Sen. Lindsey Graham (R-S.C.) died over the weekend of aortic dissection, according to a preliminary examination by the medical examiner.
An aortic dissection means there’s a tear in the aorta, said Dr. Linda Le, a vascular surgeon with Houston Methodist in Texas.
The aorta is the largest blood vessel in the body, explained Dr. Milind Desai, a cardiologist and medical director of the Center of Aortic Diseases at Cleveland Clinic, “which takes the blood from the heart and distributes it all over the body.”
“The wall of the aorta has three layers, and fundamentally, what dissection means … there was a tear in the aortic wall such that the blood that should be pumped all the way to the rest of the body is now entered into the layers between the aortic wall,” Desai said.
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The most common cause of aortic dissection is an aortic aneurysm, Desai said. This causes the aortic wall to get thinner while the aorta gets bigger, he explained. Folks tend to have a genetic disposition for this aortic wall thinning.
“Think of it as a balloon: Once you expand the balloon past a certain level, it bursts. So that’s essentially what happens in the setting of a dissection,” Desai said.
Roughly 13,000 Americans die of aortic dissection each year, and it tends to be more common in adults over 60, but it doesn’t exclusively happen in this group.
“It can happen to even young patients if they have some sort of connective tissue disorder or family history of aortic dissection,” Le said.
It can also happen if you’ve had a traumatic injury, used cocaine or “anything that’ll create a high blood pressure situation,” said Le.
Uncontrolled high blood pressure is a risk factor for aortic dissection, Le noted. Smoking also puts you at higher risk.
Symptoms include a “tearing” chest pain.
There’s a range of symptoms that can come with an aortic dissection, depending on what kind of dissection you have, but sudden, severe chest or back pain is common, Le said.
Desai said it may feel like a “tearing pain.” Belly pain, and even symptoms of a stroke (such as difficulty speaking and weakness in one side of the body) can also happen.
Symptoms of aortic dissection require immediate medical attention. “This becomes a surgical emergency. So then you are racing against time, essentially,” Desai added.
“If I’m a patient, I do not want to wait till my aorta dissects,” Desai said.
If you have risk factors for aortic dissection or aortic aneurysm, such as a family history, it’s important to be seen by a doctor who can monitor your health and diagnose and/or treat the condition before it becomes a major problem.
“The key here is recognizing people who have an aneurysm and following them up serially to a point where we would say that the dimensions are dangerous enough that we need to operate and replace that diseased part of the aorta,” said Desai.
Think of it as a pipe that is about to burst, Desai said. “You want to replace that piece of the pipe before it bursts.”
“The most common way of making the diagnosis is if there’s a family history, or you do some imaging study for something else, and you accidentally identify the disease,” he said.
When you have a dissection of the aorta, there is a high fatality rate if you don’t get immediate medical attention.
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Knowing your family history and treating high blood pressure are important ways to prevent aortic dissection.
To prevent aortic dissection, the most important thing you can do is control your blood pressure, said Le.
If you have high blood pressure, see a doctor who can prescribe lifestyle interventions or medications to get it into a healthy range.
“Anybody that has some sort of aortic pathology that’s less than 60 years old needs to be tested for some sort of genetic disorder,” said Le before adding that it’s also important for family members to get tested as well.
According to Desai, “what we recommend is all first-degree relatives of people with thoracic — meaning aortic aneurysms in the chest — all first-degree relatives should be screened for aortic aneurysm.”
There are treatments available for aortic dissection but, again, it’s emergent and has a high mortality rate. Being aware of any factors that put you at higher risk can help doctors address the issue before it’s an emergency.
“The best prevention is identification and operation at an appropriate time, or before it gets beyond a danger level,” said Desai.