Analysis: How aortic tears can happen

Buffalo, N.Y. (WBEN) - After learning U.S. Sen. Lindsey Graham died of an aortic tear on Sunday, some are wondering what can cause that. One local doctor says several factors come into play.

"Aortic dissection and rupture obviously is a life-threatening condition," said Dr. Linda Harris, Chief of Surgery at Kaleida Health. "If a person has an underlying aneurysm, those can also dissect and/or rupture, and that can happen from underlying atherosclerosis, which is hardening the arteries, related to smoking as well as genetics. Genetics is not something we can control; smoking is something we can control,"

Harris adds high blood pressure also plays a significant role.

"Those who have higher blood pressure are at higher risk for both of those. So when you look at the risk factors for aortic dissections, we do see them with some genetic conditions, things like Marfans, which is a connective tissue problem that has people who are very tall and very long arms and legs, and it's just their tissue is a little bit weaker in the blood vessels, so they have a higher risk of this happening," Harris explained with WBEN. "Those people who have really high blood pressure and things that can make that worse, there are some that it's just high blood pressure out of control. But if you use cocaine, that also has been shown to spike the blood pressure, we'll sometimes see in younger, otherwise healthy people who use cocaine that they'll have an aortic dissection, which can be deadly."

She says the other thing she sees it in is sometimes with extreme weightlifting, which can really increase the pressure, and that can also cause aortic dissection trauma.

Harris notes they can be detected before it's too late.

"Aortic aneurysms can be detected by suspicion. So people who are at higher risk with, if you have a family member who has an aneurysm, or who's had a dissection, or if you have a connective tissue disorder, those people who are overly flexible can be in that group as well. Then seeing your physician and making sure that they send you for appropriate testing, like ultrasounds and CAT scans, can help," Harris said.

"The aortic dissections that occur from the trauma and the high blood pressure is if you have a severe pain in your chest or back, you want to immediately get to an emergency room at a center that is capable of handling those kind of problems, which is heart and vascular. So this is not the community hospitals, which are amazing places, but you want to go to a place where you have cardiac and vascular care."

That's because there are two types.

"There's the type A, which is the part closer to the heart, and there's the type B, which is the part that's past the blood vessels to the arms and the brain," Harris said. "The type A is a surgical emergency. Within 24 hours, many people will die from that if it's not treated because the dissection or the rip can go backwards into the heart, and it can then basically cause what we call a tamponade, where the blood goes around the heart and the heart can't beat because it's compressed, or it can dissect and rip into the arteries that supply the heart, and then the heart gets starved for blood. So the the type A is a surgical emergency; they go almost immediately. The type B, which is the type that starts after the branch to the left arm, can also be emergencies at times. But most of the time, we start with medical management, which is controlling the blood pressure. If the person has uncontrolled pain, if they have evidence that it's leaking, or if they aren't getting blood flow to vital organs, and that could be to the kidneys, to the gut, to a leg, then it becomes a surgical emergency also, and we still have to go in and treat that immediately."

Harris says there are some ways you can reduce your risk.

"If you have high blood pressure, making sure it's well controlled. We can't always control, unfortunately, the diseases that we have. But if your blood pressure is 140 to over 200, that can be a problem," she said. "So if you have high blood pressure, taking your medication, checking it on a regular basis. If you have connective tissue disorders, making sure you see your physicians on a regular basis and get the right assessments. Everyone should quit smoking. That's that's very simple. It's not easy to do, and I fully understand that. But smoking has no positives and a lot of negatives for it. So those are things that we can do if people, you know, and obviously not using cocaine, and with weightlifting, I wouldn't tell people not to weightlift, but they need to be aware that if they have any severe pain, that that can be a significant problem, and can be a dissection, and potentially consider: Do you need to lift a massive amounts of weight? Or are more repetitions at a lower weight going to give you the results that you want? Because that can still provide nice muscular definition without the increased risk."