A point of contention among vascular surgeons is the lack of understanding among the public, and even medical people, about the difference between aortic dissections and aneurysms. To be fair, I don’t have any first hand knowledge of what happened to John Ritter, although the media reported that he had an aortic dissection. Put plainly, a dissection is when the walls of the artery strip away from each other because blood flows directly into the wall of the vessel, instead of through the middle of it.In contrast, aneurysms are abnormal bulging of the arteries which can sometimes lead to rupture. Many people are diagnosed with aneurysms that are completely asymptomatic, and undergo elective repair of them before a rupture happens. Dissections are trickier. Until a dissection actually happens, there will usually be no findings on physical exam or on CT scan.
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Good point.
I just wrote a post about dissections as well which may be of interest:
“Which is most likely: your chances of diagnosing a deadly aortic dissection on your next shift, winning some $ with your next Powerball ticket, being struck by lightening during your life time, or seroconverting after being stuck with an 18 g angiocath used in an HIV positive patient?”
Evidence suggests Ritter presented with an apparent STEMI — he was given heparin and sent to the cath lab. Angio showed the vascular accident. So if the coronaries were involved, the likelihood is much higher that it was a dissection. Thoracic aneurysms are very rare indeed, and ascending thoracic aneurysms are even more so.
Cheers,
Sf
A colleague recently saw a thoracic aneurysm rupture which presented atypically. I have seen dissections, but not aneurysm rupture. Thanks for the comments.
My Father-in-law had aortic aneurysms for which he had surgery. It is genetic in nature and as the disease is asymptomatic, it is better to be cautious and have regular check up. This post may be useful for all read WHAT IS AN AORTIC ANEURYSM?
And one of the bad things about dissections is that they too may be assymptomatic (painless) until the dissection becomes so severe that disruption of the the tunica media and adventia is imminent or occurs, which can result in a large lac in the artery and possible death from massive hemorrhage. Mortality from ruptured aorta’s is as high as 80%.