Thoracic Aortic Dissection: What To Know

Senator Lindsay Graham recently died unexpectedly from a thoracic aortic dissection, taking the world by surprise. 

Is this something you should be concerned about for your own health? You may actually have already been tested for this, even if the results were not shared with you. Here is a discussion about what an aortic dissection is, why and how it occurs, how to find out if it applies to you, and what you can do to stop it from posing danger.

Transcript

Why Dissections Make Headlines

William Davis, MD 0:00

The topic of thoracic aortic dissections has come up in the news recently because Senator Lindsey Graham recently died of a thoracic aortic dissection. So what is that? Is it important to you? Should you be concerned about for your health or the health of someone close to

What The Thoracic Aorta Does

William Davis, MD 0:16

you? Well, think of it this way: when you feel your heartbeat with a hand, say on your chest, you're feeling the left ventricle, the main pumping chamber of your heart that squeezes with each heartbeat. And every time it squeezes or contracts, it ejects blood into the aorta, the thoracic aorta. And the thoracic aorta is an ascending portion that comes from the heart, then it crosses over to the left, so-called transverse thoracic aorta, and then a descending thoracic aorta. And then it goes to the lower part of the chest and abdomen. So it's the largest artery of the body and is the recipient of the high pressure flow from your heart. So the aorta is subject to very high pressure flow. You know that value you get with the blood pressure, like 120 over 80. Well, that 120 millimeters of mercury is the pressure that your aorta is seeing. It's blood pressure. As compared to, say, venous pressure, like when they draw blood from your arm, that's from a vein, and that's very low pressure. The pressure there is maybe five, seven, or eight or ten millimeters of mercury. So aorta 120 normally or so millimeters of mercury. If you're hypertensive, it can be much higher, of course, right? 150, 160, 200 millimeters of mercury. That would, if you open an artery, you would see it squirt. It's a very high pressure system. So the aorta receives

Dissection Basics And Bicuspid Valve

William Davis, MD 1:37

this flow. Now the aorta is subject to disease, and there's several forms of disease. Now there's congenital forms and there's acquired forms. The congenital forms are much less common. That's probably not what Mr. Graham had. Do you remember John Ritter, the actor in Three's company? He probably had a congenital form, meaning two common ways that happens, two congenital forms, the least common way. One would be that you have what's called a bicuspid aortic valve. And all that means is we all have an aortic valve that opens when your left ventricle contracts. It looks like a pie cut in three pieces, or supposed to be. When you have a bicuspid valve, it looks like a pi cut in two pieces. And that's often associated with a weakness of the aortic of the aortic wall, of the connective tissue, the structural tissues of the thoracic aorta. So you can have a bicuspid valve accompanied by an enlarged thoracic aorta, and that can be subject to either dissection or aneurysm. Dissection simply means there's a little tear in the tissue-thin lining of the aorta, and blood thereby is allowed to get underneath that tissue thin layer and then travel up. It's excruciating and it can result in death within minutes to hours typically. So that's the bicuspid aortic valve with a weakness of the aortic

Tall Thin Bodies And Hidden Risk

William Davis, MD 3:02

wall. Another form of congenital aortic disease would be somebody who's really tall and skinny. Long arms that often bend excessively at the elbows. These people also often have lax other joints. They can take their thumb and put it down near their wrist. They often have uh thrown out their shoulder joints or hip joints. They tend to have a very flat chest, sometimes a little, a little concavity in the chest. We call a pectus excavatum. And that can be associated with uh aortic enlargement. And so if you know somebody who's very, very skinny, very thin, very long arms, very loose joints, that's a person who should be investigated for this. Now, those are the least common forms.

Hypertension And Aorta Enlargement

William Davis, MD 3:45

The more common form is it occurs in people with hypertension, usually, not always, but usually. And over many years of hypertension, the aorta is weakened and it enlarges. Now, a normal diameter aorta is about 3.0 centimeters. It varies depending on body size. If you are a 6'5 guy, your aorta might be 3.2 centimeters at the upper end of normal. If you are a 5'1 woman, you might be more towards 2.8, 2.9 centimeters. But you can see it kind of clusters around 3.0 centimeters. Now, here's something to know. If you had any kind of imaging study in the chest, but especially a CT heart scan or a CT scan of the chest or an MRI of the chest or an echocardiogram, all those methods you can readily see the aorta and its diameter can be measured. So an enlarged aorta is a diseased aorta. And if it's enlarged, it's much more prone to those two problems dissection or aneurysm. And when you get to about above five centimeters, typically 5.5 centimeters, the danger, uh, the risk of danger is much greater. And so typically what happens is we track the diameter of aorta, and when you get into the five-something range, you start to think about getting surgical replacement of both of the aorta, sometimes of the aortic valve.

