Aortic Dissection Explained: Lessons After Senator Lindsey Graham’s Sudden Death

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Hello, folks. Dr. Maurice Selby here, medical director, producer,
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and co-host of Health in Harlem on WHCR 90.3 FM and the Health in Harlem podcast.
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While we strive to bring you the most up-to-date, reliable, evidence-based information
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to help you live the healthiest life possible, this show does not substitute
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for an evaluation by a trained and licensed medical professional.
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It is highly recommended that any advice or recommendations on medications,
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treatments, nutrition, fitness, preventive services, etc.
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Be implemented under the guidance and supervision of your primary medical provider
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or appropriate specialist.
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With that said, we hope that you enjoy and learn from our program and please
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be sure to let us know how we can best serve you in future shows.
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Ladies and gentlemen of the listening audience. My name is Maurice Selby,
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a.k.a. Dr. Mosel. My name is Reed.
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And you're listening to Health in Harlem on WHCR 90.3 FM New York and the Health in Harlem podcast.
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And ladies and gentlemen, we have a really special program.
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I think anytime you give us an opportunity, Reed and I were discussing this,
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anytime we get an opportunity to talk about heart disease in this country,
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cardiovascular disease, We're going to take it. All right. That's it. We're going to take it.
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Unfortunately, on Saturday, July 11th, 2026, Senator Lindsey Graham was reported
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to be deceased by media outlets.
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First and foremost, while I, me personally, and just as a disclaimer,
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this is not the opinion of Health in Harlem as a whole,
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but I personally did not agree with its politics, but I think it's important
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that we observe a moment of silence for Senator Graham before we proceed.
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Now, as tragic as Senator Graham's passing was, I'm hoping that we can have
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conversations about his,
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passing and that this might spawn more robust conversations in this country,
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that allow for a healthier, a healthier political climate.
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And really just in terms of our democracy, right, healthier conversations as
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a whole that can contribute to that as far as our political climate,
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having good faith debates and or you can even call them arguments.
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Right. But in good faith in that ultimately through compromise,
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we're able to ensure that Americans have what they need to live lives that are happy and productive.
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And on this program, of course, we talk about that from the standpoint of health.
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Primarily, there is still not a lot of information about what happened with Senator Graham.
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But some things that seem to be clear at this point was that it was reported
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that there was a call for emergency assistance to assistance to Senator Graham's residents.
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It was reported that there was a complaint of chest pain, and Senator Graham
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was taken to a local hospital where he ultimately...
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Was declared deceased. Preliminary reports from the medical examiner determined
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the cause of death to be due to an aortic dissection.
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And again, very tragic as far as the loss of Senator Graham.
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Politics and all of that stuff aside.
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But again, anytime on this program, anytime we have an opportunity to talk about
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things like cardiovascular disease, heart disease, the leading killer of Americans,
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right? We're going to take that opportunity.
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And I'm pretty sure Senator Graham would have been in agreement with that,
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us talking about this topic.
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Yeah, absolutely. And I just want to add the reason why we talk about this so
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much is not only is it the number one killer, and it's such an important topic,
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but largely preventable.
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If this were something that weren't preventable or something like that,
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we probably wouldn't harp on it that much.
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But this is something that with the right information the right treatment plans,
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talking about it can be one of the main causes of prevention just getting that
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information out there sharing it with everybody that you know,
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yeah it's crazy how something like this can be,
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with proper prevention and treatment can be almost eradicated and so it's crazy
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how it continues to persist so widespread,
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and that's why we're so passionate about it because we could save or,
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not we but there could be so many lives saved just with better access to information
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better access to health care prevention literature all that kind of stuff so
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that's why we feel so passionate about it on this show and just
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across the board in this country in the medical industry.
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Facts, man. And that's the thing, Reid. I'm glad you said it,
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put it in those terms, just because it seems like something like this just happens, right?
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Like Senator Graham coming from Ukraine, and there was no indication prior that
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something was amiss, right? And it seemed like this thing just happened.
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And while in the acute sense, yes, a person just develops an aortic dissection acutely often, right?
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The vast majority of cases, this is something that does not just happen,
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right? This is something that develops over a long period of time.
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And we're going to talk about some of the things that lead to that.
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And really from the standpoint of, hey, this is something that for the vast
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majority of people is preventable.
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And that's something that I'm hoping, as difficult as it is to talk about the
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passing of someone, as difficult as it is to just talk.
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About what it takes to live a happy, healthy life in this day and age,
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in this country, there are opportunities here.
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And I'm hoping that we can leave this conversation empowered as we get into that.
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Just a couple of things that we definitely need to before we delve into our main topic.
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We need to talk about this cyclospora outbreak, a lot of updates as far as.
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Taylor Farms de Mexico on July 17th announced that they were they were voluntarily
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removing all of iceberg lettuce sourced from central Mexico from the U.S. market.
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So they initiated a recall that included market side brand products available at Walmart.
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Also, there was a good amount of
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this stuff sent to Taco Bells throughout multiple states in the country.
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And so we've seen these recalls. We've seen Taco Bell even sort of put out notices
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that they were removing iceberg lettuce from their menus in affected states.
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And and so, right, we see this thing going around is cyclospora infection.
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And this is what we were talking about last week on the program.
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Ladies and gentlemen, it's just paying attention to these bulletins as far as
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these recalls, as far as restaurants and restaurant chains that have been affected in order to avoid this.
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And again, I mean, from the standpoint, right, the bright side,
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we were talking about, yeah, this is not COVID or an equally morbid or mortal disease, right?
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Something that is causing widespread death. This is not it. But we talk about just.
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Inconvenience, to put it lightly, right? You know, really bad diarrhea and other
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GI upset, gastrointestinal upset. This could be avoided by avoiding this infection.
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So really pay attention to these advisories.
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Taylor Fresh Foods, right?
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Distributed these recalled iceberg products from June 29th through July 16th.
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There are a number of states. We'll actually put the link to the CDC advisory
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on this. So you can look at the affected states, but it is a wide range of them.
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I think they predominantly sort of narrowed it down to five states that are
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most severely affected, but I'm looking at a list of at least 20 here in which
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we need to be on the lookout for.
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And again, this is still something that is emerging as far as this information.
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And so we might see these recalls extended right to other states,
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other products, and as we said, even other restaurants involved.
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So just be on the lookout for that information.
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Yeah. And from what I understand even about the CDC test for cyclospora in the
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Taylor Farms products was that the initial positive tests turned out to be a false positive.
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So like you said, it was all voluntary recalls by Taylor Farms to take their products off the shelf.
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But as of right now, the CDC still has not had a confirmed positive test for
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cyclospora in any of their samples so continues to be out there,
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could be one huge batch of contaminated produce it could be a couple different things.
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So I think just like we said in the last show, paying attention to where your
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produce comes from, maybe buying local produce could be a bit safer.
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Cooking your food, cooking your greens, switching to maybe cutting out the salad
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and going for something, baked cauliflower or something that might be a little bit low risk.
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I think part of the difficulty with cyclospora is because of the long incubation
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period, it's really difficult to tie down to a specific thing.
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Whereas if you get food poisoning or something it's like oh okay yeah i had
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that sketchy nachos from 7-eleven last night that probably did it,
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whereas you have to think back up what did i have 10 days ago within that incubation
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time frame and another point of complication without getting too into politics
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but the cdc had a cyclospora lab they still do but it did receive very significant
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cuts with the doge cuts the department of government efficiency,
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that was led by elon musk this is probably another thing that's hampering their
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abilities to get out there and test as many samples as possible it's just their
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reduced capacities for these kinds of things.
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Yeah man another thing that's going on probably as we are recording this they
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are getting started on this There is a,
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convening of the FDA Advisory Committee Thursday, July 23rd and July 24th.
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This will be a meeting mainly to determine whether specialized pharmacies can
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produce injectable peptides, several injectable peptides that were banned by
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the Food and Drug Administration several years ago.
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This is a 19-member committee of largely pharmacists, physicians,
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and scientists that I will meet over the course of the next couple of days. And.
