Silent killer: Everything you need to know about aortic dissection

Heart and vascular surgeons operate on an aortic dissection patient

It isn’t exactly news that multiple diseases can inhabit our bodies without notice. Unfortunately, we’re doing ourselves a disservice if we only acknowledge ailments such as cancer or high blood pressure as “silent killers.” Aortic dissection, which begins as a tear in the aortic wall, also deserves a spot on that list. The often-fatal condition is blamed for more than 13,000 deaths a year in the U.S.

To mark American Heart Month, we spoke to the co-director of the University of Chicago Medicine’s Center for Aortic Diseases (UCCAD) to learn more about aortic dissection, how it’s prevented and how it’s treated. Although the disease may fly under the radar, it has been the cause of death for several renowned actors, such as Lucille Ball and John Ritter, and Broadway composer Jonathan Larson.

Q: Why isn’t aortic dissection splashed across the front pages?

A: Well, for starters, the diagnosis can be complicated. According to Ross Milner, MD, a vascular surgeon and professor of surgery at UChicago Medicine, the condition can often be confused with a heart attack or pulmonary embolus, which is a blockage in the lung. Aortic dissection, however, is the most common and most deadly catastrophe to strike the aorta, which is the body’s main artery.

“An aortic dissection is a tear in the lining of the aorta,” Milner explained. “Patients usually have severe, tearing back pain and chest pain when it first occurs.”

The loss of blood flow caused by a leaky aorta means there’s less oxygen for vital organs such as the brain, the kidneys and even the heart. The consequences can be deadly. As many as 40 percent of people who experience aortic dissection die almost instantly, and the risk of death increases by 3-4 percent every hour the condition is left untreated.

“These patients, who have excruciating pain, need to go to an emergency department immediately,” said Milner.

Q: What are the different types of aortic dissection?

A: Before we go any further, it’s important to note that there are two types of aortic dissection: type A and type B. In UChicago Medicine’s aortic program, heart surgeons – Valluvan Jeevanandam, MD; Takeyoshi Ota, MD, PhD; and Tae Song, MD – specialize in repairing type A dissections, which begin in the ascending aorta. Vascular surgeons – Trissa Babrowski, MD; Matthew Blecha, MD; Chelsea Dorsey, MD; Ross Milner, MD; Lewis Schwartz, MD; and Christopher Skelly, MD – specialize in type B and work to fix damaged blood vessels. Type B dissections occur when there’s a tear in the lower aorta.

Both types are deadly.

“The reason to treat a type A dissection immediately is that the complications of an acute aortic dissection are life-threatening,” he said. “The most common concerns are heart attack due to injury to the coronary arteries from the dissection; acute failure of the aortic valve due to the tear, which prevents blood from being pumped from the heart correctly; and rupture that causes the sac that surrounds the heart to fill with blood.”

The timeframe to treat type B isn’t any longer.

“Type B dissection also needs immediate treatment,” he said. “The first line is usually admission to an intensive care unit with aggressive blood pressure control.”

Milner
Dr. Milner with a patient

Q: Is there a way to know if you’re at risk for aortic dissection?

A: Yes. People with poorly controlled blood pressure are at the highest risk. Those with diseases such Marfan’s Syndrome (and other collagen vascular disorders) are also at high risk.

“It is very important for people with high blood pressure to comply with their medical therapy to prevent complications from high blood pressure,” Milner said.

Other common risk factors include an existing aneurysm, polycystic kidney diseases or even chest trauma that can lead to an aortic dissection.

Q: So what can you do?

A: Here is some good news: Keeping your blood pressure under control can be an important step to protect yourself.

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For over 100 years, the world-renowned clinicians and scientists at the University of Chicago Medicine have specialized in the diagnosis, care and management of all types of aortic conditions.

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Ross Milner, MD

Ross Milner, MD

Ross Milner, MD, is an internationally recognized expert in vascular surgery. He specializes in the treatment of complex aortic diseases.

Learn more about Dr. Milner