An aortic dissection, a tear in the inner layer of the body’s largest artery, is a life-threatening medical emergency that can occur with little warning.
The condition was identified as the cause of death of rugby player Hyron Andrews, following an autopsy conducted by French authorities, the Lions Rugby Company confirmed on behalf of the Andrews family.
Andrews died while on tour with the 10bet Lions ahead of their Investec Champions Cup and Vodacom United Rugby Championship fixtures.
According to the autopsy report, his death was caused by an aortic dissection, which most likely occurred on an aortic aneurysm.
French authorities described the cause of death as “a tear in the aorta (due to natural causes), which led to a significant accumulation of blood within the sac surrounding the heart”.
Dr Alexandra Lansky, director of the Heart and Vascular Center Clinical Research Program at Yale University in New Haven, Connecticut, explained that the condition is uncommon but highly lethal.
Lansky said this makes early and rapid recognition, and emergency medical care urgent.
What is an aortic dissection?
The aorta is the body’s largest artery. It carries blood from the heart to the rest of the body, arching over the heart before descending through the chest and abdomen.
The aortic wall consists of three layers. When the inner lining tears, blood can flow between these layers, creating a false channel that can restrict blood flow to vital organs.
Dr Adam W. Beck, director of vascular surgery and endovascular therapy at the University of Alabama at Birmingham, explained that the blood can also force the layers apart, causing the dissection to spread.
The outermost layer of the aorta is thin and can eventually rupture, potentially leading to fatal complications.
An aortic dissection involving the ascending aorta, the section closest to the heart, is particularly dangerous. It can deprive the heart of blood or cause blood to accumulate in the sac surrounding the heart.
According to Lansky, an ascending aortic dissection is one of the most lethal cardiovascular emergencies.
Treatment depends on where the dissection occurs. Tears in the upper part of the aorta require immediate surgery, while dissections affecting the lower, descending sections may be treated with medication, Beck said.
He is a co-author of the American Heart Association's Guideline for the Diagnosis and Management of Aortic Disease.
What causes an aortic dissection?
Aortic dissection can be associated with atherosclerosis, a condition in which plaque builds up in the arteries. However, this is not the primary cause of most aortic dissections, Lansky said.
Although aortic dissection and coronary artery disease are different conditions, they share several cardiovascular risk factors.
According to Beck, these risk factors more commonly affect the lower part of the aorta.
They include:
High blood pressure: Longstanding, uncontrolled hypertension is probably the highest risk factor, Beck said. Over time, high blood pressure can damage artery walls, even when a person does not feel unwell.
Smoking: Tobacco use is a major risk factor for atherosclerosis. A history of smoking 100 or more cigarettes over a lifetime is also a major risk factor for abdominal aortic aneurysm.
High cholesterol: Unhealthy cholesterol levels increase the risk of abdominal aortic aneurysms and other cardiovascular events, including heart attacks.
An aortic dissection can occur even in someone without plaque-lined arteries. However, atherosclerosis can increase the risk.
Who is most at risk of an aortic dissection?
Men are more commonly affected than women, Lansky said, and most aortic dissections occur in people between the ages of 50 and 70.
Family history and inherited conditions can also play a role.
Beck said about 20% of thoracic aortic aneurysms and dissections have a familial component.
Genetic conditions that increase the risk of aortic dissection in younger people include Marfan syndrome, a connective-tissue disorder.
What are the warning signs of an aortic dissection?
The hallmark symptom is sudden, severe chest or back pain, often described as tearing or ripping, or as the worst pain a person has ever experienced, Lansky said.
Other warning signs include:
Pain that moves from the chest to the back or abdomen.
Sudden shortness of breath.
Fainting.
Stroke-like symptoms, including limb weakness or difficulty speaking.
Weakness or numbness.
Loss of a pulse or differences in blood pressure between the arms.
These symptoms require immediate emergency medical evaluation.
However, many patients do not experience warning symptoms before an aortic dissection occurs. Identifying people who may be at increased risk is therefore important, Lansky said.
Anyone experiencing sudden, severe chest or back pain, particularly with the other symptoms described above, should seek emergency medical care immediately.
Can an aortic dissection be prevented?
Prevention focuses on controlling cardiovascular risk factors and identifying people who may be at increased risk of aortic disease.
1. Control high blood pressure
Aggressive blood pressure management is an important preventive measure.
Beck warned that hypertension can cause irreversible damage to artery walls over time, even when a person does not feel unwell.
2. Stop smoking
Helping smokers quit is another important part of reducing cardiovascular risk.
Beck identified tobacco smoking as a particularly significant risk factor for atherosclerosis and, consequently, aortic dissection.
3. Manage cholesterol and other cardiovascular risk factors
Managing unhealthy cholesterol levels can help reduce the risk of atherosclerosis and other cardiovascular complications.
Medications such as statins reduce the risk of atherosclerosis and may therefore also reduce the risk of aortic dissection, Beck said.
4. Know your family history and screening options
Screening can help identify certain forms of aortic disease in people at increased risk.
Ultrasound screening for abdominal aortic aneurysm is recommended for men aged 65 to 75 who have ever smoked.
Other types of scans can be used to assess people with a family history of thoracic aortic disease.
For people with inherited disorders, lifelong monitoring and specialist care with a cardiologist can significantly reduce the risk of catastrophic events, Lansky said.
Why early recognition matters
Aortic dissection is a serious condition that can develop suddenly and lead to life-threatening complications, including restricted blood flow to vital organs, bleeding around the heart and rupture of the aorta.
Although not every case can be prevented, managing high blood pressure, stopping smoking, controlling cholesterol and identifying people with inherited or familial risk factors are important parts of prevention.
seanne.rall@iol.co.za
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