Get Your Aorta Diameter Measured

William Davis, MD 5:08

Now, here's the thing to know though. If you had any of those imaging tests, you likely had the aorta imaged, and you want to know the diameter of the aorta, of the ascending thoracic aorta. It could be specified on the report. Let's say you had an echocardiogram, it should say aortic root, sometimes it says, and it'll be something like 3.2 centimeters, whatever. Uh or if you had a CAT scan or CT heart scan, it should specify. If it does not, you can call the center, whoever did it, if it was in the recent past, within the last few years, and ask them for that measurement. If they say we didn't, the doctor didn't measure it, say please pull it up and measure it. It's very easy. It's very easy to do. It was like checking oil in a car. It takes about a minute, okay? But people are lazy. And so you have to sometimes make a nuisance of yourself to get them to do that. Now, what if maybe they told you, didn't tell you, and your thoracic aortic diameter was 3.6 centimeters. That is, it's larger than it should be. It's not yet at the size where it poses risk to you, right, for dissection or rupture of an aneurysm. But we know that once the aorta enlarges above its normal 3.0 or so centimeters, it tends to enlarge 1 to 2 millimeters per year, or 0.1 to 0.2 centimeters per per year. So you can imagine it could be as soon as about seven to ten years, and you could have an aorta that's another centimeters larger. So if it was 3.6, now it's 4.6, and another few years, you're into the five plus range, right? Now you have a real problem on your hands. So why wouldn't they often tell you? It's been my experience that rarely are you told that your thoracic aorta is enlarged unless it achieves surgical proportions. That is, if they say, well, it's 5.5 centimeters, you need to meet with a thoracic surgeon and have your aorta replaced, which is a major undertaking with a lot of risks. Why wouldn't they tell you? Oddly, the bias in healthcare is that unless it poses an imminent danger, they typically don't tell you, which of course is silly. So what if you have somewhat enlarged aorta? It might be 3.6 centimeters, it might be 4.2 centimeters, you know it's going to get bigger by about 1 to 2 millimeters a year, 0.1 to 0.2 centimeters per year.

Food Nutrients Microbiome To Slow Growth

William Davis, MD 7:31

Well, you need to do all the things we do in my programs. That is, we eliminate the foods that trigger formation of small LDL particles. That's the stuff that adds to atherosclerosis. So that enlarged aorta typically also has atherosclerosis in its wall. And that, by the way, is a source for many strokes or strokes of unknown origin. No, it comes from the thoracic aorta. It comes from fragmentation of an aortic plaque in the ascending thoracic aorta. So we address the causes of small dense LDL particles, weak grains and sugars. We address common nutrient deficiencies that, if unless you correct them, lead to insulin resistance and inflammation that drives hypertension and atherosclerosis in the aortic wall. So vitamin D, magnesium, omega-three fatty acids, iodine. When put together, when those four nutrients are put together, they synergize to minimize insulin resistance and inflammation, the drivers of aortic disease and hypertension. And then, of course, we address the microbiome, the gastro-intestinal microbiome, by doing such things as mycebo yogurt, because we're trying to push back the invasion of fecal microbes into the small intestine as well as colon, because that results in endotoxemia, that is the entry of bacterial breakdown products into the bloodstream, a major driver of insulin resistance, inflammation, and hypertension and disease atherosclerosis. And so you can, I've done this numerous times where somebody comes in with a somewhat enlarged aorta, you can take steps to stop that process. In other words, if you if you're at, let's say, 4.2 centimeters, you can keep it 4.2 centimeters. Maybe another echocardiogram a year later, 4.2 centimeters. Another echo, another late year later, 4.2 centimeters. It's easy to do, but you have to focus on it and then track

Track With Echo And Act Early

William Davis, MD 9:24

it over time. The easiest way, of course, is an echocardiogram, an ultrasound, because there's no radiation involved. Doing repeated CT scans or MRIs is more, is it's more costly. And of course, CT scan involves radiation. So the easiest way to track this would be an echocardiogram if your aorta is enlarged. But the key here is if you had any kind of imaging study like that, get the diameter of your thoracic aorta. If it's not sighted, tell them you want it, or have, let's say, an echocardiogram done so that you can get a new, more recent measurement of your diameter of your thoracic aorta. You don't want to follow the footsteps of Lindsey Graham because you can see how catastrophic it is. Once you get to the point where you have a dissection or rupture of an aneurysm, survival is measured typically in minutes. And so you don't want to get anywhere close to that, nor do you want to have to meet with a thoracic surgeon to have it surgically corrected. It's an awful, awful, very dangerous procedure. You want to put a stop to it. You're given a crystal ball by that thoracic aortic measurement. Put it to use and you can stop it.