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There is concern that some of the experts on this panel or some of the individuals
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on this panel are members of the committee that sell or dispense peptides,
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thus presenting a potential serious conflicts of interest with respect to the
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issues to be discussed at this meeting.
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This is just one of those things that really we're talking about this on Health
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in Harlem from the standpoint, ladies and gentlemen, of peptides, right?
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On many corners of the Internet and especially on social media are all the rage.
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You see a lot of influencers sort of talking about this stuff,
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the stacks, quote unquote, that they do or the regimens that they sort of abide
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by with various peptides to achieve certain outcomes, wellness outcomes.
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Just be mindful that now it's not right to sit here and say that,
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oh, man, peptides are just, you know, evil and, you know, totally disregard
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this stuff. That's not what we're saying on Health and Harlem.
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There are peptides that are in regular use, that are part of regular pharmacologic
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therapies, things like insulin, even GLP-1 medications, right,
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such as terzepazide, ozempic,
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you know, those things. Those are peptides.
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The difference is that these are peptides that have been studied through randomized
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controlled trials, looked at for not only their primarily safety,
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first and foremost, but their efficacy, right, that they actually work and achieve
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the health outcomes that they were designed to achieve.
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Sort of lead to, right? So blood sugar control, especially with diabetes or
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even with the recent use of GOP-1s, right, for dealing with challenges in obesity and overweight.
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That's what those were, right, studied for. These peptides, these other things
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that are out there, we need to be careful because there's just not sufficient evidence.
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And I think that'll be sort of what will be hashed out today or over the next
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couple of days with this committee, right, is what is the evidence showing us?
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Are they, number one, first and foremost, safe, right?
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And especially we're talking about doling these out to compounding pharmacies
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that'll sort of be producing this stuff, right?
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What is the safety around them? What is the evidence as far as efficacy,
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right? As far as how they work and are they effective at achieving the goals, right?
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That they're designed for. That's the, those are the questions.
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That's what's going to be up for debate.
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And it's just something to be on the lookout for.
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We'll be definitely, we talked about already, like we need to devote time to this
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on Health in Harlem so that folks, regardless of what happens over the next
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couple of days with this advisory committee meeting, right, we can inform you
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all, give you information that you can make,
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really informed decisions about this.
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But it's something that I would say in general, I would be very careful with
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using any of these substances right now with the limited evidence that is out
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there as far as their safety and even regarding their efficacy or.
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You know their ability to achieve the outcomes that are desired and we've seen
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it all right read read as far as weight loss and,
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individuals using them for like muscle you know yeah anti-aging and anti-aging
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everything there's no evidence for a lot of these things.
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That people are promoting them for, sleep and all that stuff,
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like just be wary of that.
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And they come with costs too. So even outside of just safety,
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right, first and foremost, and do they actually work, but people doling out
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a lot of funds, a lot of money that can be put to other things that could achieve
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better health outcomes,
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right, and that have better evidence behind them, such as getting some good,
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running or walking shoes, right?
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If you're going to do a lot, a couple hundred dollars, maybe it's for an investment
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in a nice pair of shoes you can go out and get physical activity that'll help you with a lot of things,
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yeah just an example absolutely and i just want to echo what you said with currently
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there's no fda approved peptides i believe right.
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Well, I mean, aside from what we mentioned as far as like things like insulin,
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Ozempic or, you know, the GOP ones, those are peptides.
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So that's the thing that I think was misconstrued because some of the really
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vocal proponents of this are like, well, you know, this is this is revolutionary and we need to.
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It's like, no, nobody ever said that these things don't deserve to be studied.
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Right. Or investigated further. What we said is that right now is not sufficient evidence.
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Oh, I think what I was thinking is there's no currently FDA-approved compound
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peptides, right? They don't approve anything compounded.
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So a lot of the stuff that you're seeing for sale on websites like HIMSS or
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those sort of direct-to-consumer things where you just kind of fill out a survey
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and you get a prescription for a compounded peptide thing.
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None of that is FDA-approved. And while it may turn out in the future to be,
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useful with limited side effects, none of that is really studied.
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And so, again, it's just like a risk sort of benefit scenario.
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Whereas it really worth taking a drug that is largely untested,
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side effects unknown, long-term use unknown, for aesthetic reasons or whatever it might be.
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That's up for you to decide but I definitely lean more on the safety side of
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things so that's just where I stand with those kinds of things.
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No, I hear you, man. Be careful. That's what we're saying. And I'm really going
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to be looking at this and seeing what develops or what comes out of this committee
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meeting over the next couple of days.
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And we'll bring that to you on this program so you can make,
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again, more informed decision.
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I would not be surprised, honestly, if they came out of this.
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Now, one thing to understand is that this is not binding as far as what this committee says.
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Right. That does not mean that
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the FDA commissioner or the agency is obligated to follow that advice.
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Right. And it can even be overruled by the secretary of the Department of Health
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and Human Services, RFK, who is a proponent of these things.
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But just be wary of, again, right, making an informed decision,
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because unfortunately, and this is kind of what we alluded to,
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right, six members of this committee,
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having some conflicts of interest, even just politically, right?
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There are things that might be informing this committee or informing this decision
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ultimately of the FDA that might not necessarily be have the backing of,
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you know, the large consensus of the scientific community.
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And especially when we talk about the evidence behind them, right, might be lacking.
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So that is that's why we want you to be careful in making decisions about this stuff.
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With that said, whew, that was a lot, man. Oh my goodness. Just those two topics.
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I mean, those are shows in and of itself.
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Let's get to the topic at hand, man. Let's get to the topic at hand.
00:17:55.985 --> 00:17:57.099
We're going to start with a fist.
00:17:57.471 --> 00:18:03.106
Folks, simple enough. I think this sets up a solid analogy. So just hang on to that thought.
00:18:03.946 --> 00:18:07.516
Ball up your fist in front of you right now and just look at it.
00:18:07.516 --> 00:18:09.353
Or if you want to picture it, close your eyes.
00:18:10.086 --> 00:18:13.536
Fist is powerful. That's one thing, at least in my mind that pops,
00:18:13.536 --> 00:18:17.086
you know, if I make a random association, but just picture your mind,
00:18:17.086 --> 00:18:21.468
just the size or even before you of your fist and,
00:18:22.101 --> 00:18:25.396
take into account the size of your fist and understand, right,
00:18:25.396 --> 00:18:27.718
this is about the size of the average heart.
00:18:28.298 --> 00:18:33.196
The average heart weighs about 250 grams or so. So you can even maybe think
00:18:33.196 --> 00:18:37.615
about holding an apple or grapefruit to get an idea as to just the solid weight
00:18:38.028 --> 00:18:40.001
of our heart. And you got it right, right there.
00:18:40.576 --> 00:18:45.076
And now just, we're going to take a second to just talk about the cardiac cycle
00:18:45.076 --> 00:18:47.246
and a little bit of hemodynamics.
00:18:47.803 --> 00:18:53.482
So the heart, right, in and of itself beats about 70 to 80 beats per minute.
00:18:53.922 --> 00:18:58.216
We're talking about well over 100,000 beats per day over the course of one's
00:18:58.216 --> 00:19:02.399
lifetime, 2.5 billion beats over the course of our lives.
00:19:03.188 --> 00:19:07.728
And now let's go back to that fist, right? Because we're talking about pressure, essentially.
00:19:08.204 --> 00:19:12.006
Now, pressure is not a bad thing. It actually facilitates flow.
00:19:12.883 --> 00:19:16.156
And ideally, right, we talk about our hearts pumping, right?
00:19:16.156 --> 00:19:18.946
We need pressure in order to get blood where it needs to be,
00:19:18.946 --> 00:19:23.106
right? To our vital organs, to our periphery, right? Our muscle,
00:19:23.106 --> 00:19:26.506
our musculoskeletal system, so we can go on and do the things that we need to
00:19:26.506 --> 00:19:27.951
do in our day-to-day lives.
00:19:28.590 --> 00:19:31.996
And especially when we talk about nourishing our vital organs,
00:19:31.996 --> 00:19:36.945
so our heart, brain, kidneys, right? Pressure is not a bad thing,
00:19:37.189 --> 00:19:41.653
right? This allows us to carry on our vital functions in our bodies.
