Senator Lindsey Graham, 71, died suddenly on Saturday from an aortic dissection, a catastrophic cardiovascular event that can prove fatal within minutes. Preliminary findings from the District of Columbia’s Office of the Chief Medical Examiner identified the cause of death as an aortic dissection due to arteriosclerotic cardiovascular disease.
An aortic dissection is a severe medical emergency where a tear occurs in the inner layer of the aorta, the body's largest artery. Blood surge through this tear can cause the layers of the aortic wall to separate, potentially disrupting blood flow to vital organs or leading to a fatal rupture. "It can come on in minutes or days and may be hard to recognize," said Dr. Marc Siegel, a Fox News senior medical analyst, who was not involved in Graham's care. He explained that the condition often manifests with sudden, severe symptoms.
Dr. Kenneth Perry, an emergency physician, likened the aorta to a hose with multiple layers. If these layers separate, akin to a tear in a hose, water pressure can cause further progression. In the aorta, he noted, this typically begins with a small tear, often exacerbated by severely elevated blood pressure, and can progress to the point where vital organs are deprived of blood. "The only way to survive such a diagnosis is very early identification and strict blood pressure control with emergent operative management," Perry stated.
The preliminary findings in Graham's case pointed to arteriosclerotic cardiovascular disease, a condition closely associated with atherosclerosis, where plaque buildup hardens and narrows arteries. This process can weaken the aortic wall over time, increasing the risk of dissection. Other contributing factors and high-risk groups include uncontrolled high blood pressure, older age, male gender, existing cardiovascular disease, aortic aneurysms, certain inherited connective tissue disorders, smoking, high cholesterol, diabetes, obesity, and physical inactivity.
Symptoms of an aortic dissection can be abrupt and may resemble those of a heart attack or stroke. Experts advise calling 911 immediately if experiencing sudden, severe chest or upper back pain described as tearing or ripping, shortness of breath, sudden severe abdominal pain, loss of consciousness, stroke-like symptoms, or leg pain and difficulty walking. "Aortic dissection is one of the diseases that emergency physicians think of often when someone presents with chest pain — specifically pain described as a tearing sensation, with elevated blood pressure," Perry said.
Early diagnosis, typically through imaging tests like CT scans or echocardiograms, and prompt treatment are crucial for survival. Type A dissections, affecting the ascending aorta near the heart, usually require emergency surgery. Type B dissections, in the descending aorta, may be managed with medication to lower blood pressure and heart rate, though surgery or stents are sometimes necessary. Without treatment, the mortality rate for acute aortic dissection is high, with the risk of death increasing significantly with each hour of delay for Type A dissections.
While not all cases are preventable, individuals can reduce their risk by managing blood pressure and cholesterol, quitting smoking, maintaining a healthy weight, and adhering to treatment plans for existing heart or vascular conditions. Those with a family history of aortic disease or connective tissue disorders are advised to discuss screening with their healthcare provider.