The Late Senator Lindsey Graham and Aortic Dissections

By Anthony Robniak, MD

Lindsey Graham, the Senator from South Carolina, reportedly spoke with others and sounded in good health just hours before his death this past Saturday night. The initial report indicated the Senator died from an aortic dissection.

What is the aorta?

In adults, the aorta is a blood vessel the diameter of a garden hose and shaped like a big candy cane. The shorter tip of the candy cane balances on top of the heart. The hook of the candy cane occurs just below the neck, and the long end of the candy cane travels down the chest and into the abdomen. There are numerous vessels branching off the aorta that direct freshly oxygenated blood from the heart to the rest of the body. The wall of the aorta is sub-divided into separate layers that lay directly onto one another.

What is an aortic dissection?

A dissection occurs when the layers of the aortic wall separate from one another. The inner layer of the wall peels away from the outer layer resulting in freely flapping tissue inside the aorta. This tissue can disrupt the normal direction of freshly oxygenated blood from the heart to the rest of the body. An aortic dissection can occur anywhere along the length of the candy cane, and the consequences are generally more critical the closer a dissection occurs to the heart.

How common are aortic dissections?

They are uncommon. Every year, there are only a few thousand new aortic dissections discovered across the US. A portion of these new dissections occur on the long end of the aortic candy cane and do not require an immediate procedure to correct. However, dissections that occur on the short end of the candy cane are relatively more common, and these do require correction. Additionally, there are certain genetic conditions that increase the risk of suffering from an aortic dissection.

Will I know if I am suffering from an aortic dissection?

Most likely. Folks who have suffered from aortic dissections in the past have often reported rapid onset of a severe pain in the chest or back. This pain typically peaked in intensity within minutes of onset. If the free flapping layer then blocks the flow of oxygen-rich blood, the downstream lack of blood supply can result in eventual numbness, weakness, chest pain, abdominal pain, light headedness, or fainting. These symptoms should prompt immediate evaluation in a hospital emergency department.

What can I do to prevent an aortic dissection?

Controlling blood pressure is the primary way to reduce your risk of suffering from an aortic dissection. If your primary care provider prescribed you a medication to reduce your blood pressure, it is important for you to take that medication as prescribed. Regular exercise, smoking cessation, and eliminating stimulant use can also help to optimize your blood pressure.

Routine primary care starting in childhood can screen for genetic risk factors that may increase the risk of developing an aortic dissection.

Anthony J. Robniak, M.D., is a second-year internal medicine resident at UNC Health Southeastern. In addition to offering services you’d expect from a community healthcare system, UNC Health Southeastern provides a number of specialized services that are unique to our system and not available anywhere else in the region. To schedule an appointment, call our referral line at 984-974-CARE. To learn more, visit UNCHealthSE.org.