Michael Cartagena, age 28, woke up one morning in August 2022 with a sharp pain that started in his back and took his breath away. He knew something was wrong and asked his mom to call 911.
“When it first started happening, I thought I was having a heart attack or a stroke,” Cartagena remembers. “One side of my body was affected; I couldn’t breathe and I couldn’t move. I felt semi-paralyzed.”
The excruciating pain traveled from his back to his upper chest and down to his right leg as he waited for the ambulance to arrive. He says the pain was so intense that he could not talk and found breathing difficult. Once he arrived in the emergency department, the pain persisted and was unrelieved by any pain medications.
The emergency physicians ordered a CT scan that showed an aortic dissection, starting at the top of his aorta and traveling down into his abdomen and pelvis.
Aortic dissection occurs when there is a tear in the inner layer or lining of the aorta. This tear causes blood to leak or flow between the layers of the aortic wall. As blood enters the layers, this rush of blood causes the aorta to ‘split’ into two parts: the existing natural channel and a new false channel. If not promptly treated, the dissection can lead to complications, including reduced blood flow to vital organs, organ damage and even death.
When this artery’s inner layer or lining tears, it demands immediate attention and intervention. The risk of death increases every hour the condition is left untreated.
Cartagena was transferred to Baylor St. Luke’s Medical Center, where a team of specialists awaited his arrival. Heart surgeon Dr. Lauren Barron took him to the operating room for an emergent repair of his aorta. After almost three weeks recovering in the hospital from his lifesaving surgery, Cartagena went home to his two beautiful daughters.
Now, he is insistent that others are aware of their health. “The best advice I can give is maintaining your health. Stay alert about your health and go to the doctor for regular health checkups. If you have high blood pressure, make sure you get it under control.”
Symptoms and Risk Factors
Symptoms of aortic dissection can mimic those of other heart-related conditions, which can make it a challenge to diagnose. Aortic dissection is called “the great pretender” because of this mimicry. The most common symptom is the sudden onset of chest pain that individuals describe as sharp, tearing or ripping. Pain may also present in the neck, back or abdomen. Individuals may experience numbness or weakness in any of the limbs, which may be confused for a stroke. Pain in any of the above areas may migrate or be transient, which may lead individuals to believe the symptoms have improved or resolved. Additional symptoms include passing out (syncope), dizziness and a feeling of impending doom.
Aortic dissection is a medical emergency. If you have symptoms of aortic dissection, call 911.
Several factors can increase the risk of developing an aortic dissection, including high blood pressure, an enlarged aorta (aortic aneurysm), smoking, connective tissue disorders (such as Marfan, Loews-Dietz or other related syndromes), having a bicuspid aortic valve, having a family history of aortic dissection, aortic aneurysms or unexplained sudden death.
A computed tomography or CT scan easily diagnoses an aortic dissection. A CT scan is a diagnostic imaging technique that uses a combination of X-rays and computer technology to produce detailed images of the body, including the bones, muscles, fat, organs and blood vessels.
Barron emphasizes the urgency of treatment, saying, “Aortic dissection requires rapid evaluation and management because it is often life-threatening. Any delay in seeking medical attention can significantly impact the outcome and may result in death.”
Even if a patient’s dissection is not immediately life-threatening or severe, they will need close monitoring and will most likely need surgery later.
Surgical Intervention: How It Works
Surgery for aortic dissection typically involves one of two approaches: open surgery or endovascular repair and depends on the location of the aortic dissection.
- Open surgery: In this traditional approach, the chest is opened, and the damaged section of the aorta is replaced with a synthetic graft. The surgery is conducted under general anesthesia and the heart is temporarily stopped while a heart-lung machine maintains blood circulation. This approach allows for precise repair and replacement of the damaged aortic segment.
- Endovascular repair: Endovascular repair relies on a special device called a stent-graft, a fabric-covered metal tube. It is a minimally invasive technique, where instead of a large incision, a small incision is made near the groin, through which a catheter is threaded up through an artery and into the aorta. A stent-graft is then placed at the site of the dissection to reinforce the weakened aortic wall and redirect blood flow back into the true channel, effectively sealing off the false channel. This less invasive approach leads to shorter hospital stays and quicker recovery times.
Recovery and Outlook
Recovery from aortic dissection surgery depends on the surgical approach and the individual’s overall health. In open surgery, recovery might involve a longer hospital stay, limited physical activity and follow-up appointments to monitor progress. Endovascular repair usually offers a quicker recovery, with patients often able to resume regular activities sooner.
Either way, patients must be seen regularly (usually every three to 12 months) for follow-up imaging. This is to ensure possible changes can be caught and acted upon in a safe and timely manner. Patients will also be prescribed blood pressure medicine to help control heart rate and blood pressure.
If you have high blood pressure, you should talk to your primary care provider or cardiologist. If you have any symptoms or a sudden onset of sharp pain or suspect an aortic dissection, you should call 911.
By Brittany Rhoades, instructor and clinical nurse specialist in the Department of Surgery – Division of Cardiothoracic Surgery, and Tiffany Harston, communications associate with the Michael E. DeBakey Department of Surgery.