The American football writer Grant Wahl died last week after a catastrophic tear in a major blood vessel leading out of his heart, his family has said. Wahl’s sudden and completely unexpected death in Qatar last week shocked everyone who knew him and his journalism and triggered speculation about the reason, which included dark suggestions about retaliation by the Qatari government for a critical report that he had filed and possible links to Covid-19 vaccines. Wahl was 49 years old and healthy at the time of his death. “I really do feel some relief in knowing what it was,” Wahl’s wife, infectious diseases expert Dr Celine Gounder, told reporters after an autopsy in the United States. She was quoted as saying that Wahl probably died instantly and without feeling pain. The autopsy found that Wahl had an “ascending thoracic aortic aneurysm”, a weakening of the blood vessel that often goes undetected, The New York Times reported. As the aneurysm grows, it may produce a cough, shortness of breath or chest pain, the report said — some of which Wahl experienced while in Qatar. Preparing for UPSC? Use CRACKUPSC20 code here to get an extra 20% discount on Indian Express subscription. The condition An aneurysm is a localised weakening of the wall of a blood vessel, which causes the vessel to bulge in that area — as a result of which the vessel may widen to more than 50 per cent of its usual diameter. Aneurysms are more commonly seen in arteries than in veins. The aorta is the main artery that carries oxygenated blood from the heart to the rest of the body; it is also the body’s largest blood vessel. An aortic aneurysm is a weakening and bulging in a portion of the aorta; “thoracic” refers to that section of the blood vessel that passes through the chest. According to a note by Johns Hopkins Medicine, aneurysms occur more often in the portion of the aorta that runs through the abdomen rather than the chest (causing what is called “abdominal aortic aneurysm”). An aneurysm increases in size over time, and the wall of the blood vessel gets progressively weaker in that area. The vessel may ultimately burst or separate, triggering a bleeding rush that can be life-threatening, and potentially lethal. Causes and symptoms Among the possible causes of thoracic aortic aneurysm, the Johns Hopkins note lists (i) degenerative disease that causes breakdown of the aortic wall tissue; (ii) genetic disorders; (iii) family history; (iv) vasculitis, or inflammation of the arteries; and (v) atherosclerosis, or the build-up of plaque on the walls of the artery. In rare cases, an infection can also trigger an aneurysm. The NYT report said doctors are exploring whether Wahl had Marfan syndrome, a genetic disorder that increases the risk of this type of aneurysm. He was tall and thin and had long arms, all of which can be signs of the syndrome, the report said. The US Centers for Disease Control and Prevention (CDC) page on Marfan syndrome describes it as a genetic condition that affects connective tissue and can damage the blood vessels and cause aneurysms of the aorta. The syndrome presents in around 1 in 5,000 individuals and is caused by a mutation in the FBN1 gene that limits the body’s ability to make the proteins needed to build connective tissue, according to the CDC. The Johns Hopkins information sheet says symptoms of thoracic aortic aneurysms may depend on the location, size and speed of growth of the bulging; often, there are no symptoms at all. Symptoms, if they appear, may include (i) pain in the jaw, neck, chest, or upper back; (ii) wheezing, coughing, or shortness of breath (due to pressure on the trachea); (iii) hoarseness (due to pressure on the vocal cords); and (iv) trouble swallowing due to pressure on the oesophagus. These symptoms are not unique to thoracic aortic aneurysms, which may delay focussed medical attention. Wahl had complained of a cold in the days before he passed away. He collapsed in the press box during the Argentina-Netherlands quarterfinal match, and could not be revived. Diagnosis and treatment According to the Johns Hopkins note, a doctor may look at the patient’s medical history and carry out a detailed physical examination, including a computed tomography (CT) scan, magnetic resonance imaging (MRI), an echocardiogram (Echo), a transoesophageal echocardiogram (TEE), a chest X-ray, and an arteriogram (angiogram). Treatment may include monitoring the size and rate of growth of the bulge through an MRI or CT, and managing risk factors such as quitting smoking, controlling blood sugar (for diabetics), losing weight (if overweight), and eating healthy. Medicines may be prescribed for high cholesterol or high blood pressure. Surgical intervention may be needed if the aneurysm is large or is causing symptoms, and may include thoracic aortic aneurysm open repair (making a large incision) or endovascular aneurysm repair (EVAR), which requires small incisions in the groin. The surgery could remove the aneurysm, or insert a stent to support the blood vessel against possible rupture.
