CATES: Aortic dissections on the rise

By Carol A. Cates, MSN, MBA, RN

Chief Nursing Officer

Odessa Regional Medical Center

On November 14, 2006, my husband received a shocking phone call from his stepfather. He called my husband to tell him that his mother had passed away very unexpectedly and very quickly that morning. So quickly, he didn’t even have the chance to call and say they were in the hospital before she was gone. They were vacationing in St. Louis when my mother-in-law woke up in the middle of the night with sudden severe back pain. It was so bad, they called 911. When the ambulance got there, she was not just having severe back pain, she was pale, and the responding paramedics found her blood pressure was very low. They raced her to the closest Emergency Department (ED), which happened to be a very reputable teaching hospital in St. Louis with a huge number of resources. There could not have been a better place for her to go. On arrival to the hospital a cardiovascular surgeon quickly took her from the ED to the Operating Room (OR), but they could not save her. She died on the operating table. The cause was a thoracic aortic dissection. It was so shocking to us because his mom always seemed so healthy. That is the big problem with aortic dissections. The conditions that lead up to them are completely asymptomatic until the aorta dissects, and then it’s very difficult to save someone, even with the best possible resources.

Arteries are the blood vessels that carry blood from the heart to the rest of the body. The aorta is the biggest of all the arteries. It starts at the aortic valve, which is where blood exits from the heart, and runs down through the chest and into the belly. At about the level of the top of the pelvis, the aorta splits into two arteries, known as the iliac arteries. Those arteries lead down into the pelvis and then split into smaller and smaller arteries that supply the lower half of the body with blood. Before getting to the legs, up in the chest and abdomen are smaller branches that come off the aorta that supply the head, the arms, and all the organs in the belly. All arteries are made up of 3 layers of muscle. Each muscle layer runs in a different direction to give the artery walls strength as blood pulses through them at approximately 100,000 times each day. An aneurism, which is the defect that can lead to dissection, occurs when the layers of an artery split on the inside. When that happens, blood can seep in between the layers creating a pocket-like area. Because the blood can seep in, but then can’t get back out, it sits in that pocket. Blood that sits, clots. As more and more blood seeps in, that pocket gets bigger and bigger. As the pocket gets bigger, because of the blood clotted inside, it also gets heavier. Eventually, just like if you filled up a sock with rocks, the weight stretches the fabric, in this case the artery walls, thinner and thinner to the point they eventually tear. That is called an arterial dissection. It’s bad anywhere in the body because its internal, it’s difficult to stop the bleeding. Emergency surgery is the only solution. An aortic dissection is especially bad because of the sheer volume of blood that travels through the aorta. People with severe aortic dissections can lose their entire blood volume in about a minute.

According to the American Heart Association, aortic aneurisms are occurring more and more frequently in all populations over the last decade, but especially in women and in black adults. The causes and risks are the same as most heart and vascular related problems: uncontrolled high blood pressure, obesity, smoking, and diabetes. Old age is also a risk factor for aneurisms. Aneurisms for the most part have no symptoms. Aortic dissections may have symptoms of sudden, severe back pain that radiates downwards, often described as “tearing” pain, pain in the jaw, neck, shoulder or arms, and shortness of breath. Paleness, dizziness, cold sweats, and fainting can also be symptoms. If you are experiencing these symptoms, please seek medical attention immediately by calling 911.

The good news with aneurisms is we are getting much better at fixing them if we find them before the dissect. Vascular surgeons can now put a special device called a stent into the aorta that blocks off those internal pockets so they cannot keep growing to the point they rupture. Those surgeons insert the stents through a couple of small incisions into the femoral arteries in the groin. Most people only require an overnight stay in the hospital for that procedure.

The trick with aneurisms and dissections is like so many things, prevention by mitigating risk factors and early detection when we cannot prevent. Both are best done by having a good relationship with a primary health care provider and getting routine medical screenings and care. If you have any of the risks for aneurism, please speak to your primary health care provider during your next visit about your individual risks and need for additional screening.

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