00:19:42.448 --> 00:19:46.128
And we think about the aorta, right, the topic of this program,
00:19:46.604 --> 00:19:50.139
it is held under constant tension as it carries blood from the heart.
00:19:50.627 --> 00:19:54.634
And depending on the needs of our body, right, it can even auto-regulate, right?
00:19:55.114 --> 00:19:58.597
It is an elastic vessel, has multiple layers.
00:19:58.708 --> 00:20:04.338
If we imagine a garden hose, right, you have an inner lining or the core layer, right, an inner tube.
00:20:04.901 --> 00:20:08.959
You also have a reinforcement layer, right, which is usually a sort of a mesh
00:20:09.389 --> 00:20:12.326
or polyester line or nylon fibers, right?
00:20:12.912 --> 00:20:16.436
Typically arranged in an array to give support to that.
00:20:16.953 --> 00:20:21.770
And then finally, we have sort of an outer layer that provides protection,
00:20:22.129 --> 00:20:25.711
right, for the hose as a whole, garden hose as a whole.
00:20:26.471 --> 00:20:29.484
But thinking about it, right, the pressure subjected to, you can't just have
00:20:29.484 --> 00:20:33.994
a solid tube or a simple tube because, right, it'd be more prone to rupture.
00:20:33.994 --> 00:20:38.261
It might not be as elastic if it were just like, let's say plastic that it was made out of.
00:20:38.824 --> 00:20:44.343
And so we have this multi-layered hose that allow us to sort of water our garden,
00:20:44.837 --> 00:20:49.076
and carry out other sort of home care things, right?
00:20:49.668 --> 00:20:51.914
But then we think about the layer of our arterial system, right?
00:20:51.914 --> 00:20:55.674
And we're talking about something that is, right, multi-layered, right?
00:20:55.674 --> 00:20:58.354
And there's a purpose for that because it carries out different functions.
00:20:58.354 --> 00:21:03.004
So the layers of our arterial system are very similar in that we have an intimal
00:21:03.004 --> 00:21:08.294
layer composed of cells that are very closely aligned or approximated there, right?
00:21:08.294 --> 00:21:12.274
Think intimate, Right. When we think of the intima, something is very close
00:21:12.274 --> 00:21:17.244
and it even keeps things within it. Right. Such as our blood volume circulating
00:21:17.244 --> 00:21:19.034
throughout the body, even keeps
00:21:19.034 --> 00:21:22.168
things out of it, such as contaminants and stuff from the environment.
00:21:22.901 --> 00:21:27.017
And then we think about the media layer, right? So this is the sort of middle layer.
00:21:27.452 --> 00:21:36.032
It is very much composed of smooth muscle that facilitates blood flow in our circulatory system.
00:21:36.032 --> 00:21:41.062
And so this smooth muscle can contract and lessen the diameter of those blood
00:21:41.062 --> 00:21:45.274
vessels, right? And increase the pressure to distribute blood throughout our bodies.
00:21:45.535 --> 00:21:51.232
They can also relax, right? And also decrease our blood pressure through that.
00:21:51.232 --> 00:21:54.862
But again, to facilitate the movement of blood throughout our bodies to nourish
00:21:54.862 --> 00:21:56.971
our cardiovascular system.
00:21:57.525 --> 00:22:02.349
And then finally, we have the adventitial layer or the tunica adventitia,
00:22:02.599 --> 00:22:05.995
which is mostly a lot of connective tissue.
00:22:06.215 --> 00:22:11.706
There's a lot of collagen and elastin in that layer to allow flexibility of those blood vessels.
00:22:12.125 --> 00:22:16.352
And then also there are blood vessels in that, microscopic blood vessels that
00:22:16.352 --> 00:22:22.522
supply nourishment to the blood vessel itself, in addition to nerves that are in that layer that.
00:22:24.062 --> 00:22:30.282
Allow our bodies to communicate, our brains to communicate to the smooth muscle
00:22:30.282 --> 00:22:35.914
on whether to constrict or to dilate in order to facilitate blood flow throughout the body.
00:22:36.601 --> 00:22:41.252
And we can go on, man. We can have a whole show where we're just talking about,
00:22:41.732 --> 00:22:44.610
hemodynamics and blood flow throughout the body.
00:22:44.954 --> 00:22:50.562
But one of the things to really understand, the organ itself is an incredible organ, right?
00:22:50.956 --> 00:22:57.959
It is the most elastic portion of our circulatory system, the arterial system.
00:22:58.401 --> 00:23:01.232
And that is really because it needs to accommodate the blood flow that's coming
00:23:01.232 --> 00:23:04.632
from the heart, that is being pumped from the heart, right? And direct that
00:23:04.632 --> 00:23:06.580
blood to our vital organs, right?
00:23:06.899 --> 00:23:10.552
Sending it up to our brains to provide nourishment for our neurons so that we
00:23:10.552 --> 00:23:18.172
can think, we can carry out our, you know, automatic functions such as breathing, right?
00:23:18.172 --> 00:23:21.842
But also those things that we do voluntarily, such as, you know,
00:23:21.842 --> 00:23:26.240
moving around, walking around, manipulating our environment in space.
00:23:26.870 --> 00:23:31.712
But then also it has to get that blood to our other organs, right,
00:23:31.712 --> 00:23:36.204
to our gastrointestinal system, shunting that blood down to our extremities
00:23:36.529 --> 00:23:41.620
so that we can move around, really just carrying out all of the vital functions of our body.
00:23:42.857 --> 00:23:45.684
This is what our aorta is designed to do.
00:23:46.281 --> 00:23:50.452
And the fascinating thing is, right, as we said, pressure is not a bad thing,
00:23:50.452 --> 00:23:54.165
folks, right? This is what allows our bodies to redistribute blood,
00:23:54.803 --> 00:23:59.312
but there is a limit to that, right? And that's what we're going to get into.
00:23:59.652 --> 00:24:04.152
Kind of what Reed alluded to earlier is that a lot of the complications that
00:24:04.152 --> 00:24:07.562
we see when we talk about somebody having an aortic dissection,
00:24:07.562 --> 00:24:12.173
we are talking about, right, an endpoint, if you will.
00:24:12.832 --> 00:24:17.726
Right? You didn't just wake up with an aortic dissection one day,
00:24:17.726 --> 00:24:20.251
you know, just randomly somebody develops that.
00:24:20.530 --> 00:24:24.296
In very, very few instances, that's the case. We're talking about something,
00:24:24.296 --> 00:24:29.046
right? A disease that builds up over time that ultimately makes you more prone
00:24:29.197 --> 00:24:31.014
to developing a complication like this.
00:24:31.368 --> 00:24:36.772
And unfortunately, when you reach that stage, right, we're at a point where,
00:24:37.370 --> 00:24:39.786
I'm not going to say very little can be done for you, but we're talking about
00:24:39.786 --> 00:24:44.490
a serious complication that can not only be life-threatening,
00:24:44.989 --> 00:24:47.726
but even if you survive, we're talking about something that could lead to serious,
00:24:48.266 --> 00:24:50.277
disability and something that,
00:24:51.366 --> 00:24:56.516
the vast majority of cases we can entirely avoid by paying attention to some
00:24:56.516 --> 00:25:01.366
of the things that we talk about week in, week out on this show with regards to prevention.
00:25:02.545 --> 00:25:05.766
That's one of the things that we need to get to. Yeah, absolutely.
00:25:05.766 --> 00:25:08.900
And like you said, pressure is not a bad thing. In fact, it's a good thing.
00:25:09.300 --> 00:25:13.406
It's usually the inability to withstand that pressure that causes issues.
00:25:13.406 --> 00:25:17.206
So we'll talk about it in a little bit, but things like hypertension,
00:25:17.206 --> 00:25:23.326
atherosclerosis that affects the ability of the aorta and other components within the,
00:25:23.926 --> 00:25:30.175
circulatory system to expand and contract like it needs to, that's when you run into some issues.
00:25:30.628 --> 00:25:34.566
But let's talk about the topic at hand, aortic dissection. So it's pretty,
00:25:35.226 --> 00:25:38.586
from a comforting level, it's a pretty rare condition, but it's caused by the
00:25:38.586 --> 00:25:39.956
tearing of the aortic wall.
