The death of U.S. Senator Lindsey Graham from an aortic dissection has brought renewed attention to a rare but life-threatening medical emergency that doctors say requires immediate diagnosis and treatment to improve the chance of survival.

An aortic dissection occurs when a tear develops in the wall of the aorta, the body's largest artery, allowing blood to separate the layers of the vessel wall. Bill Novak, MD, a cardiologist at OSF HealthCare, says it’s like a crack in a pipe and it can get bigger and create a tear with increased pressure, including from high blood pressure. Although uncommon, with it occurring in about 3 to 3.5 per 100,0000 people, aortic dissection can quickly become fatal if it is not recognized and treated.

“The aorta is the main artery that leaves your heart, and if you have a tear in the aorta, it can be potentially life-threatening. It can cause a heart attack. It can cause stroke. It can cause heart failure, rupture of the aorta, and sudden death.”

Many aortic dissection symptoms overlap with other medical emergencies. Actor John Ritter died after his aortic dissection was misdiagnosed and it was treated as a heart attack.

Challenge to diagnose

"It's dangerous because it's relatively uncommon," says Dr. Novak. "It can sometimes be a challenge to diagnose since a lot of the symptoms overlap with heart attack and other conditions such as pulmonary embolism, and it's obviously a potentially life-threatening type of a problem."

Diagnosis requires immediate emergency imaging such as an MRI or an echocardiogram.

Anyone experiencing sudden, excruciating pain or other unexplained symptoms to seek emergency care immediately. Dr. Novak says while severe chest or back pain is often considered the hallmark symptom, people can also experience shortness of breath, fainting, heart failure or reduced blood flow to the arms or legs.

Treatment varies depending on the location and severity of the tear. Some patients require emergency surgery, either through an open surgical procedure or an endovascular approach, while others can be managed with medications (like beta-blockers) to strictly lower blood pressure and reduce the force of heart contractions. Surgery or stent placement may be needed if complications arise.

Dr. Novak says people at the greatest risk include older adults.

Know the risks

“How old you are is important. That increases your risk. If you smoke, that’s going to increase your risk and obviously treating your cholesterol is going to reduce the chance you’re going to develop certain types of plaque in your arteries which can also put you at a higher risk for having this problem.”

Senator Graham had a history of atherosclerosis (plaque build-up), also known as hardening of the arteries.

There are other people Dr. Novak points out who need to be monitored regularly, including those with conditions such as Marfan syndrome, Ehlers-Danlos syndrome, and Loeys-Dietz syndrome which weaken blood vessel walls and are the primary cause of aortic dissection in younger individuals.

“If you do have some risk factors such as a bicuspid valve, connective tissue disease, or an aneurysm, those things do have to be monitored on a regular basis."

An aneurysm is a bulging, weak area in the wall of a blood vessel. While it can occur in any blood vessel, it most often develops in an artery rather than a vein. An aortic aneurysm is the most common type.

While aortic dissection remains relatively rare, physicians say the national attention surrounding Graham's death serves as a reminder that recognizing warning signs and seeking emergency medical care without delay can save lives. Also, family history is important. If you have a close relative who has suffered from an aortic aneurysm or sudden arterial dissection, early testing and genetic counseling can be lifesaving.

Dr. Bill Novak is a cardiologist at OSF Cardiovascular Institute in Bloomington.

Video clips with Dr. Bill Novak

At 94 years old, every day counts for Jim Bier.

The Champaign, Illinois, resident, U.S. Army veteran, and retired map-maker is able to manage things like visiting the store and strolling his backyard gardens – a space resembling the University of Illinois Japan House gardens, which Bier designed. It all comes with less chest pain and easier breathing thanks to a minimally-invasive heart procedure offered at OSF HealthCare.

“I’ve been at home, exercising, building up my legs, and I don't have the difficulties breathing like I did before all this happened back in the garden days,” Bier says. “And so I would say I'm in very good shape at this point.”

Bier pauses and adds with a chuckle, “From my waist up. I still have to work on my legs.”

Approved by the U.S. Food and Drug Administration in 2011, transcatheter aortic valve replacement, or TAVR for short, deals with a thickened aortic valve in the heart that can’t fully open. This reduces blood flow and could mean symptoms like chest pain, shortness of breath, fainting, and fatigue.

Tariq Enezate, MD, a cardiologist at OSF HealthCare Cardiovascular Institute in Urbana, Illinois, explains that the TAVR procedure begins with making a small cut near the patient’s groin. The doctor then inserts a small catheter – “smaller than my little finger,” Dr. Enezate notes – and guides it up to the heart to insert a new valve. This is opposed to the more invasive open-heart surgery, which can lead to a longer and more painful recovery for the patient. Minimally-invasive surgeries like TAVR also avoid the need to stop the patient’s heart.

“Those patients are old. They have a lot of diseases. So, many of them, they are not good candidate for surgery. And the surgery team might think they might not be in good shape and strong enough to handle the stress of open heart surgery,” says Dr. Enezate of potential TAVR patients. “In those situations, TAVR is actually lifesaving.”

For Bier, the lifesaving series of events began on Christmas Eve of 2021. By then, Bier had been dealing with heart problems for nearly a decade and had used a blood thinner after open heart surgery didn’t yield the best results. But a visit to the emergency department that day turned into a week-long stay and the question: What more needed to be done? Eventually, Bier says doctors told him about one last surgery that was needed – “the big one,” as Bier puts it. He needed a new heart valve.

An avid reader, Bier researched the TAVR procedure to allay his concerns.

“I’m a person who goes with the flow,” Bier says. “You talk to any of the nurses who've dealt with me at the hospital. They're saying all the time, ‘Go with the flow.’ That's what I kept telling them all the time. And in that way I'm pretty optimistic about it.”

Still, Dr. Enezate recognizes that even minimally-invasive heart surgery may cause stress. He says the patient’s care team – everyone from the cardiologist to the anesthesia team – meets with the patient and their family several times before the procedure.

After TAVR patients go home, Dr. Enezate explains, they eventually will enter cardiac rehabilitation to rebuild the strength needed to do the everyday activities they love. Other appointments with a provider and medications like a blood thinner are also typical.

“We have a big team of doctors, nurses, nurse practitioners, therapists, social workers, and so many people,” Dr. Enezate says. “Take care of the patient, take care of their family, answer their questions, get the tests, the procedures that they need. And after the procedure, we are on top of things.”

At OSF HealthCare Heart of Mary Medical Center in Urbana, where TAVR recently launched, that team includes Dr. Enezate, Ashraf Al-Dadah, MD, Alaa Ujayli, MD, and Kelli Lamaster, the cardiac program coordinator. Each of them undertook years of schooling and training to be able to successfully oversee operations like TAVR.

“If you asked a cardiologist 10, 20 years ago and you tell them a patient with valve replacement can go home next day, they would think that you're crazy,” says Dr. Enezate. “But now, it is reality.”

Visit the OSF HealthCare TAVR website for more information and to find a provider near you.

Interview clips - Jim Bier

B-Roll

Previous TAVR stories from the OSF HealthCare Newsroom

Mick Jagger Recovering After TAVR Procedure - April 5, 2019

Forging the Path – TAVR for Congenital Heart - December 10, 2021

New Innovations are the Heartbeat of TAVR - November 3, 2022