When Catastrophe Strikes, ‘Think Aorta’

LOS ANGELES (Sept. 16, 2022) — Vascular and cardiac surgeons in the Smidt Heart Institute at Cedars-Sinai know all too well the danger that looms when a patient experiences a tear in their heart’s main artery, called an aortic dissection. The condition, however, is often mistaken by patients—and even some physicians and nurses—for a heart attack, which can delay diagnosis and subsequent lifesaving surgery.

Cedars-Sinai experts are looking to change that during Aortic Dissection Awareness Week, beginning Sept. 16. Their mission: teaching the public to know the telltale signs, risk factors and available treatment options for aortic dissections.

“Aortic dissections are often referred to as ‘the great masquerader’ because symptoms may be mistaken for other conditions such as a heart attack or stroke,” said Ali Azizzadeh, MD, director of the Division of Vascular Surgery, associate dean of Faculty Affairs and vice chair of Programmatic Development in the Department of Surgery. “If you experience severe chest or back pain, it’s imperative you go to the Emergency Department for a complete work-up that screens for aortic dissection.”

The aorta, which rises from the heart’s left ventricle—the major chamber that pumps blood out of the heart—is filled with oxygen-rich blood that travels throughout the body. When a tear occurs, blood spills through the inner layer tear and into the middle layers of the aorta, causing them to separate, or dissect. When that happens, it can deprive the body’s organs of vital blood supply.

“The mortality rate for an aortic dissection is about 1% an hour for the first 48 hours, making every second count,” Azizzadeh said. “Equally as important is seeking care, whenever possible, at a medical center with specialized, comprehensive services in treating aortic dissections.”

Cedars-Sinai has a dedicated Aortic Program within the Smidt Heart Institute, with highly specialized surgeons, cardiologists, anesthesiologists and other specialists who are on call and available to facilitate transfers from other hospitals.

“Better than treating an aortic dissection, however, is preventing it,” said Michael Bowdish, MD, vice chair of the Department of Cardiac Surgery in the Smidt Heart Institute. “Using advanced imaging techniques, we can predict which patients are at highest risk of developing an aortic dissection—then monitor and treat them appropriately. It’s the beauty of our comprehensive care approach.”

But when an aortic dissection can’t be prevented, lifesaving treatment options are at-the-ready at Cedars-Sinai. 

“The way we surgically treat aortic dissections today is vastly different than how we treated them 10 years ago, or even five years ago,” said Bowdish. “We now have minimally invasive approaches—both for endovascular and open-heart procedures—that can get patients back home within a few short days.”

One of these options is using minimally invasive endovascular stent grafts, in which Cedars-Sinai surgeons have served as leaders in the development and adoption of the technology.

“Thoracic endovascular aortic repair, known as TEVAR, is one example of a minimally invasive procedure where surgeons can reline the tear related to aortic dissection using a small puncture in the groin,” said Azizzadeh.

Despite novel treatment advances, aortic dissections still kill more Americans than road traffic accidents.

Azizzadeh and Bowdish say a person’s best defense against the condition is knowing the risk factors, which include 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.

Lifestyle risk factors can also cause an aortic dissection. These include extreme straining associated with bodybuilding, illicit drug abuse, poorly controlled high blood pressure, and in rare instances, pregnancy, especially in women with aortic aneurysms and connective tissue disorders.

But Azizzadeh says the best advice is that if you experience severe chest, back or abdominal pain, head for the Emergency Department and ask the doctors to do a work-up that screens for an aortic dissection.

Read more from the Cedars-Sinai Blog: Is It a Heart Attack? Or Could It Be an Aortic Dissection?