Grant Wahl death: How uncontrolled BP can lead to an aortic aneurysm and rupture

“Aortic dissection is a medical emergency that occurs when the inner layer of a large blood vessel branching off the heart (the aorta) tears. It most commonly affects men and it is life-threatening. It’s believed that most aortic dissections are caused by an underlying vulnerability of the aortic wall that may be inherited. In others, the stress to the aortic wall from constant high blood pressure can weaken the aorta wall, resulting in a tear and dissection,” says Dr Nishith Chandra, Principal Director, Interventional Cardiology, Fortis Escorts Heart Institute, New Delhi.

“This tear or damage usually happens due to pressure or weakness inside the aorta, causing the layers to split and break the aorta wall. The other reason can be if there is an underlying condition with slow breakdown of the cells that make up the walls of your aorta. The breakdown silently goes on for many years before the weakened area of the aortic wall tears. This damage leads to blood leaking inside the body cavity and the rest of the organs are unable to receive the normal amount of blood which they need for proper functioning. Ultimately, the aorta ruptures completely. An aortic aneurysm is like a balloon in a particular area of the wall of the aorta or across the entire segment of the aorta while an aortic rupture is a complete tear through all three layers of the aorta leading to an aorta dissection,” explains Dr Bimal Chhajer, Cardiologist and Director, SAAOL Heart Centre, and former consultant at AIIMS, Delhi.

“Factors like uncontrolled high blood pressure (hypertension), hardening of the arteries (atherosclerosis), weakened and bulging artery (aortic aneurysm), an aortic valve defect (bicuspid aortic valve) or a narrowing of the aorta at birth (aortic coarctation) are known to increase the risk of aorta dissection,” he adds.

There are mainly two types of Aorta Dissection- Type A and Type B. “The first one happens closer to the heart, in the first part of the aorta, which is immediately life-threatening and needs immediate medical assistance while Type B is when the damage or tear is farther down the aorta. In these cases, surgeries are needed depending on the location of the tear and if it is or isn’t cutting off blood flow to the organs,” says Dr Chhajer.

WHY MEN ARE MORE AT RISK THAN WOMEN?

Men are much more prone to suffering from these heart conditions than women. “This is because of the difference in the structural components of the aortic wall between the sexes,” says Dr Chhajer. Studies have shown that while aortic aneurysms are more common in men, when they do happen in women, the outcomes are poorer.

SIGNS AND SYMPTOMS OF AN IMPENDING AORTA TEAR

Some signs are similar to a heart attack. “But look out for a sudden, severe chest or upper back pain, radiating to the neck or down the back, loss of consciousness, and shortness of breath. Watch out for pain, including the abdomen and the middle back. Dizziness, fainting or a sudden bout of low blood pressure are definite indicators. Acute severe chest pain, nausea, or shortness of breath, a weak pulse and sweating are also common symptoms,” says Dr Chandra.

CAN PEOPLE WITH RUPTURED AORTA SURVIVE?

“The condition can be managed with surgery only if it is done before the aorta ruptures. Less than one half of people with a ruptured aorta survive. Those who survive will need life-long, aggressive treatment of high blood pressure. Nowadays, non-surgical methods like an endovascular aneurysm repair also can be done in selected cases of tear of aorta,” says Dr Chandra. If a type A dissection shows up in CT or MRI, the patient should be operated on immediately. The highly specialised repair operation involves replacement of the aortic root with a vascular graft, reimplantation of the coronary arteries and resuspension of the aortic valve. In some cases it may be necesssary to replace the valve.

ARE INDIANS PRONE TO IT?

There haven’t been many studies done for aortic aneurysms in India in the recent past but according to studies done in the USA, almost 15,000 to 20,000 people die because of it every year.