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What Is an Aortic Dissection?
The sudden and deadly condition that killed Senator Lindsey Graham doesn’t strike as often as other cardiovascular issues but can become more common after 50
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Key takeaways
- An aortic dissection is a sudden tear in the aorta that can disrupt blood flow or cause a fatal rupture.
- Symptoms can mimic other cardiovascular emergencies, including severe chest or back pain, weakness and shortness of breath.
- High blood pressure is the leading risk factor.
Sudden and severe pain in the chest is often associated with a heart attack, but in rarer cases it may signal another health emergency — an aortic dissection, the condition that killed Sen. Lindsey Graham this past weekend.
During this life-threatening condition, a tear occurs in a layer of the body’s largest artery, the aorta, disrupting the flow of oxygen-rich blood to the body or rupturing the aorta completely.
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“It happens all of a sudden,” says Dr. Thomas MacGillivray, chairman of cardiac surgery at MedStar Washington Hospital Center in D.C. and physician executive director of cardiac surgery at MedStar Health. “And people can go from one minute feeling perfectly fine to another minute being in a life-threatening condition or dying suddenly.”
How an aortic dissection happens
You can think of the layers of the aorta like a roll of paper towels, MacGillivray says. The innermost layer — the cardboard roll in this analogy — is the intima; the thick middle layer, or the paper towels, is called the media; and the outermost layer that holds it all together, like the plastic wrap covering the paper towel roll, is the adventitia.
When a person develops an aortic dissection, the cardboard roll layer gets a split in it, “and the blood, which is pumped under pressure normally through that channel, now gets pumped into where the paper towel [layer] is, the media,” MacGillivray says.
Blood flowing between the layers can disrupt normal blood flow to other parts of the body, or even stop it, and can lead to organ damage, a heart attack, stroke and other complications.
The pressure from it all can also cause the aorta to rupture. “And if it ruptures, the person bleeds to death within a matter of seconds, usually,” MacGillivray says.
As many as 40 percent of people with an aortic dissection die almost immediately, according to University of Chicago Medicine.
Tears in the aorta typically occur in areas where the stress on the aortic wall is highest, such as the beginning of the artery, known as the ascending aorta, according to the Cleveland Clinic. Aortic dissection in the ascending aorta is nearly two times more common than a dissection in a lower part of the artery.
Symptoms are sudden and can be severe
An aortic dissection is a medical emergency that can happen without warning, making it important to recognize the symptoms quickly.
According to the American Heart Association, common symptoms can mimic other cardiovascular emergencies. They can include:
- Sudden and severe chest pain
- Back pain
- Neck or jaw pain
- Feeling faint, weak or short of breath
A rapid and weak pulse, heavy sweating, confusion, belly pain and loss of vision can also be symptoms of an aortic dissection, the Cleveland Clinic says. “Some people can just suddenly feel really poorly,” MacGillivray adds.
Emergency open-heart surgery is usually required in people who are diagnosed with an aortic dissection.
High blood pressure is the biggest risk factor
An aortic dissection happens at a weakened area in the aortic wall, though it’s not entirely known what causes the wall to weaken. “We think that there is an underlying disease or underlying predilection of the wall of the aorta” to make it more susceptible to a tear, MacGillivray says.
Certain factors can raise your risk of an aortic dissection, the most common being high blood pressure.
Other risk factors include:
- Atherosclerosis (plaque buildup in your arteries) or high cholesterol
- Smoking/tobacco use
- Having a connective tissue disease
- Aortic valve disease
- Chest injury or trauma
- A family history of aortic dissection
Age is another risk factor. “Most people experience a dissection between the ages of 50 and 70,” Dr. Manesh Patel, chief of the Division of Cardiology at Duke Health and the volunteer president of the American Heart Association, said in a news release. And men are more likely to experience an aortic dissection than women.
Know your risk — and act quickly
If you’re at risk of aortic dissection, the best thing you can do, MacGillivray says, is to be proactive about it.
“If you have high blood pressure, you want to make sure that you keep your blood pressure under control and you stay in touch with your primary care doctors or providers or your cardiologist and get checkups,” he says. Doing so can also lower your risk of other cardiovascular diseases, as well, he adds.
What’s more, if you have a family history of aortic dissection, ask your doctor to evaluate your risk, possibly even with imaging tests.
“And then, in the unlikely event that somebody were to develop chest pain or back pain, please don’t ignore it,” MacGillivray says. “Most people, they’re not sure what’s happening, but they’re quite sure something is wrong. You don’t want to ignore it. You don’t want to pass it off as something else.”
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