NPR’s A Martinez speaks with American Heart Association’s volunteer president Dr. Manesh Patel about aortic dissection, the preliminary finding of what led to Sen. Lindsey Graham’s death.
Transcript
A MARTÍNEZ, HOST:
Preliminary findings in Senator Lindsey Graham’s death attribute it to aortic dissection. It was caused by a type of heart disease. We wanted to better understand the condition, so we’ve contacted Dr. Manesh Patel. He is the president of the American Heart Association and chief of cardiology at Duke University. Doctor, so aortic dissection – what is it? How common is it?
MANESH PATEL: Yeah. Thanks for the question, A. I mean, first and foremost, it’s important to think about the aorta itself, which is the largest artery in the body. It carries oxygen-rich blood from the heart to the rest of the body. So we tell our patients often it’s like the big highway leaving your heart, with branches to your head and arms and other things. And dissection is when there’s a tear in the wall of that artery that causes a flap that can extend up and down that artery and cause, obviously, lots of complications. It occurs somewhere between 5 to 30 people per million, so about 10,000 to 13,000 people in the United States can have an aortic dissection.
MARTÍNEZ: Is this something that is hereditary? So if someone’s father or mother has this, are they at risk?
PATEL: There are genetic disorders that are called connective tissue disorders that lead to aneurisms or weakening in the aortic wall, and that can lead to dissection and aortic disease in younger adults. So certainly people that may have histories of people in their family having aneurisms or, unfortunately, aortic dissections should be evaluated to ensure that they don’t have aneurisms or aortic disease.
MARTÍNEZ: OK. What are some of the symptoms or maybe some of the warning signs?
PATEL: Yeah. It’s important to recognize that there are genetic disorders, as I said, but there are also people who don’t have genetic disorders that have this happen. In fact, aortic dissection frequently’ll happen between people in the ages of 50 to 70 – more common in men than women. But often it starts with a sudden, severe pain. It’s described that people will have back pain or jaw pain or even feeling faint. They can have severe, sudden chest discomfort. Many of these symptoms can mimic other cardiovascular emergencies, and so we often tell people when they have these types of symptoms – anything concerning – they should seek medical attention.
MARTÍNEZ: Does the tear happen all at once, or is it slowly getting thinner and thinner to the point where it breaks?
PATEL: Yeah. It’s important to recognize that aortic dissection can happen along that artery in many places. When it happens in the ascending part or the first part of that artery before the branches to the head and neck, it’s the most dangerous. And that tear can happen immediately. But then, as that blood is filling behind that tear, it can slowly go forward, or it can happen faster. And depending on where it goes, you can imagine that flap causes the complications. So if it blocks the arteries to the brain, people could have a stroke. It can bleed back around the heart, unfortunately, or it can rupture and lead to severe bleeding. It’s estimated for that type of aortic dissection – that ascending or dissection at the front of the aorta – that the risk of death, unfortunately, is 1% to 2% every hour after the symptoms start.
MARTÍNEZ: OK. And who is at risk most for this condition?
PATEL: You know, it’s people that are, unfortunately, at risk for cardiovascular disease. And it’s silent. You don’t often know…
MARTÍNEZ: OK.
PATEL: …These risks. But these are people with blood pressure problems, people with arterial atherosclerosis – or a hardening of the arteries – unfortunately, people that may have been using tobacco – other things that can put you at risk for cardiovascular disease.
MARTÍNEZ: And, Doctor, one last thing, just because we live in a time when conspiracy theories can have a life of their own. Is there anything someone could have done somehow to cause aortic dissection to happen?
PATEL: You know, unfortunately, outside of the things we’ve just discussed, aortic dissection as we know it is a natural, unfortunately – although uncommon – disorder leading from these risk factors. So it’s not clear to me that there are – things could happen outside of blunt trauma. Aortic dissection is often a natural process from these hypertension or other risk factors that lead to this tear.
MARTÍNEZ: That is Dr. Manesh Patel of the American Heart Association and Duke University. Doctor, thank you.
PATEL: Thank you.
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