An ER doctor reveals the 1 heart condition that he never wants to see in his hospital because it is 'so scary' — and how to prevent it

• In rare cases, the aorta — our largest blood vessel — can tear and burst, causing an aortic dissection.
• An MD in Boston says it's "among the scariest" issues ER doctors encounter. 
• It's rare, but some preventative measures can reduce your risk.

The aorta — the big, critical vessel that sends fresh blood from your heart out into your body — is a sacred space.

That's what Dr. Jeremy Faust remembers learning back when he was a first year medical student, and his anatomy professor referred to the cane-shaped tube in the middle of the body as the "holy of holies." 

As an experienced emergency physician in Boston today, and an instructor at Harvard Medical School, Faust says even now "there are only a few things that make me genuinely feel a surge of adrenaline-induced panic" when he's working in the ER.

Some of the very biggest panic-inducing conditions he treats today are aortic dissections, which are tears in the fabric of the important artery coming directly out of our hearts. 

"I can think of almost no condition that I fear more," Faust said in a recent edition of his "Inside Medicine" newsletter.

Faust said there is often a "profound sense of helplessness" he has as a doctor when he treats a severe, type A, acute aortic dissection, which is why he stresses early diagnosis, and awareness of a few critical preventative measures, are both key.

A 'profound sense of helplessness' when aortic dissections aren't diagnosed or treated early enough

Journalist Grant Wahl, one of the most revered soccer reporters, died of a ruptured aortic aneurysm in Qatar earlier this month, after he collapsed during a quarter final match between Argentina and the Netherlands.

It's possible Wahl's aorta bulge went undiagnosed for quite some time. But once it tore open, resulting in an aortic dissection, "there was almost nothing anyone could have done to save him," Faust said, echoing what Wahl's wife, Dr. Celine Gounder, said about his death last week.

"The scary thing about aortic dissections" especially those like Wahl's type A, acute, aortic dissection, Faust said, is how quickly they can progress.

"I can think of patients who were well enough to be on their cell phones to tell their family of the diagnosis — to extraordinarily unwell (unconscious and fighting for their lives) in a short period," Faust said. 

"With each and every heart beat" the tear "worsens due to the shearing stress of blood being blasted into it," he added.

Ideally, doctors would work to stabilize the patient's blood pressure, Faust said, but doing that when the patient's aorta has already ruptured, significantly disrupting blood flow, can cause a cascade of other life-threatening issues, like strokes or cardiac arrest.  

The 'double-edged sword' for aortic dissection patients 

"Treating dangerously low blood pressure caused by an aortic dissection is a double-edged sword," Faust said.

On one hand, if doctors don't raise the blood pressure, the patient may have a stroke.

"But if we do raise the blood pressure, we're at risk of making the overall situation worse, by causing that tear in the lining of the aorta to get bigger," he explained.

This is a big part of why 40% of aortic dissection patients die near immediately, as they bleed out of their body's largest artery.

The condition is rare, but there are risk factors — and early diagnosis is key 

Aortic aneurysms are exceedingly rare. Fewer than 10,000 people die of aortic aneurysms in the US every year, according to the Centers for Disease Control and Prevention. 

But it's often difficult for doctors to diagnose aortic aneurysms ahead of time, because the bulges don't tend to cause symptoms until around the time they burst into dissections. A chest CT scan may identify small aneurysms, so sometimes the condition is uncovered by happenstance during another exam, or by a doctor trained to recognize odd heart murmurs or unusual blood pressure patterns. 

It's possible that Wahl had a condition that made him more susceptible to aortic aneurysms called Marfan syndrome, a tissue disorder that can predispose people to the catastrophic ruptures. People with Marfan syndrome tend to be very tall and thin, with long arms, legs and fingers. According to the Cleveland Clinic, "most aortic dissections are caused by an underlying vulnerability that may be inherited," like Marfan or Loeys-Dietz syndrome. First degree relatives of aortic dissection patients (including parents, siblings, or children) should be screened for aortic issues.

Other conditions that can lead to aortic aneurysms and dissections include high blood pressure (which damages aortic tissue), aging, traumatic chest injuries, smoking, heart disease, and Turner syndrome. 

Aortic dissections often manifest as a sudden, sharp, severe chest or upper back pain, and can feel like tearing, stabbing, or ripping inside the body.  

"The sooner an aortic dissection is detected, the better the odds of survival are," Faust said.