Aortic Aneurysm/Dissection - 'These are the Scary Ones'
MADISON - One presents with deep, throbbing chest pain and shortness of breath. The other presents with deep throbbing chest pain and shortness of breath.
But mistaking an aortic dissection or an aortic aneurysm for a heart attack can have debilitating and deadly ramifications. That's why it's critical for patients, primary care and emergency-room physicians to understand the differences between these distinctly dangerous vascular events, but also to involve specialists who know how to treat them and limit their impact—like the vascular and cardiac surgeons at UW Hospital and Clinics.
Between 9,000 and 10,000 patients each year suffer an aortic dissection, a tear in the inner wall of the aortic artery that creates a parallel channel of blood flow, placing pressure on the artery wall and potentially causing a reversal in blood flow back towards the heart or rupturing in the chest.
Most dissections occur spontaneously, although patients with uncontrolled high blood pressure are much more likely to experience one. The actor John Ritter died of aortic dissection, and King George II, the monarch who occupied the British throne during the American Revolution, may have died of one as well.
In these cases, time is of the absolute essence— the mortality rate for unrecognized aortic dissection may be as high as 75 percent over the first 24 hours.
"Most of the time, patients come in with excruciating chest pain or back pain, so the first thing a physician is likely to think is that this person is having a heart attack," says Dr. Girma Tefera, a vascular surgeon with UW Hospital and Clinics who specializes in aortic aneurysm care. "In fact, in patients who survived dissection, up to 35 percent of the time, aortic dissection was not the first diagnosis in the emergency department."
Abdominal aortic aneurysm (AAA) is the most common type of aneurysm, a condition in which the wall of a key artery balloons and then bursts. Only half of patients experiencing an aortic rupture make it to the hospital. National statistics indicate that the overall mortality for AAA adds up to a shocking 75-80 percent.
"When you talk about minutes and seconds counting, nothing is as critical as vascular catastrophes like this," says Dr. Michael Abernethy, a flight physician who staffs UW Health's Med Flight helicopter. "These are the scary ones—people are literally dying in front of you."
Dan Wouters was one of the rare lucky ones. Last January, the Appleton native was driving back from Iowa with his wife, Nan, having just picked up a new labrador retriever puppy. Dan had been experiencing increasingly sharp back pain, when suddenly, everything went south.
"I just saw this blinding light in front of me, and everything became black on the edges, like a black-and-white photograph," Wouters recalls.
Wouters had an abdominal aortic aneurysm, and it had just begun to rupture. His wife drove him to a nearby convenience store. A few minutes later, he collapsed. Luckily for Dan, EMS volunteers at the Dodgeville Fire Department responded quickly and called UW Med Flight.
Under the care of Dr. Abernethy, Wouters was flown to UW Hospital, where a UW Health surgeon, Dr. Matthew Mell, had just enough time to surgically repair the aneurysm and save his life.
"I had fifteen minutes to get to Madison, and they got me there in 12.5," says Dan, who continues to recover from his ordeal at home with is now 10-month old puppy, Kenya. "It was very traumatic for me, but I'm so grateful. I realize that I've been given a second chance."
Physicians can quickly diagnose an aortic dissection or aneurysm with a simple CT scan. But patients can help avoid catastrophe by not dismissing symptoms like back or flank pain. Wouters' only early symptom was back pain.
Dr. Tefera recommends that people with high blood pressure or a family history of aneurysm take advantage of occasional free screenings to gauge their risk.
"This is a condition that, if it's caught in time, can be managed and treated," he says.
For more information about the vascular surgery program at UW Hospital and Clinics, call (608) 263-8915 or visit uwhealth.org/heartandvascular.
Date Published: 07/31/2008