What Causes an Aortic Dissection? A Cardiologist Explains the Life-Threatening Condition

The recent death of U.S. Sen. Lindsey Graham from an aortic dissection has drawn renewed attention to a rare but life-threatening cardiovascular emergency that often strikes without warning.

While uncommon, aortic dissection is a medical emergency that requires immediate treatment. Dr. Constantine Monzidelis, a cardiologist at Crystal Run Healthcare, says the condition is most often linked to uncontrolled high blood pressure, though genetics, smoking and high cholesterol can also increase risk.

“It’s the large pipe that comes from your heart that sends all the blood and oxygen to your whole body,” Monzidelis said of the aorta. “At times when there’s shear stress and high blood pressure, it can actually split in two.”

A medical emergency that can affect the entire body

Unlike a heart attack, which occurs when blood flow to the heart muscle is blocked, an aortic dissection happens when the inner layer of the aorta tears. Blood forces its way between the layers of the vessel wall, creating a dangerous separation.

Because the aorta supplies blood throughout the body, the consequences can be catastrophic.

“It usually presents like the worst pain in your life,” Monzidelis said. “Crushing chest pain that usually shoots back to your back.”

As the tear spreads, it can cut off blood flow to the brain, limbs or internal organs.

“When that split happens, it can split to the brain and cause a stroke,” he said. “If it splits to your arms, your legs or other organs, it will compromise your blood flow, and it can really be deteriorating for someone’s life.”

Knowing the symptoms

Chest pain caused by an aortic dissection differs from the soreness associated with strained muscles, Monzidelis said.

Musculoskeletal pain is often tender to the touch or worsens with movement. Pain from an aortic dissection is typically severe, constant and may radiate from the chest into the back.

“It’s really pressure — like an elephant sitting on your chest,” he said. “Especially with this dissection, it really will travel from the front to the back of the body.”

Anyone experiencing sudden, severe chest pain should seek emergency medical care immediately.

High blood pressure is the biggest risk factor

Monzidelis said uncontrolled hypertension is the leading risk factor for aortic dissection because years of elevated blood pressure weaken the walls of the aorta.

“It’s just a shear tearing force that can happen,” he said. “It opens up just like a zipper.”

Most patients who experience an aortic dissection are older than 50. Younger patients are more likely to have inherited connective tissue disorders or a family history of aortic aneurysms and related conditions.

That family history is important for patients to discuss with their primary care provider, he said.

Prevention starts with knowing your numbers

Although an aortic dissection often occurs without warning, many of its risk factors are preventable or manageable.

Monzidelis encourages people to schedule regular primary care visits and monitor their blood pressure, cholesterol and blood sugar.

“Ideally we want to keep people’s blood pressure less than 130 over 80,” he said.

He called high blood pressure, diabetes and high cholesterol “the silent killers” because they often develop without obvious symptoms but significantly increase the risk of cardiovascular disease.

People with severely elevated blood pressure may experience headaches, blurred vision or lightheadedness, but many have no symptoms at all.

For that reason, Monzidelis said prevention depends on routine screening and healthy habits.

“Knowing your blood pressure numbers, knowing your cholesterol numbers, and simply doing things that will be better for your health like diet and exercise” can make a meaningful difference, he said.

Even modest activity can help.

“Just doing a 15-minute walk at the end of the day,” Monzidelis said, “can help your blood pressure drastically as well.”

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