Among the notable figures who have died from aortic dissection are prominent American diplomat Richard Holbrooke; composer and playwright Jonathan Larson; and actor John Ritter, whose widow established a charitable foundation for aortic health in his name.

Dr. Ashish Jain, a vascular surgeon at Novant Health Heart & Vascular Institute - Elizabeth, spoke with reporters and Healthy Headlines about aortic dissection, what causes it, who’s most susceptible to it, and how to prevent it.

What is aortic dissection?

The aorta is a big blood vessel, the main blood vessel that comes off the heart and directs blood flow to the rest of the body. Think of it kind of like a pipe, and the wall of that pipe is composed of three layers. An aortic dissection occurs when the innermost lining of that wall becomes detached from the rest of the wall. So blood from the heart, in a very forceful manner, is able to extend not only through the true channel of the pipe, where it’s supposed to go, but also within the lining of the wall, where it’s not supposed to go.

That can lead to several damaging effects. The most significant are when that blood penetrating the wall of the aorta starts to approach the heart or causes a free bleed, which can lead to a very dramatic expedited demise for any patient. But blood within that false channel can also lead to things like robbing organs of essential blood flow — like the kidneys, the intestines, even the legs. So it can be a very devastating condition.

What are the chances of survival?

The NIH (National Institutes of Health) estimates around 13,000 people a year die from aortic dissections, and if you look at a lot of those patients, about 40% of them don’t even make it to the hospital before they pass. ... Of the people who do make it to the hospital, up to 15% still pass away within the first 30 days after their dissection is treated due to the morbidity and mortality associated with this terrible condition.

What causes aortic dissection?

Most people who present with aortic dissections have had a long-standing history of uncontrolled high blood pressure, and on top of atherosclerosis, which is kind of the hardening of the blood vessels related to plaque and cholesterol that develops inside blood vessels over time — years to decades. So it’s a combination of these effects that ultimately injures the inner lining of the aorta and sets up the possibility of aortic dissection.

What are the warning signs of aortic dissection?

A majority of patients we hear from describe a tearing chest pain as the first indication that they’re having trouble. It’s hard for a lot of patients to differentiate between that chest pain being related to a heart attack or something else. But what everyone basically says is that it’s their worst chest pain ever, and a lot of times, it’s described as stabbing pain that kind of radiates from the chest all the way through the back. Many patients describe sharp pain between their shoulder blades.

Sometimes it can be a little bit less obvious. Some people describe it as upper abdominal pain or discomfort that they thought might be related to acid reflux, similar to what some patients describe with heart attacks. So, although the warning signs are there, sometimes they’re very apparent. Sometimes they’re less apparent.

Time is of the essence when symptoms like this develop. It’s essential, especially for patients with a history of high blood pressure, cholesterol, smoking history, age older than 65 — if you start experiencing any of these symptoms, it’s imperative to come to the emergency department right away to be evaluated.

Unfortunately, it is described as a sudden killer. We don’t really have a lot of warning signs that a dissection is about to happen until it does, and typically, the first presenting sign is that severe, tearing chest pain that people describe.

Are there different types of aortic dissection?

There are technically two types, A and B.

A Type A dissection is when that tear in the aortic lining occurs so close to the heart that the blood permeates the layers of the blood vessel into the layers of the heart itself through the heart’s pericardium, the tissue that surrounds the heart. That’s a more immediate fatal bleed, and that can lead to things like cardiac arrest. It can lead to a true rupture where the artery starts to bleed externally into the chest, and therefore type A dissections are typically the ones that we get most concerned about.

Type B dissections, instead of traveling towards the heart, travel down the aorta toward the rest of the body, and although these are typically treated in a medical fashion — in the sense that they don’t all need emergency surgery — these can lead to emergent complications as well: Things like loss of blood flow to the intestines or the kidneys that can result in severe damage to the patient’s organs, severe acidosis in the bloodstream ... a response that can be very difficult to recover from, not only in the initial phase but even after surgery.

Who’s most susceptible to aortic dissection?

It appears that it is more common in men, by about a 3-to-1 ratio. Patients above the age of 65 are much more likely to have an aortic dissection than patients younger than that, unless those younger patients have a genetic predisposition to such things. And then certain populations, such as the African American population, have been historically described as being at higher risk for complications from atherosclerotic disease.

How can I prevent an aortic dissection?

A modifiable risk factor that’s really common, at least in the southeast, is smoking. It’s a major indicator and leading cause of vascular damage in general, and aortic dissections are more common in people who smoke.

I can't emphasize enough the importance of preventive care. Lots of people talk about surgery, and certainly surgeons like myself are around for a reason. But patients would benefit more if they didn’t have to come to us. ... I advise all patients to maintain regular visits with their primary care physician, maintain regular lab work and blood pressure checks, stay compliant with medications that are prescribed for cholesterol, diabetes, blood pressure — those are all essential in improving cardiovascular health, but also blood vessel health in general.