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As more and more younger people are coming into our OPDs with heart attacks and sudden cardiac arrests, there is another less talked about cardiovascular threat that creeps up on us silently, namely the tear that happens in the aorta or the main “pipe” that arises from just above the heart and carries oxygenated blood from it to the rest of the body including the brain, limbs and all the organs. It is the main channel of blood flow.
The aorta is the highway to the heart but is prone to damage with uncontrollable hypertension, or undetected high blood pressure. The good part is any abnormality of the heart is easily detectable with a simple echocardiogram and chest X-ray and is preventable with the same kind of lifestyle correction that’s applicable to other heart diseases, namely controlling high blood pressure and diabetes, doing exercises, getting sleep, eating clean, giving up smoking and managing stress. The bad part is that there’s low awareness of aortic complications, which develop over time and, therefore, need to be addressed within an early window. For once the aorta ruptures, then a surgical intervention is needed real quick. The risk of fatality is 25 per cent but with every hour of delay, that risk goes up by one to two per cent every hour.
WHAT IS AORTIC DISSECTION OR TEAR?
An aortic dissection is a tear in the aortic wall. How does this happen? Uncontrolled hypertension raises the levels of cortisol in the blood which accelerate plaque deposition along the aorta walls too. Over a period of time, they get calcified and erode these walls. Now the aorta has three layers of walls. The plaque penetrates the two walls and thins them out. Remember the aorta is the highway to the heart and when it is blocked, the heart finds it difficult to pump blood and the voluminous blood pileup here ends up exerting pressure on the last wall. Sometimes at a high blood pressure of 160/100 mmHg, the accelerated blood flow just bursts through the remaining wall. This rupture is called aortic dissection, and can cause stroke and paralysis.
The loss of blood flow caused by a torn aorta means there’s less oxygen for vital organs like the brain, kidneys and the heart itself.
WHAT ARE SIGNS AND SYMPTOMS?
Patients report a sharp chest and abdominal pain, breathing difficulties, numbness in the limbs and sweating.
WHAT ARE TRIGGERS?
Poorly controlled hypertension is the main reason, which is compounded by lifestyle induced diabetes, and obesity at a young age. Most young people choose a wrong diet by ordering food from restaurants. The combination of white sugar, white bread, preservatives, additives, chemicals and processed oil end up clogging blood vessels far more quickly in younger people than older ones. Additionally, those with pre-existing connective tissue diseases, such as Marfan’s syndrome, Ehlers-Danlos syndrome and other collagen vascular disorders, are also at high risk of aortic tears. Other common risk factors include an existing aneurysm, polycystic kidney diseases or even chest trauma.
WHAT IS ANEURYSM IN THE AORTA?
When the aorta walls thin out and the blood enters to dilate and balloons it up, this pouch is called aortic aneurysm. This enlargement happens silently. If you have risk factors, a history of sudden death in the family or a family member who has had a heart valve surgery, then go for early screening. Not all aneurysms warrant open heart surgery and reconstruction with an artificial graft. I recommend an annual heart screening after 40 and every five years prior to that. Of course, the best way to prevent an aortic disease is making sure your blood pressure is well under control with WHO flagging it as a major trigger for cardiovascular diseases among Indians.
