"Gradually, then suddenly." - The Sun Also Rises,
Ernest Hemingway, 1926
What is happening in the walls of our largest artery, the aorta, gradually and silently, until one day, suddenly, there is a crisis? What about the pressure on a weakened aortic wall?
My thoughts, as this September Awareness 2022 begins, are with a woman who lives in the eastern US. She began this year deeply grieving the sudden death of her husband, reviewing his medical background, and bravely seeking answers, thinking of others in their family.
Sudden Aortic Death
It is an unspeakable tragedy when a long and happy life journey together ends without warning, without even a moment for any last expressions of love.
Early in the morning, she heard the normal sounds of her husband arising, the routine start of a new day. But then, there was a great noise, the sounds of something falling on the stairs. She rushed to see what was wrong.
He never called to her, he never said her name. With her first glimpse of him, collapsed below her at the bottom of the stairs, she heard a little moan. By the time she reached him, he was already gone.
There were paramedics, but then instead of a rush to the emergency room, the wait for the medical examiner to come to their home. Yes, he is among those who never reach a hospital alive.
The medical examiner called the next day to tell her what was found by autopsy: death was due to natural causes. What were those natural causes? Cardiac tamponade due to aortic dissection. His heart could no longer beat, compressed rapidly into stillness by his own blood filling the sack around it.
Athletic, Still Active and Youthful at 80!
Throughout his life, he was healthy and very athletic, excelling in rigorous sports. He remained very active and engaged in the community in his 80th year.
He had been seeing a cardiologist for about 6 years, because of his aorta.
They were told that he did not have an aortic aneurysm, "just an enlarged aorta". His wife interpreted that as "don't worry". He faithfully had annual visits with the cardiologist over those last 6 years.
After his death, his cardiologist told his widow that his aorta had only grown one centimeter in 6 years, and was not that large. He also mentioned his age as a consideration in terms of any intervention.
Some Details
He had a trileaflet aortic valve. He had a "funnel chest" that was never corrected by surgery. There is a bicuspid aortic valve in his blood relationship.
What about his blood pressure? He was taking one blood pressure medication. He took blood pressure readings at home for awhile, and then later stopped.
What was his blood pressure during the days preceding and on the morning of his aortic crisis?
When the Thief Strikes
I hope it was some comfort to spend time with me, for her to tell me about this wonderful man so abruptly stolen from her. I think of her, together all those decades, coping through those first days, weeks, and now months without him.
There are many aortic specialty centers in that part of the United States where this family is. She cannot go with him for another opinion. The cruelty of this disease has done its worst.
She can, however, encourage their family, his living blood relatives, to seek out evaluation and care at one of them. Sadly, they now have a family history of a fatal aortic dissection to list on medical forms, due to the loss of a vibrant man, still youthful regardless of his number of birthdays.
Yes, they know now that no matter what it is called, "enlarged aorta" or "aneurysm", it can kill.
May rigorous pursuit of answers
prevent thoracic aortic disease
from gradually,
then suddenly,
doing its worst.
~ Arlys Velebir
Bicuspid Aortic Foundation
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