00:25:39.956 --> 00:25:42.714
It's life-threatening and requires immediate medical attention,
00:25:43.190 --> 00:25:48.206
but in terms of rarity, in cases per million people per year,
00:25:48.206 --> 00:25:50.957
it only accounts about 5 to 30 cases.
00:25:51.549 --> 00:25:57.296
For ER visits, specifically ER visits about acute abdominal chest or back pain,
00:25:57.296 --> 00:26:01.493
aortic dissection accounts for about 3 in 1,000 visits.
00:26:01.940 --> 00:26:07.895
So these are people already going to the ER for specifically abdominal chest or back pain.
00:26:08.179 --> 00:26:12.086
A lot of that time, it tends to be cardiovascular. It could be a lot of other
00:26:12.086 --> 00:26:17.554
things, but aortic dissection is only about 3 in 1,000 visits of those kinds of cases.
00:26:18.106 --> 00:26:21.937
Real quick read. I say, thank God. Yeah, I can imagine.
00:26:22.320 --> 00:26:28.596
As an ER doc, man, this is one of those things like you want to get an ER doc's attention. Right.
00:26:29.296 --> 00:26:33.656
This is this is one of those diagnoses to mention or to write.
00:26:33.656 --> 00:26:37.987
Think about it like you. You mentioned this to any emergency room physician,
00:26:38.272 --> 00:26:42.476
you know, physician assistant, nurse practitioner, even nurses that are caring
00:26:42.476 --> 00:26:45.412
for patients that that suffer this complication.
00:26:45.876 --> 00:26:47.322
Right. This diagnosis.
00:26:47.856 --> 00:26:51.686
Right. This is hair raising on all levels. I mean, not only for the patients
00:26:51.686 --> 00:26:55.266
coming through, because we're talking about, you know, at least the way it's
00:26:55.266 --> 00:27:00.238
been described to me by patients, right, is, you know, the worst pain imaginable.
00:27:00.610 --> 00:27:04.439
And just thinking about tearing, you know, tearing discomfort,
00:27:04.915 --> 00:27:08.014
you know, 10 out of 10 pain in severity.
00:27:08.281 --> 00:27:09.768
This is what patients describe.
00:27:10.371 --> 00:27:13.476
Not every patient, because there are some more subtle presentations.
00:27:13.476 --> 00:27:17.906
I always teach our resident physicians and medical students.
00:27:17.906 --> 00:27:22.808
I'm like, you know, this is one of those illnesses that typically present atypically,
00:27:23.359 --> 00:27:25.716
meaning sort of the way it's described in textbooks.
00:27:26.099 --> 00:27:29.516
You know, patients coming in, tearing chest pain as radiating to their back
00:27:29.516 --> 00:27:32.815
or moving to their back. Not everybody comes in like that.
00:27:33.332 --> 00:27:37.726
Right. And they can have variable presentations or variable signs and symptoms.
00:27:38.133 --> 00:27:41.372
But this is something that, you know, is not only scary for patients,
00:27:41.819 --> 00:27:43.506
but the providers caring for these
00:27:43.506 --> 00:27:47.421
patients really because we know how devastating it could be, you know.
00:27:48.182 --> 00:27:54.109
Yeah, absolutely. Like you said, signs and symptoms, typically chest pain, tearing or ripping.
00:27:54.486 --> 00:27:59.212
But it's often severe, not always. Like you said, it can even manifest as kind
00:27:59.212 --> 00:28:04.945
of pain in the back, might even be abdominal pain, neck pain, maybe even a headache.
00:28:05.352 --> 00:28:09.485
So it's not super clear. Sometimes it can masquerade as a heart attack.
00:28:09.839 --> 00:28:14.227
It might not be super clear exactly what it is. But I think.
00:28:14.956 --> 00:28:19.334
With everything taken into account, the signs and symptoms, I think it's also
00:28:19.334 --> 00:28:22.717
important to know who is most at risk for these kinds of things.
00:28:23.100 --> 00:28:27.697
So about 75% of cases occur in those aged 50 to 65 years.
00:28:28.098 --> 00:28:30.345
I think Lindsey Graham was just over 70.
00:28:30.867 --> 00:28:34.153
So a little bit past that age range, but right around there.
00:28:34.513 --> 00:28:37.323
Male gender is the majority of people.
00:28:37.729 --> 00:28:42.504
Those with a history of hypertension atherosclerosis cardiac surgery and connective
00:28:42.504 --> 00:28:47.454
tissue disorders other risk factors include high cholesterol cigarette smoking
00:28:47.774 --> 00:28:52.274
drug use that kind of stuff especially things like cocaine or what we call,
00:28:52.794 --> 00:28:55.254
sympathomimetics yes it can also be,
00:28:55.854 --> 00:29:00.794
the onset of it can be associated with maybe physical exertion leaning down
00:29:00.794 --> 00:29:04.054
to pick up something heavy exercising very heavily,
00:29:04.554 --> 00:29:07.018
weightlifting, that kind of stuff, but not always.
00:29:07.488 --> 00:29:11.848
From what I understand, Lindsey Graham had just gotten home from an overseas trip.
00:29:12.266 --> 00:29:15.794
And so I don't know what he was up to. Maybe he was making his bed,
00:29:15.794 --> 00:29:19.377
moving his mattress around something, but maybe he was just hanging out and sitting down.
00:29:19.806 --> 00:29:22.906
So it's not always associated with physical exertion, but it can be.
00:29:23.522 --> 00:29:28.994
As well as, yeah, just a family history is, I think, one of the most important
00:29:28.994 --> 00:29:31.324
things in these kinds of cases as well.
00:29:31.324 --> 00:29:33.878
And one of the most important things when it comes to prevention,
00:29:34.267 --> 00:29:37.984
knowing your family history of these kinds of things, family history of heart
00:29:37.984 --> 00:29:40.397
attacks, stroke, cardiovascular disease.
00:29:40.774 --> 00:29:45.014
Looking at Lindsey Graham's family history, his parents both died when he was
00:29:45.014 --> 00:29:47.102
20 or when he was in his 20s.
00:29:47.525 --> 00:29:51.934
His mother died of Hodgkin's lymphoma. His father died at age 68,
00:29:51.934 --> 00:29:53.673
I believe, of a heart attack.
00:29:54.033 --> 00:29:57.654
And so this is the kind of thing where if you know your family history and you're
00:29:57.654 --> 00:30:02.854
paying close attention to it, getting checked out from an earlier age and getting
00:30:02.854 --> 00:30:06.974
continual checkups, I think, can play a large role in prevention of these kinds
00:30:06.974 --> 00:30:08.997
of disastrous incidents.
00:30:11.044 --> 00:30:15.218
And especially when we talk about the connective tissue disease component of this reed,
00:30:15.847 --> 00:30:21.367
just because those typically, and we're talking about things such as Marfan's
00:30:21.707 --> 00:30:24.297
syndrome, Ehrlich-Danlos syndrome,
00:30:24.825 --> 00:30:30.467
basically syndromes that are heavily influenced by genetics, right?
00:30:30.467 --> 00:30:36.497
So familial syndromes that can literally change the composition of these blood vessels, right?
00:30:36.497 --> 00:30:40.545
As we said, this multilayered system, the intimal, medial layer,
00:30:40.905 --> 00:30:44.907
and the tunica adventitia could change the composition of those vessels to make
00:30:44.907 --> 00:30:47.888
them more prone to weakening in areas,
00:30:48.266 --> 00:30:51.795
aneurysms developing, and ultimately to things like aortic dissection.
00:30:52.219 --> 00:30:56.747
But we mainly know that through family history. Now, in each of those syndromes,
00:30:56.747 --> 00:31:00.957
there are other things, other characteristics to look out for that can maybe
00:31:00.957 --> 00:31:03.822
hint at somebody having a disorder like that.
00:31:04.170 --> 00:31:09.637
But again, just knowing that family history can be vital, not only for making
00:31:09.637 --> 00:31:13.607
a diagnosis like this, but even right before we even get to the point of diagnosis,
00:31:13.607 --> 00:31:16.087
how do we prevent individuals from having this.
