Aortic Dissections: A Ticking Time Bomb for Doctors

An aortic dissection is an emergent condition in which the inner most layer of the aorta (the large vessel that comes out of the heart) develops a a tear. The blood that is being pumped out of the heart into the aorta then passes through the tear, separating (dissecting) the inner most layer and the middle layer of the blood vessel and creating what is known as a "false lumen" (false passageway for the blood to travel). As the pressure of the blood inside this false lumen gets to be too much, the blood-filled channel will rupture through the outside wall, resulting in a catastrophic loss of blood and ultimately death. As a result, doctors are trained to recognize the hallmark signs and symptoms of a developing aortic dissection and timely treat it before it ruptures. Like most other severe processes, if an aortic dissection is diagnosed early and treated promptly, the chance of survival great improves. Patients who have chronic hypertension (high blood pressure), narrow aortas or atherosclerotic arteries (hardening of arteries) are considered to be at a higher risk of developing an aortic dissection than others.

Signs and Symptoms

The hallmark signs and symptoms of an aortic dissection include: (1) severe chest or back pain -- often described as stabbing, tearing or a ripping pain; (2) shortness of breath; (3) acute onset of weakness or paralysis on one side of your body; (4) loss of consciousness. In all hospitals, when a patient presents with the sudden onset of severe chest or back pain, doctors know there are three conditions that they must rule out first, because those conditions could kill the patient imminently. Those conditions are a heart attack, pulmonary embolism (blood clot) or an aortic dissection.

How is an Aortic Dissection Diagnosed

If a patient presents with these kinds of symptoms, physicians should immediately order what is called a Transesophageal Echocardiogram (or TEE for short), a CT Scan or an MRI. A TEE is a test that uses sound waves to create an image of the heart and the aorta. The camera is dropped down the patient's esophagus near the heart and aorta and shows whether there is a tear or not. A CT scan is less invasive, using x-rays to give the doctors a cross-sectional view of the body. Contrast (a liquid that illuminates on the CT) is injected to make the heart and blood vessels, including the aorta, more visible. Finally, an MRI may be used to make pictures of the heart and aorta using magnetic fields and radio wave energy.

Treatment

Treatment for an aortic dissection depends on the location of the tear in the aorta. For example, the aorta, which is shaped like a candy cane as it comes out of the heart, could tear in what is called the ascending aorta (the part coming out of the heart) or in the curved arch section itself. In these circumstances, the tear is called a Type A dissection and the treatment is almost always surgical repair. If the tear happens to occur in the descending aorta as it travels away from the heart (the long side of the candy cane), it is called a Type B dissection. In this circumstance, it is possible to medically treat the tear with medications such as beta blockers to reduce the heart rate and lower the blood pressure to prevent the dissection from worsening. Sometimes, however, surgery will nonetheless be necessary to prevent a catastrophic blood loss.

At STSW, our attorneys routinely handle cases in which doctors have negligently failed to timely diagnose or treat aortic dissections. In many instances, patients' lives could have been saved had doctors suspected aortic dissection and transferred the patient to a facility that could perform the surgery emergently. If you or a loved one have been the victim of malpractice stemming from an undiagnosed or untreated aortic dissection, call our lawyers for a free consultation.