Is It a Heart Attack? Or Could It Be an Aortic Dissection?

Los Angeles (September 20, 2021). –But the growing pain in his chest led him to a hospital near his home in Azusa, California, where he learned he had an aortic dissection, a tear in the wall of the aorta, the body’s main artery. Three major surgeries and one stroke later, Cooper found out he wasn’t fully cured. In fact, tests revealed he had developed another aneurysm. If not treated, a dissection can lead to a ballooning in the aorta, called an aneurysm, which can be fatal if ruptured.

That’s when Cooper came to Ali Azizzadeh, MD, a leading vascular surgeon at the Smidt Heart Institute.

“After all of my health issues, I needed a medical center that treated a high volume of patients and, honestly, knew what they were doing,” said Cooper, an Azusa resident who is home and recovering well from his latest surgery, in which Azizzadeh used an innovative technique pioneered at Cedars-Sinai. “Now that my heart issues are finally resolved, I can breathe a sigh of relief and focus on healing from my stroke.”

Azizzadeh, professor and director of the Division of Vascular Surgery at Cedars-Sinai and associate director of Vascular Therapeutics in the Smidt Heart Institute, said “Our team is referred some of the most complex cases from other leading centers, which continuously provides an opportunity to innovate and offer the latest and most promising techniques.”

The surgical technique used for Cooper is what Azizzadeh refers to as the Thoracic Endovascular Aneurysm Repair, or TEVAR, with a “candy plug” technique.

The method is so novel that Cooper’s recent surgery was livestreamed to over 1,200 vascular surgeons attending a recent conference in Sao Paulo, Brazil.

“As a teaching and training hospital, we are always eager to share our innovative techniques with other centers around the world, which can then use these techniques on their own patients,” said Azizzadeh.

Raising Awareness

Azizzadeh and his colleagues in the Smidt Heart Institute hope to use Aortic Dissection Awareness Week, now through Sept. 26, as an opportunity to raise awareness about aortic dissections for medical professionals and patients alike.

There are two types of aortic dissections—Type A and Type B—and they require different levels of care and expertise. Type A dissections, like Cooper experienced, are more common and require immediate open heart surgery and are extremely life-threatening, whereas Type B dissections are usually treated with medications and minimally invasive procedures.

“In many cases, the more common forms of aortic dissections are confused for heart attacks since the

 symptoms are similar—including severe chest, back or abdominal pain, shortness of breath, pain in the arms or legs, weakness or heavy sweating,” said Pedro Catarino, MD, director of Aortic Surgery in the Department of Cardiac Surgery at the Smidt Heart Institute. “It is imperative patients be diagnosed correctly, and quickly, as the death rate for aortic dissections increases 1% every hour the diagnosis and surgical repair are delayed.”

Risk Factors

Risk factors for the condition include aneurysms, a personal or family history of thoracic disease, bicuspid aortic valve disease, and certain genetic syndromes, including Marfan syndrome, Loeys-Dietz syndrome, vascular Ehlers-Danlos syndrome and Turner syndrome.

“Several lifestyle and trauma-related conditions can trigger aortic dissections,” said Catarino. “These triggers can include extreme straining associated with bodybuilding, illicit drug abuse, poorly controlled high blood pressure or discontinuing necessary blood pressure medications.”

Another rare but possible trigger for aortic dissection is pregnancy, especially for women with aortic aneurysms and connective tissue disorders. These women are at higher risk of aortic dissection during late pregnancy and delivery and should be carefully monitored by a cardiovascular specialist.

“Aortic dissections and aortic aneurysms are serious conditions with no one-size-fits-all approach to treatment” said Azizzadeh. “By seeking emergent care immediately and being cared for by an experienced team, lives can be saved. That is our ultimate hope—to get patients like Thomas back to their lives, healthier than when they first walked through our doors.”

Read more from the Cedars-Sinai Blog: The Cedars-Sinai Specialist Aortic Service and Acute Aortic Dissection