00:31:17.027 --> 00:31:22.816
Complication, even if they do have some some things that make them more predisposed to developing it?
00:31:23.251 --> 00:31:28.876
Right. If you have, let's say, Marfan syndrome, you know, maybe this is something that through,
00:31:29.323 --> 00:31:35.637
surveillance, right, keeping an eye on any aneurysmal or dilated or widened
00:31:35.637 --> 00:31:38.425
segments of the aorta, right, we can reduce,
00:31:38.930 --> 00:31:42.617
the complication of somebody developing an aortic dissection.
00:31:42.930 --> 00:31:46.663
And that's where, as Reed said, right, sort of that regular...
00:31:47.266 --> 00:31:52.512
Care that an individual receives through a primary care physician or a primary
00:31:52.512 --> 00:31:53.726
care provider, whether it's,
00:31:54.208 --> 00:31:58.898
a physician assistant, a nurse practitioner, somebody that you see on a regular basis,
00:31:59.380 --> 00:32:04.202
that makes sure, right, you are staying healthy, that makes sure they are screening
00:32:04.202 --> 00:32:10.160
appropriately for illnesses like this, including the predisposing factors such as hypertension.
00:32:10.992 --> 00:32:15.083
Hypercholesterolemia, those things, right, that is paramount.
00:32:15.245 --> 00:32:16.720
That is of paramount importance.
00:32:17.010 --> 00:32:19.506
And we talk about preventing illnesses like this.
00:32:20.114 --> 00:32:23.835
And I just want to just take a second to talk about, right, the long-term exposure,
00:32:24.341 --> 00:32:29.972
to just high pulsatile pressure and how that can lead to the development of this.
00:32:29.972 --> 00:32:35.324
And we said, right, we're talking, you know, more than 100,000 beats per day of our heart.
00:32:35.672 --> 00:32:41.918
We're talking about over the course of one's lifetime, billions, right, of heartbeats.
00:32:42.295 --> 00:32:48.025
And our arterial system being subjected to that constant pressure over the course of a lifetime.
00:32:48.553 --> 00:32:52.482
So going back to our fist, right? Just thinking about it, I got to create a
00:32:52.482 --> 00:32:58.032
sound effect for this read other than my fist like this, but we can do this
00:32:58.032 --> 00:32:59.063
and just think about, right?
00:32:59.872 --> 00:33:04.712
The walls of our arterial system, the aorta being constantly subjected to that
00:33:04.712 --> 00:33:07.898
pressure over time. And for the most part, right?
00:33:08.327 --> 00:33:10.905
Just again, our...
00:33:11.517 --> 00:33:15.766
Aorta being a very compliant portion of the circulatory system,
00:33:16.079 --> 00:33:22.164
right, with that elastin, the collagen that is embedded in those layers of the
00:33:22.164 --> 00:33:24.824
aorta, right, it can handle that pressure.
00:33:24.824 --> 00:33:28.954
It is designed to accommodate that pressure and redistribute it in order to
00:33:28.954 --> 00:33:31.974
get blood throughout our body, our circulatory system.
00:33:32.438 --> 00:33:35.462
But like we know, right, everything kind of has a limit.
00:33:36.020 --> 00:33:41.418
And eventually from long-term exposure to high pulsatile pressure.
00:33:41.830 --> 00:33:44.144
So meaning, right, we are in the
00:33:44.144 --> 00:33:49.834
realm of high blood pressure that is uncontrolled for a long time, right?
00:33:49.834 --> 00:33:55.124
We talk about eventually, right, this high pressure, sheer stress being exerted
00:33:55.124 --> 00:33:57.284
on the aortic walls leading to,
00:33:57.804 --> 00:34:03.754
damage and eventual weakening, right, of that blood vessel that leads to things
00:34:03.754 --> 00:34:08.484
like mucoid accumulation, So literally mucus and inflammation developing in
00:34:08.484 --> 00:34:11.619
the arterial walls, resulting from that constant,
00:34:12.147 --> 00:34:15.074
bombardment with those high pressures, right?
00:34:15.074 --> 00:34:17.814
We talk about changes in the smooth muscle layers, right?
00:34:17.814 --> 00:34:22.434
And dysfunction in those smooth muscle layers that lead to the generation of
00:34:22.434 --> 00:34:24.104
that smooth muscle, right?
00:34:24.104 --> 00:34:28.984
And the loss of the ability to control the diameter of those blood vessels and
00:34:28.984 --> 00:34:32.865
how it accommodates that stress that is being subjected to constantly,
00:34:33.237 --> 00:34:35.594
right? from that pressure.
00:34:36.238 --> 00:34:41.672
And then we also talk about fibrosis developing, right, in those vessels.
00:34:42.107 --> 00:34:46.424
And ultimately, the vessel wall is becoming more stiff and, again,
00:34:46.424 --> 00:34:51.624
less compliant and less able to accommodate the pressures that it is being subjected
00:34:51.624 --> 00:34:54.714
to, especially when we talk about high blood pressure.
00:34:54.714 --> 00:34:59.318
And ultimately, we end up with a situation where there is so much damage,
00:34:59.653 --> 00:35:04.355
right, and eventual weakening of those layers that the vessel can tear,
00:35:04.918 --> 00:35:10.957
leading to a, what we call a false lumen or tract that develops and ultimately can be catastrophic.
00:35:11.252 --> 00:35:15.664
Everything from, right, loss of blood volume in these layers and not able to
00:35:15.664 --> 00:35:17.388
get blood to our vital organs.
00:35:17.788 --> 00:35:22.534
But we also talk about complications such as things like cardiac tamponade,
00:35:22.534 --> 00:35:27.164
where blood accumulates around the heart and literally shuts it down to everything
00:35:27.164 --> 00:35:29.454
from complications from stroke, right?
00:35:29.454 --> 00:35:35.494
That blood vessel lumen being interrupted and the normal smooth blood flow through
00:35:35.494 --> 00:35:38.404
that vessel being disrupted to the point where there's more turbulent blood
00:35:38.404 --> 00:35:42.378
flow that leads to clot formation and sending that to,
00:35:42.901 --> 00:35:45.070
you know, regions including the brain.
00:35:45.587 --> 00:35:49.014
Thus, right, there are some individuals that have an eric dissection,
00:35:49.014 --> 00:35:53.104
but it comes off or presents as like a stroke-like syndrome.
00:35:53.964 --> 00:35:58.524
Because of blood clots that have been sent to other parts of the body or whole
00:35:58.524 --> 00:36:03.474
parts of the body not receiving enough blood flow and individuals maybe sometimes
00:36:03.474 --> 00:36:06.370
presenting with what we call limb ischemia.
00:36:07.084 --> 00:36:13.364
So it seems like the leg or your upper extremity is not getting enough blood
00:36:13.364 --> 00:36:18.234
supply because that distribution of blood has been disrupted because of the
00:36:18.234 --> 00:36:20.906
tear in that aortic wall.
00:36:21.494 --> 00:36:23.564
But I think we all get the image in our minds, right?
00:36:24.814 --> 00:36:30.244
This is not a complication that you want from longstanding hypertension and
00:36:30.244 --> 00:36:34.038
these other risk factors that can largely be controlled, Reed.
00:36:34.799 --> 00:36:38.463
Yeah, absolutely. It's like you said, it's all largely controlled.
00:36:38.463 --> 00:36:42.703
And so it's incredibly important to know your family history,
00:36:42.703 --> 00:36:45.804
know your risks, and get regular checkups.
00:36:46.291 --> 00:36:51.301
So yeah, let's talk about aortic dissections. There's essentially two different categories.
00:36:51.614 --> 00:36:54.783
But I think to talk about them a little bit deeper, we need to understand the
00:36:54.783 --> 00:37:01.007
anatomy of the aorta a little bit better. So the aorta is the main artery that
00:37:01.122 --> 00:37:04.699
all the blood that the heart is pumping out goes into.
00:37:05.122 --> 00:37:09.513
So you've got the ascending aorta, which goes up, that then turns into the arch
00:37:09.513 --> 00:37:13.087
of the aorta, which from the arch, it branches off into the.
