Aortic dissection; what is it and what do you need to know

Welcome back to the Wisconsin Live Desk here on your Monday afternoon. I want to talk as we were talking earlier today about the tragic passing of U.S. Senator Lindsey Graham over the weekend and just kind of the suddenness of it all. I know it came as a shock to many just after videos resurfaced of him less than 24 hours prior up moving around and walking. I'll show you the latest statement from President Trump posted on Truth Social earlier this morning saying, I recommended to Governor Henry McMaster Lindsey Graham's wonderful sister Darlene to serve as interim senator from the great state of South Carolina. This would be a fabulous tribute to Lindsey who loved her dearly. It is up to the governor of South Carolina at the end of the day to make that call. There is a press conference happening in just a couple hours here that we will bring to you in part live on the Wisconsin Live Desk to hopefully get more information on that front. But I want to talk about the actual disease that they realized after getting the autopsy report yesterday that caused Senator Graham's death actually and it's a form of heart disease. So I want to bring in Dr. Paul DeMusto with UW Health to just kind of talk more about this because excuse me there is the president leaving right now as we speak but there we are. But doctor I kind of want to talk about it because some people may be hearing about this specific type of condition for the first time. So can you kind of give a rundown of what it is and what type of age groups are affected? Yeah well thank you for having me on and aortic dissection as we've learned with Senator Graham's case can be a lethal problem but some of the things that can predispose people to it are high blood pressure that's particularly uncontrolled. Certain younger groups of people can have inherited connective tissue diseases such as Marfan's or Ehlers-Danlos that predispose them to this and some people can have an abnormal aortic valve in their heart that also predisposes them to something like this. Is this something that you typically diagnose or is it come on suddenly like this case with Senator Graham? Oftentimes the first time people know about any sort of this problem is when the actual event happens like with Senator Graham. This usually is kind of a silent killer if you will and people don't know or see anything wrong until the actual dissection occurs. What is the difference between this versus a heart attack if there is one? Good question. So a heart attack affects the arteries that supply blood to the heart muscle itself which causes the heart pump if you will to stop working well. An aortic dissection is the main artery leading out of the heart and so that means it's you can think of it almost like a water main break. In some cases and we don't know for sure but I would suspect in Senator Graham's case that actually obstructs the flow to the heart muscle and can lead to sudden death. I know every case has got to be different depending on who the person is but talking timeline here how quickly is it from when you have the symptoms to when you're actually having the episode? It's a good question. Usually you don't feel anything until the tear or the dissection itself occurs. There are different types or different areas of the aorta that can dissect and if it happens in more in what we call the descending thoracic aorta that runs down through your chest that oftentimes is less lethal initially and we have a little more time for treatment. If it occurs in the ascending aorta right by the heart or where the arteries that to the brain and arms come off that can be a true surgical emergency as in this case I suspect. For people who might be watching who might be concerned about loved ones or themselves what is the the typical age group or gender that might be more susceptible to having an episode like this? Yeah we typically see it sort of two age groups. Those that are particularly young oftentimes will have some abnormal connective tissue in their body and there usually are other signs of that that a person may be diagnosed with that earlier on before an aortic dissection happens and then the other group is sort of this 60 to 70 year old age group like Senator Graham where they've had potentially high blood pressure that hasn't been well controlled for a period of time or they have this abnormal heart valve that wasn't detected previous. So what can you talk more about what can be do can be done if anything to avoid having something like this happen? Yeah the biggest thing is controlling blood pressure. You know we talk a lot about that and but blood pressure control is the biggest thing that we can do to prevent something like this from happening in terms of you know the risk that people can modify. Obviously you can't change your connective tissue or your aortic valve without surgery. What are the odds of surviving something like this? I mean I know you firsthand have performed surgeries that maybe have involved these types of things. What does that look like? Yeah so the surgeries for a type a dissection which we don't know for sure but if I had to guess would be what happened in Senator Graham's case. That involves open heart surgery where we open the chest, go on the heart lung bypass and cool the patient down and replace that part of the aorta. For surgeries for the aorta farther down in the chest then that can be done sometimes endovascularly minimally invasively with stents or sometimes we have to open the chest for those as well. You had asked previously about survival and time and things and the difference in where it's at really where the dissection is versus what we call a type a in the ascending aorta or a type b in that descending part that goes down the side of the chest makes a difference. Only when a type a dissection occurs only about half the patients even make it to the hospital and I think that's what happened I had to guess in this case. For people who might have loved ones and that includes me my dad had heart failure and now has a pacemaker I think when something like this of a condition is making headlines is there anything that you would recommend people doing that could do now to maybe help prevent this? I know you had mentioned blood pressure as well but any recommendations of scans or screenings that can be done to maybe catch something like this at all? Yeah unfortunately there there really isn't the the biggest thing that we can look for or check for is whether there's an aortic aneurysm or a dilation of the aorta that also can put people at a risk of having a dissection like this and the quitting smoking is the other big thing people can do because that weakens the arteries and can lead or predispose people to this. Is there anything else that you feel like we haven't touched on that you think might be important for people watching right now to know? Well I think that you know it's sort of known for heart attacks and things that if you're having chest pain you should get it evaluated immediately. Similar for this in terms of most people describe a pain that is a tearing type pain that goes sometimes from the front of their chest to their back it's something that people have never felt before it's not like I slept wrong or lifted something wrong it's it's a definitive thing that's definitely different and to seek emergency medical attention if something like that were to occur. Otherwise quitting smoking, controlling blood pressure, if there's any sort of family history of aortic aneurysm or dissection talking with their doctor about potentially getting an ultrasound or a CT scan to look for an aneurysm that could predispose them to this. Yeah a key here seems like to act quickly if you are experiencing those feelings. Dr. Nemesto with UW Health. Thanks so much for joining us today on The Live Desk.