 You may have heard recently about actor Alan Thicke’s unfortunate passing as he was out playing hockey with his son and he unexpectedly collapsed. I always loved Alan Thicke, and have so many childhood memories of watching his family grow up on Growing Pains. I always thought he looked great for his age, slim and vibrant. It may be a personal misconception, but I always assume that celebrities can afford the best medical care that money can buy. A few days later, when TMZ revealed that his cause of death was a “ruptured aorta”, I was just as surprised as most of you. “What’s that?” you may have thought, followed by “How can I prevent that from happening to me?” Did you know that John Ritter and Lucille Ball also died from an aortic dissection? It’s more common than you may think! Unfortunately, aortic rupture is an insidious disease that can sneak up on anybody. What’s even worse is that you have less than a 10% chance of survival once your aorta ruptures, 90% of people not even making it to the hospital!
Let’s first talk about the anatomy. The aorta is the largest blood vessel in your body, about an inch in diameter and a foot long. Every artery that courses through your body comes off the aorta, thus it is responsible for being the starting point of all the blood flow you have for your entire life. To give you some perspective, the aorta will pump almost three supertankers worth of blood during your lifetime! The aorta starts at your heart and goes upwards for a couple of inches, before heading straight down towards your legs and ending in your pelvis. It lives towards the back of your abdomen, sitting right on top of your spinal cord. Every artery in your body is made up of multiple layers that help it to stay strong and regulate blood flow. The aorta has three layers: a smooth surface on the inside, a muscle layer in the middle to change the diameter as needed, and an outer layer to provide structural support. This multi-layer anatomy is also the location of a lot of the disease processes that effect your aorta, or any other artery in your body. Two of the major problems that can develop in the aorta are a dissection or an aneurysm. Let’s discuss each individually. Alan Thicke, based on his death certificate, most likely had an aortic dissection. This is where the layers of the aorta tear apart from each other and, within seconds, blood enters in between, totally blocking the artery and the blood flow to all the other arteries that come from it. This tear, and the resulting occlusion of the aorta, literally develops in seconds. Unless diagnosed immediately and taken to surgery within hours, it’s usually not survivable. Most people suffer a dissection due to aging of the aorta (50-65 year olds are at the peak of the risk), atherosclerosis (buildup of plaque on the artery wall), or cocaine use. If you are experiencing a dissection, the symptoms are usually like a heart attack, with the addition of severe back pain and possibly signs of a stroke. Of course, with any heart attack like symptoms, you want to call 911 and head to the nearest hospital immediately. If a dissection is successfully diagnosed, an immediate surgery by a cardiothoracic surgeon would be performed through your chest, replacing the entire aorta with a synthetic tube (a major operation). As you can probably surmise, this is one serious diagnosis with not a lot of great options, almost always a death sentence. An aortic aneurysm is a different problem of the aorta where a section of it balloons outwards due to a weakness in one part of the wall. This weakness is caused by high blood pressure, plaque on the walls of the aorta, and sometimes genetic diseases effecting the strength of the aortic wall. Both Albert Einstein and actor George C Scott died of a ruptured aortic aneurysm (also knows as a “AAA”), where this ballooned portion of the aorta bursts and you die within minutes. Because it can develop in your body for many years and not have any symptoms what-so-ever, it’s often called the “silent killer”. If you have one, and it ruptures outside the hospital, there is about a 65% of never making it to the emergency room. Usually, a person will have severe abdominal pain radiating into their back, before they go into shock. The only treatment is, again, an emergency surgery where the aorta is replaced by a synthetic tube either placed through a major abdominal operation, or (a technologic breakthrough) via a catheter put inside your groin. All of this sounds terrible, doesn't it?! So how do you avoid getting into a bad situation with your aorta? There are approximately one million people living in the United States with an undiagnosed aortic aneurysm right now. Could you be one of them? Many aortic aneurysms are found by accident, usually on a radiologic study done for another reason. Your level of concern should mirror your risk factors for developing a disease of your aorta. If you are an elderly white male, you are at higher risk. If you are a smoker, you are creating the situation for this disease, and many others to develop. If you are overweight and have high cholesterol, or have been told you have atherosclerosis in other blood vessels, your risk is also higher for a AAA. High blood pressure is also associated with having aortic disease. If you have a direct family member with an aneurysm, you have a 15-25% of having one too (Robin Thicke, if you are reading, get to a doctor for a screening test)! So how can you check for a AAA? Sometimes the doctor can feel a pulsatile mass on an abdominal exam, but this is not likely. Really, the best way to know for certain if you have a AAA is to get a radiologic study, most likely an ultrasound. I personally had a full body ultrasound done to assess all my blood vessels at the age of 44, and plan to do so every few years as I grow older. Your personal physician may or may not agree with this approach, but ultrasound has no x-ray exposure, is very accurate, and is relatively quick and easy to perform. As we continue to live longer, healthier lives, it’s important, in my opinion, to constantly be checking for anatomic abnormalities in our vascular system that can sneak up on you undetected. An aneurysm that is detected early can be treated easier now than ever before, so why get to it when it is too late? The “intraluminal graft” procedure is done without surgery by inserting the synthetic tube in your groin and expanding it in your aorta. A relatively minimally invasive solution to saving your life. Longevity is achieved through a combination of a healthy lifestyle, avoiding risks, and early diagnosis and treatment. Aortic disease is a major area of concern in the cardiovascular system category. Use the ten tips below to assure that you don’t let yourself become a victim of this “silent killer”:
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August 2018
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