00:37:13.801 --> 00:37:18.973
Carotid and subclavian arteries, which essentially supply all of the blood supply
00:37:18.973 --> 00:37:22.427
to the head, the brain, neck, arms, your upper body.
00:37:22.975 --> 00:37:27.053
And then the descending aorta goes down and branches out into all of the arteries
00:37:27.053 --> 00:37:32.216
that supply your lower body, your abdomen, your legs, everything else with blood.
00:37:32.529 --> 00:37:36.613
And so the ascending aorta is before all of these branches.
00:37:36.613 --> 00:37:40.833
And so it handles pretty much all of the blood flow that comes out of the heart.
00:37:40.833 --> 00:37:46.033
So you can imagine how much blood this aorta handles, how high the pressure
00:37:46.033 --> 00:37:50.303
is there, the expanding and contracting that it does with every pump of the
00:37:50.303 --> 00:37:55.329
heart, like you said, over 2.5 billion times in your lifetime.
00:37:55.904 --> 00:38:00.246
And so this is an incredibly, Yeah, it's an incredibly important part of the body.
00:38:00.705 --> 00:38:07.531
And with it being as incredibly important, there's also if things go wrong there, they can go very wrong.
00:38:07.926 --> 00:38:10.993
So there's this very quick. Exactly. Yeah. So there's the Stanford system,
00:38:10.993 --> 00:38:15.333
which divides aortic dissection into two categories, type A being all those
00:38:15.333 --> 00:38:16.860
that involve the ascending aorta.
00:38:17.435 --> 00:38:22.718
This is the most common and the most urgent, so it requires immediate emergency
00:38:22.718 --> 00:38:27.848
surgical procedures, open heart surgery essentially, and this is including graft
00:38:27.848 --> 00:38:30.968
replacement of the damaged section of the aorta, endovascular.
00:38:31.738 --> 00:38:34.518
Stent graft repair, or a hybrid approach
00:38:34.518 --> 00:38:37.967
using techniques from both graft replacement and stent graft repair.
00:38:38.453 --> 00:38:43.308
Type B aortic dissection are all those that do not involve the ascending aorta,
00:38:43.608 --> 00:38:48.345
so it can involve the aortic arch as long as the ascending aorta is spared.
00:38:48.850 --> 00:38:54.371
And these are often less serious. They may not require surgical procedure to treat.
00:38:54.910 --> 00:38:59.438
They can be treated sometimes with beta blockers and other medications that
00:38:59.438 --> 00:39:02.728
would then lower your blood pressure and your heart rate, essentially lowering
00:39:02.728 --> 00:39:04.715
the pressure on that tear there.
00:39:05.046 --> 00:39:10.008
More severe ones may require surgery. Ideally, endovascular stent graft repair,
00:39:10.008 --> 00:39:14.630
something a little bit less invasive and can be done laparoscopically.
00:39:15.887 --> 00:39:19.767
And I wouldn't say necessarily less severe as far as the type B.
00:39:20.658 --> 00:39:25.237
I mean, you know, definitely not an emergent surgical case where they're rushing
00:39:25.237 --> 00:39:29.007
you to the operating room. And as Reed was saying, right, with the type A doing
00:39:29.007 --> 00:39:33.882
open heart surgery and putting you on cardiac bypass and things like that.
00:39:34.288 --> 00:39:38.517
But it still is very serious. And the reason being is that not only does it
00:39:38.517 --> 00:39:41.659
suck for the patient, because a lot of times patients are really uncomfortable
00:39:41.873 --> 00:39:46.820
feeling this, but the damage can propagate, meaning that tear in the wall.
00:39:47.013 --> 00:39:51.447
If you think of it like a zipper or even, you know, let's say even thinking
00:39:51.447 --> 00:39:53.077
about the garden hose analogy, right?
00:39:53.077 --> 00:39:56.747
You tear the garden hose and let's say you're manipulating it or you're running
00:39:56.747 --> 00:40:00.987
water through it, right? The pressure from inside that with the fluid flowing
00:40:00.987 --> 00:40:05.576
inside, it can propagate that disruption, meaning it can worsen that tear.
00:40:05.802 --> 00:40:09.777
That's why the blood pressure control is so clutch and the heart rate control
00:40:09.777 --> 00:40:13.857
with the beta blockers and other medications is so important because the longer
00:40:13.857 --> 00:40:16.901
that the person has an elevated blood pressure
00:40:17.337 --> 00:40:21.801
or even an elevated heart rate, which is typical for somebody that is very uncomfortable
00:40:22.126 --> 00:40:25.247
and suffering serious complication like this, right?
00:40:25.247 --> 00:40:28.437
The more that their blood pressure is elevated, the more their heart rate is
00:40:28.437 --> 00:40:33.482
elevated, that injury can propagate, meaning that a tear in the vessel wall,
00:40:33.963 --> 00:40:35.444
can continue and it can put.
00:40:36.036 --> 00:40:42.137
Those other organs at risk, even if it is type B and going down into the descending aorta, right?
00:40:42.137 --> 00:40:45.107
That's how individuals can end up with things like limb ischemia,
00:40:45.107 --> 00:40:48.672
where one of their legs might not be getting enough blood supply,
00:40:49.107 --> 00:40:52.091
or gut ischemia even, where the.
00:40:52.694 --> 00:40:57.389
You know, intestines and some of our vital gastrointestinal organs are not getting
00:40:57.389 --> 00:41:00.502
enough blood supply. And we have literally the gut dying off,
00:41:01.037 --> 00:41:04.793
right? Because of ischemia or lack of blood supply to those organs.
00:41:05.240 --> 00:41:09.139
Like this is, I'm sorry, and I know you didn't mean to not minimize the severity,
00:41:09.519 --> 00:41:15.049
but I have a clear picture of like, this is something that is in many cases,
00:41:15.049 --> 00:41:17.399
unfortunately, catastrophic, right?
00:41:17.399 --> 00:41:22.147
Where one, you know, you make it to the hospital live, that is fortunate,
00:41:22.542 --> 00:41:26.344
but it's something that we need to, you know, identify and diagnose,
00:41:26.756 --> 00:41:29.553
which can be challenging. That's a whole other conversation.
00:41:30.156 --> 00:41:34.559
But then, you know, I think really going back to sort of what we hoped was an
00:41:34.559 --> 00:41:39.861
opportunity in this program and talking about this was prevention.
00:41:40.453 --> 00:41:44.109
Like, we don't want you to get to this point, you know, especially if we're
00:41:44.109 --> 00:41:48.609
talking about modifiable risk factors, things like hypertension,
00:41:48.899 --> 00:41:52.429
things like smoking, cigarette smoking, which I think we've already,
00:41:53.079 --> 00:41:56.779
I think we did a decent job, but we tried, Reed, right, illustrating sort of
00:41:56.779 --> 00:42:00.119
what has happened from a pathophysiologic level, right?
00:42:00.119 --> 00:42:03.551
What is happening to these blood vessels as they're being bombarded with pressure.
00:42:03.929 --> 00:42:06.759
But just imagine that you got uncontrolled high blood pressure bombarding that
00:42:06.759 --> 00:42:08.729
blood vessel second to second.
00:42:09.380 --> 00:42:12.979
Right. But then add to that, you smoke cigarettes and now you have all of these,
00:42:13.461 --> 00:42:18.818
compounds, these chemicals that add additional insult to injury already.
00:42:19.295 --> 00:42:23.098
Right. And further denude or break down those blood vessel walls.
00:42:23.336 --> 00:42:26.023
We're just talking about a setup for catastrophe. Right.
00:42:26.651 --> 00:42:29.372
And that's something that we want to avoid as much as we can.
00:42:29.761 --> 00:42:32.410
Yeah, absolutely. Because it's harder treating your dissection.
00:42:33.366 --> 00:42:35.610
You come with a dissection, getting you to the operating room,
00:42:35.610 --> 00:42:39.170
whether you got a type A or controlling your blood pressure with beta blockers.
