Saturday, August 25, 2012

Aortic Dissection in the Cath Lab

Dissection in the cath lab? 
Picture courtesy of
Are they studying frogs in there?

Most people associate the word "dissect" with the lifeless little frog they cut apart and studied in biology class. An online search of the word "dissect" describes a separation or cutting apart. Whatever does this have to do with hospitals and cath labs?

If we think about our blood vessels at all, we probably think of them as simple tubes of tissue through which our blood flows. Nothing about our bodies is that simple, and these vital highways through which our blood travels are no exception. 

The aorta is the largest artery in our body. One of the wonderful things about it are the three layers that make up the wall. No doubt there are many reasons for those layers and what they do. But sometimes something goes wrong, and the inside layer tears. If that were the only layer, blood would pour out into the body, and life would end in moments. But the aorta has two more layers, the outside layer being the strongest. With that outer layer holding, there is hope. If we picture blood inside the wall, pushed under pressure as the heart beats, the blood is separating the layers of the aorta. And this is where the word dissect comes in; there is a separation of the layers of the aorta - dissection of the aorta, as described by this medscape link.

So that is it - nothing to do with frogs at all! It is a gruesome thought that our own blood, powered by our heart, is tearing apart our largest blood vessel, separating the layers of our aortic wall.

Torn Aorta Detours Through the Cath Lab
They do study something in the cath lab - typically the arteries of the heart. They are looking at these arteries to see if they have any blockage - commonly called heart disease. "Cath" stands for catheter, which is threaded into the arteries of the heart, where x-rays pictures of arteries high-lighted by dye are taken. This is the angiogram or heart cath.

But sometimes, while looking at the arteries of the heart in someone with chest pain, they may discover the heart is fine, but there is something else - a torn, bulging aorta. It is one of the most critical, dangerous discoveries in the human body - terrifying for medical professionals, patients, and families. Getting the person out of the cath lab and into the operating room is the only hope for someone with Type A dissection. Sometimes, they make it against all odds. Sometimes, they do not.

At the Bicuspid Aortic Foundation,
 we call aortic disease "the OTHER KILLER in the chest". 

Heart disease is the number one killer of both men and women. But the diseased aorta kills too. Because of the confusion with heart disease, the number of people it kills is not known. What about those deaths thought to be heart attacks, but unconfirmed by autopsy or other clear evidence?

When the aorta is torn and bleeding (dissection), there is no time to be lost. Greater awareness of the OTHER KILLER in the chest can help medical professionals, patients, and families think about and find it, ideally without taking detours to the cath lab, looking for heart disease.

Heart disease is not the only killer.

 Remember the diseased aorta,
 the OTHER KILLER in the chest.