the inner layer of the aorta wall. About one-third of patients die before they reach medical attention because it can lead to aortic rupture, or the tear can block off blood flow to the brain and other organs.
- There are different types of aortic dissection. What is the difference and does the type change how serious it is?
There are generally two types of aortic dissections. Type A occurs in the ascending aorta, where the main artery exits the heart, and Type B generally occurs in the descending aorta, or where the aorta travels in the back of the chest. They can extend all the way down through the abdominal portion to the branches in the legs. Both types are serious. Type A requires emergency open-heart surgery as it is life threatening. Type B can be managed medically with blood pressure control, but some patients require an urgent intervention if they have persistent pain or end organ involvement, meaning reduced blood flow to organs.
- What are the warning symptoms people should watch for?
Unfortunately, there are no warning signs. Aortic dissections are associated with an enlarged aorta or an aortic aneurysm, and most are asymptomatic until the time of the dissection. Patients often complain of severe excruciating pain that starts in the chest and radiates through to their back often between the shoulder blades. They describe the pain as feeling like they are being torn or ripped.
- What raises a person’s risk of aortic dissection?
Risks for aortic dissection include hypertension or high blood pressure, history of smoking, advanced age, arteriosclerosis and family history of aortic aneurysms or dissections. There are genetic conditions associated with aortic dissections and aneurysms that include Marfan’s syndrome and Ehlers-Danlos syndrome.
- If aneurysm or aortic problems run in your family, when should you get checked?
It is best to be checked early so that you can be started on blood pressure medications and have surveillance imaging studies if you have a family history. Known aortic aneurysms are usually treated with surgery at around 5 cm as the risk of surgery is less than the risk of rupture and dissection at this size. The risks increase exponentially the larger the aorta. Genetic testing can also be done in relatives of patients with known familial syndromes.
- How is a dissection diagnosed, and why is it sometimes missed even by trained doctors?
It is usually diagnosed with a CT scan of the chest. It can be missed because the symptoms can be confused with a heart attack or musculoskeletal or back pain. John Ritter, the actor known for his role on “Three’s Company,” died from an aortic dissection and rupture while he was being worked up for a heart attack. Unfortunately, many people are diagnosed at autopsy after a sudden death, as was the case with Senator Graham.
- Should the average person be worried about this after a high-profile case like Senator Graham’s?
The average person should have concern if they have history or poorly controlled high blood pressure or known enlargement of the aorta.