00:42:39.170 --> 00:42:42.470
And your heart rate and giving you all these medications and controlling your
00:42:42.470 --> 00:42:47.400
pain, right? If we can just take that off the table by focusing on these modifiable
00:42:47.400 --> 00:42:52.731
risk factors that lead up to dissection, like if we can avoid this, that's the thing.
00:42:53.056 --> 00:42:54.380
You do not want to be in our emergency
00:42:54.380 --> 00:42:57.557
department with this or anybody's emergency department with this.
00:42:57.900 --> 00:43:01.900
Exactly. And thank you, Mo, for making that distinction that type B is still
00:43:01.900 --> 00:43:05.603
incredibly urgent, can be extremely bad.
00:43:06.027 --> 00:43:10.710
Type A obviously being something that requires immediate surgery,
00:43:10.710 --> 00:43:15.100
immediate open heart surgery, cardiac bypass, they're going to be in there for a while.
00:43:15.442 --> 00:43:20.970
Type B may not require that, but you can see how interrelated these two are
00:43:20.970 --> 00:43:24.209
in terms of seriousness when you look at the numbers.
00:43:24.760 --> 00:43:31.580
So following prompt surgical repair of type A dissection, in-hospital mortality is about 15% to 30%.
00:43:31.998 --> 00:43:35.940
And these are people that have gone to the hospital, immediately had prompt
00:43:35.940 --> 00:43:40.508
surgical repair, they still die 15% to 30% of the time.
00:43:41.007 --> 00:43:46.609
Five-year survival rate after this is 70% to 80%, 10-year survival is 50% to 60%.
00:43:47.092 --> 00:43:51.250
When we talk about type B aortic dissections that are medically managed and
00:43:51.650 --> 00:43:56.211
they have an in-hospital mortality rate of around 10-15%.
00:43:56.594 --> 00:44:02.353
So that's still extremely high for cases where they've gotten to the hospital right away.
00:44:02.603 --> 00:44:09.313
It's been very prompt. 10-15% is still really high for a rate of mortality.
00:44:09.661 --> 00:44:12.808
The rate for patients is complicated. You know what we're into though?
00:44:14.561 --> 00:44:20.441
Oh, real fast. The thing is, this is all improved over the last few decades.
00:44:20.807 --> 00:44:24.305
These are quote unquote good numbers from where we used to be where people would
00:44:24.305 --> 00:44:30.095
just, right, you know, catastrophically just die or be severely disabled because
00:44:30.095 --> 00:44:32.188
there was not as much that could be done.
00:44:32.450 --> 00:44:35.715
Like we are in a different era where we can do a lot for patients with aortic
00:44:35.715 --> 00:44:39.694
dissection, but you can see that, right, still the outcomes are still,
00:44:40.321 --> 00:44:42.887
yeah, could be better. Let's say that. Yeah, absolutely.
00:44:43.265 --> 00:44:46.475
And better as in, let's prevent this entirely.
00:44:46.910 --> 00:44:49.985
For those with type B dissections that are not promptly treated,
00:44:49.985 --> 00:44:52.808
the mortality rate is about 30 to 40%.
00:44:53.775 --> 00:44:58.485
The five-year survival rate is approximately 75 to 80%. So slightly higher than
00:44:58.485 --> 00:45:02.538
70 to 80%, but still abysmally low.
00:45:02.735 --> 00:45:06.365
And not only that, those who do survive aortic dissection, like you mentioned,
00:45:06.365 --> 00:45:10.188
often experience decreased quality of life, reduced functional status.
00:45:10.612 --> 00:45:15.018
It's extremely common to have persistent pain reduced exercise capacity,
00:45:15.483 --> 00:45:20.355
and along with that anxiety and depression because i don't think that the mental
00:45:20.355 --> 00:45:22.621
toll of these kinds of conditions is
00:45:22.952 --> 00:45:27.555
spoken about as much but the fact that you have reduced quality of life reduced
00:45:27.555 --> 00:45:32.475
mobility you're thinking about the next catastrophic event potentially happening
00:45:32.475 --> 00:45:35.200
that can all lead to a lot of anxiety and depression,
00:45:35.688 --> 00:45:43.065
and knowing that you need to get out and exercise or do things or change lifestyle
00:45:43.065 --> 00:45:46.515
behaviors in order to reduce your risk of a future event.
00:45:46.515 --> 00:45:52.580
But also after suffering an event, not being able to exercise very much, being very sedentary.
00:45:52.981 --> 00:45:58.185
I think those all play a large factor into, yeah, just like the overall mental
00:45:58.185 --> 00:45:59.767
toll that it takes on a person. Yeah.
00:46:01.694 --> 00:46:06.360
No facts, man. And so I think I think folks got their our drift right as far
00:46:06.360 --> 00:46:11.597
as why we really held the best treatment for this is just entirely preventing it.
00:46:12.205 --> 00:46:17.210
And it does not. Right. I think that is the opportunity here is that there's
00:46:17.210 --> 00:46:22.650
a lot of considering the extent of surgery, as we just discussed.
00:46:22.650 --> 00:46:28.661
And being managed with antihypertensives and stuff when you've suffered an aortic dissection.
00:46:29.350 --> 00:46:34.090
I think, Reed, nobody has to agree with me on this, but I think it's much lower
00:46:34.090 --> 00:46:37.970
hanging fruit when we talk about the things we can do as far as prevention.
00:46:37.970 --> 00:46:42.240
Yeah, absolutely. And I just want to talk about it one more time that Lindsey
00:46:42.240 --> 00:46:48.468
Graham's father died when Lindsey was in his 20s when the father was 68 due to heart attack.
00:46:48.874 --> 00:46:52.510
And so this is something that Lindsey probably knew and was on his radar since
00:46:52.510 --> 00:46:56.333
he was in his 20s, that he had a family history of cardiovascular disease.
00:46:56.757 --> 00:47:00.670
I have no idea how they went about managing it. You'd think being that high
00:47:00.670 --> 00:47:05.865
up in government, you'd have regular checkups and have some of the best doctors in the world.
00:47:06.405 --> 00:47:11.610
But people are difficult to change. And so unless somebody truly wants to change,
00:47:11.610 --> 00:47:13.261
they're often not going to.
00:47:13.806 --> 00:47:17.420
But yeah, I can only imagine that there were many conversations,
00:47:17.420 --> 00:47:22.582
at least with his doctors, about his risk for some sort of event like this.
00:47:22.942 --> 00:47:26.820
And so, yeah, I think the warning signs, you should have seen him coming,
00:47:27.273 --> 00:47:29.640
at least from a doctor check-in point.
00:47:29.640 --> 00:47:33.990
A lot of times these things may be sleeper kind of things. And in hindsight,
00:47:33.990 --> 00:47:38.100
you'll notice, okay, yeah, I had a history of atherosclerosis,
00:47:38.100 --> 00:47:39.939
which put me at risk to an event like this.
00:47:40.351 --> 00:47:44.200
But knowing your family history, I think it's oftentimes a superpower because
00:47:44.200 --> 00:47:45.558
you share the same genetics.
00:47:46.228 --> 00:47:50.170
You share the same risk factors. You grew up in a similar environment,
00:47:50.170 --> 00:47:52.091
too. You know what you've been exposed to.
00:47:52.590 --> 00:47:58.594
And so, yeah, knowing your family history can be incredibly powerful in terms of prevention.
00:47:59.485 --> 00:48:04.437
And, you know, not to really comment on Senator Graham's, right, I don't know.
00:48:04.857 --> 00:48:07.797
I mean, I don't know if his blood pressure was uncontrolled.
00:48:07.797 --> 00:48:11.347
I don't think anybody knows. And who knows if that'll ever come to light as
00:48:11.347 --> 00:48:16.941
far as, you know, his overall health status and how he regarded his health.
00:48:17.443 --> 00:48:22.617
And, I mean, as you said, right, even if he had the best access to care in the
00:48:22.617 --> 00:48:28.641
world, I think it just shows how, right, this can technically happen to anyone. Yeah.
00:48:29.111 --> 00:48:32.707
And and Senator Graham, maybe he did take his medications every day.
00:48:32.707 --> 00:48:36.935
Maybe he did his best to engage in physical activity to reduce his risk.
