Listen to Your Heart

Actors John Ritter and Alan Thicke had one thing in common besides their decades-long statuses as beloved entertainment icons. Both men died from aortic emergencies: Ritter of an aortic dissection in 2003 and Thicke of an aortic rupture last year. While these events present like a heart attack, they are drastically different and require different treatment.

When actors, musicians and other idols pass away suddenly, it’s easy for fear to creep in about the cause of death, along with grief. What happened? Is it something that can happen to me? What do I need to do to prevent it?

Dr. Tomas Martin, a private practice cardiovascular surgeon who is also on staff at Florida Hospital, discussed these aortic events in detail to shed light on what they are, who could be at risk and what you can do to protect yourself.

What is an Aortic Emergency?
The aorta is the main artery that pumps blood throughout the entire body. It begins in the breast bone (ascending aorta) and travels toward the back (aortic arch) where it reaches the spine (descending aorta) and goes down into the abdomen (abdominal aorta) where it separates into two arteries near the belly button.

Martin says two main problems can occur with the aorta: an aneurism and a dissection. Both an aneurism and a dissection can rupture, creating a life-threatening condition.

A doctor will diagnose an aneurism when an artery is 1.5 times the normal diameter, which is typically 2.5 to 3.5 centimeters in the ascending aorta and most of the aorta within the chest cavity. Aortic aneurisms can be small (4.5 centimeters) or large (Dr. Martin has seen them up to 15 or 16 centimeters), and they can occur on any portion of the aorta or along the entire aorta.

While the most common type is an abdominal aortic aneurism, Martin most commonly sees ascending aortic aneurisms as a cardiovascular surgeon. He says these types are found by sheer happenstance. “Those are found when someone gets a chest x-ray and it looks abnormal so they are sent for a CT scan,” he says.

The second type is the aortic dissection. This is a tear in the inner layer of the aortic wall that allows blood to enter the wall of the aorta. According to the American Heart Association, this new passage for blood “can rob crucial blood flow from the rest of the body, it can cause the dissection to spread and affect other arteries and can block blood flow in the true aortic channel.”
These issues caused by a dissection can weaken the aortic wall causing it to rupture, or it can lead to an aneurism.

The Symptoms and Risk Factors
Aortic emergencies present with chest pain just like a heart attack. What sets an aortic dissection apart is the shear level of pain that a patient experiences.

“The classic description is a ripping or tearing sensation in the chest,” Martin says, noting that people with this condition have symptoms and they’re usually not subtle. “A lot of women say the pain is worse than child birth.”

Since the aorta travels from the heart to the abdomen, severe pain can happen anywhere along its path. Additionally, symptoms of an aortic rupture can include clammy skin, nausea, vomiting and even shock.

According to the American Heart Association, about two-thirds of people who have an aortic dissection are male. Risk factors include high blood pressure, trauma that could cause inflamed arteries, and genetic conditions such as Loyes-Dietz syndrome and Marfan syndrome, both of which affect the body’s connective tissue.

Can it be Treated?
There are two treatment options for aortic aneurisms and dissections: surgery or medication. With surgery, the purpose is to repair or replace the injured portion of the aorta while medications work to lower blood pressure and reduce the risk for rupture.

“People need to understand that it’s a complicated problem that is best treated in larger centers, although I would go to the closest hospital,” Martin says.

Since the ascending aorta surrounds the heart, any dissection that involves this area of the aorta is considered a surgical emergency, according to Martin. This is because the mortality rate, if left untreated surgically, is so high. National statistics note the survival rate for surgical cases is 75 to 80 percent if a patient makes it to the operating room.

Aortic dissections that involve the descending aorta can typically be treated with medications. After that, there is a 95 percent survival rate with medical management in the majority of patients.

“Don’t hesitate if you’re having chest pains,” Martin says. “If you have any kind of significant, new onset of chest pain of any kind, you should go get it checked out.”

Most importantly, listen to your body. Go to the hospital, and if you’re not happy with the diagnosis, push for further tests. It was reported that Ritter was initially diagnosed and treated for a heart attack when he fell ill on set, and his dissection was not discovered in time to save his life.

So educate yourself on the condition, and if you think your symptoms are being misdiagnosed, speak up. Share your concerns and ask for a CT scan. It could save your life.

Risk Factors

Besides advanced age and genetics or family history, people with the following conditions may be at a higher risk for an aortic aneurysm or dissection.

–High blood pressure: The increased force of blood can weaken the artery walls
–Genetic conditions: Marfan’s syndrome, which causes problems in the body’s abilty to make healthy connective tissue;
–High cholesterol or artherosclerosis: A build-up of plaque may cause increased inflammation in and around the aorta and other blood vessels
–Inflamed arteries: Trauma such as car accidents, certain diseases and conditions like vasculitis can cause the body’s blood vessels to become inflamed
–Smoking: People with a history of smoking are three to five times more likely to develop an aortic aneurysm

Source: American Heart Association