00:48:37.440 --> 00:48:44.074
You know, we can't really say what you know how he engaged this or did things to prevent it.
00:48:44.539 --> 00:48:47.197
But what we are doing is just letting you know that there are things that we
00:48:47.197 --> 00:48:51.458
can do to, right, lower our risk of suffering a complication like this.
00:48:51.725 --> 00:48:55.587
And who knows, maybe it was just he came from a long trip overseas doing what
00:48:55.587 --> 00:48:59.447
I would imagine is a very stressful thing that is happening over in Ukraine.
00:48:59.447 --> 00:49:03.109
And maybe that was the thing that spiked this pressure at that time and led to this.
00:49:03.510 --> 00:49:07.087
But just understand, ladies and gentlemen, that there are things that we can
00:49:07.087 --> 00:49:11.077
do to lower our risk. And a lot of it boils down to we had a conversation with
00:49:11.077 --> 00:49:12.506
Dr. Donald Lloyd-Jones.
00:49:12.737 --> 00:49:16.487
He's the director of the Framingham Center for Population and Prevention Science
00:49:16.899 --> 00:49:19.664
and a former president of the American Heart Association.
00:49:20.076 --> 00:49:24.607
And we had a whole talk about lysoscentral aid, right? And basically eight things
00:49:24.607 --> 00:49:28.977
that we can do to reduce our risk of cardiovascular disease as a whole.
00:49:28.977 --> 00:49:33.038
That's everything from heart attacks, strokes, complications like aortic dissection.
00:49:33.630 --> 00:49:37.214
And these are the things we need to be mindful of, right?
00:49:37.214 --> 00:49:40.984
We need to be mindful of things like eating better. So eating more fresh fruits
00:49:40.984 --> 00:49:45.654
and vegetables, whole grains, lean proteins, being more active,
00:49:45.654 --> 00:49:50.471
right? Two and a half hours of moderate activity or 75 minutes of vigorous activity each week.
00:49:50.760 --> 00:49:53.254
But I'm not going to, you don't got to remember all of this right now because
00:49:53.254 --> 00:49:56.164
it's in the previous show and it's in our show notes, right?
00:49:56.164 --> 00:49:59.497
Getting healthy sleep, healthy amounts of sleep, quitting smoking,
00:49:59.817 --> 00:50:05.864
managing our body weight, right? Making sure that our levels of non-HDL cholesterol
00:50:05.864 --> 00:50:09.799
are controlled, right? AKA bad cholesterol. We want to control that.
00:50:10.217 --> 00:50:13.568
Blood pressure control, right? If there's anything to take away from this,
00:50:13.881 --> 00:50:17.172
it is that we really need to make sure that, right,
00:50:17.602 --> 00:50:22.984
we have access to a primary care physician or provider and that our blood pressure
00:50:22.984 --> 00:50:27.624
is uncontrolled because chief among them, the major risk factor in all of this,
00:50:27.624 --> 00:50:30.849
right, is blood pressure not be in control.
00:50:31.128 --> 00:50:34.114
On top of all these other things, blood sugar control, right,
00:50:34.114 --> 00:50:37.078
making sure we are not developing things like diabetes.
00:50:37.484 --> 00:50:41.455
But a lot of these things we can modify and control.
00:50:41.792 --> 00:50:45.826
And the more we do so, the less likely we are to suffer a complication like this.
00:50:46.441 --> 00:50:50.784
Now, as we close, you know, again, And it's just one of those things,
00:50:50.784 --> 00:50:56.044
as we reflect on the life and legacy of Senator Graham, regardless of whether
00:50:56.044 --> 00:51:01.029
you agree with his politics or not, I think he would be...
00:51:01.755 --> 00:51:05.383
In terms of us discussing this and passing from something like this,
00:51:05.620 --> 00:51:09.486
I think it would have been a proponent of folks being empowered with information
00:51:09.486 --> 00:51:14.736
that, hey, this is something that we can reduce our risk of suffering by paying
00:51:14.736 --> 00:51:16.612
attention to those factors.
00:51:18.121 --> 00:51:21.296
And is everybody going to avoid it, Reed? That is not something that we could
00:51:21.296 --> 00:51:25.580
say on this program. I would argue that there are going to be people that suffer this complication.
00:51:25.953 --> 00:51:27.936
And that's why when my family calls me, they're like, man, yo,
00:51:27.936 --> 00:51:30.926
Mo, I got this chest pain. What do I do about it?
00:51:31.386 --> 00:51:34.276
Something is uncomfortable enough for you to call me about it,
00:51:34.276 --> 00:51:39.116
especially chest pain, you need to go to the emergency department and be evaluated
00:51:39.116 --> 00:51:40.615
to make sure that you are safe.
00:51:40.993 --> 00:51:44.673
Are they going to send you for a CT angiogram to look for a dissection?
00:51:44.824 --> 00:51:48.036
It depends on what's going on, what your signs and symptoms are like,
00:51:48.036 --> 00:51:49.173
what your risk factors are like.
00:51:49.601 --> 00:51:52.886
But anytime you're uncomfortable, whether it's abdominal pain,
00:51:52.886 --> 00:51:58.187
severe headache, being evaluated in an acute care setting, emergency department,
00:51:58.589 --> 00:52:01.756
Some folks go to urgent care and they might very well refer you to an emergency
00:52:01.756 --> 00:52:03.476
department to be evaluated.
00:52:03.476 --> 00:52:05.976
But I want you to take those symptoms seriously.
00:52:06.458 --> 00:52:09.413
But on a prevention standpoint, there's a lot that can be done,
00:52:09.767 --> 00:52:14.498
as we stated, to reduce our risk of suffering a devastating outcome like this.
00:52:14.829 --> 00:52:18.606
And we wanted to take that opportunity to share that with you all.
00:52:18.606 --> 00:52:23.306
Yeah, absolutely. Thank you for bringing that up, Mo, because outside of prevention,
00:52:23.306 --> 00:52:25.126
early intervention is the best.
00:52:25.486 --> 00:52:29.336
So taking symptoms seriously i'm sure you see it all the time where people come
00:52:29.336 --> 00:52:32.246
in and they're like yeah i've been having chest pain for the past week and you
00:52:32.246 --> 00:52:34.814
figure out oh you're it's a heart attack yeah,
00:52:35.412 --> 00:52:41.016
and so i think getting in to see a doctor whether it's in urgent care or the
00:52:41.016 --> 00:52:46.662
er or whatever it is as soon as possible early intervention is always going to be better.
00:52:47.509 --> 00:52:50.575
Facts, man. And I've definitely had patients that have had a dissection for
00:52:50.575 --> 00:52:55.015
like days that is like, you finally came in and you were, you couldn't sleep
00:52:55.015 --> 00:52:56.686
last night because of this tearing pain.
00:52:57.168 --> 00:53:01.675
Like, you know, fortunately those people were okay. At least when they presented,
00:53:01.675 --> 00:53:05.695
you know, they were still alive, but this is something that can evolve rather quickly.
00:53:06.055 --> 00:53:09.115
And so it's not one of those things you want to put to the wayside.
00:53:09.115 --> 00:53:12.725
If it's enough to distract you from what you're doing and you got to pay attention
00:53:12.725 --> 00:53:16.195
to any sort of discomfort like that, whether it's in the back,
00:53:16.195 --> 00:53:19.755
the chest, abdomen, headache, whatever, as we discussed, like you need to be
00:53:19.755 --> 00:53:23.275
evaluated in an emergency setting. All right. I'm not going to belabor the point, man.
00:53:25.234 --> 00:53:29.530
I want to thank you all. Well, first and foremost, Reid, thank you for jumping on.
00:53:30.029 --> 00:53:33.309
Always. Always a pleasure talking with you, man, about this stuff.
00:53:33.669 --> 00:53:36.995
And I also want to thank our listening audience for listening to this program.
00:53:36.995 --> 00:53:40.954
And in advance, we thank you for spreading this information with anyone that will listen.
00:53:41.569 --> 00:53:48.239
Ladies and gentlemen, as always, this show is dedicated to the memory of Miss Gloria Thomas.