March 2004
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Aortic tears: Undetected killers
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Jedd Fisch |
Jedd Fisch was removing a golf bag from his trunk on the afternoon of
March 22, 2003, when he felt a strange pain in his back. The 26-year-old
former defensive coach for the Houston Texans professional football team
shrugged off the pain.
But the pain was still there the next morning and getting worse. By coincidence,
while having breakfast at a local restaurant, he ran into his team physician,
James Muntz, MD, a clinical associate professor of medicine at Baylor
College of Medicine. Muntz put Fisch on a muscle relaxer and called him
later to check on him. The next day, when Fisch told Muntz the pain was
getting worse, the doctor sent him to the emergency room at The Methodist
Hospital in Houston. The decision probably saved Fisch’s life.
Aortic dissection
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View illustrations of aortic
dissection |
"After a series of tests, I found out that I had dissections in both my ascending and descending aorta," Fish said. "When I went to the ER, I was certainly not thinking they would find anything wrong with my heart. I thought I had a slipped disc, they would give me some pain medicine and later we might consider some type of surgery or physical therapy down the road."
Instead, heart surgeon Joseph Coselli, MD, told Fisch he would need immediate surgery to repair the damage to his ascending aorta, and that he should call his family members to come to the hospital immediately.
"I remember asking Dr. Coselli whether we could wait a day, to give my family enough time to get there," he said. "He told me not if I wanted to see them again. It was that serious."
A silent killer
Although Fisch endured several major surgeries and months of rehabilitation, he considers himself lucky to be alive. Aortic dissections, tears in the heart’s largest artery, kill young, healthy people suddenly – often without any warning. These sudden or acute dissections number between 5,000 and 10,000 cases a year in the United States.
The condition made world headlines last fall when actor John Ritter died of an acute aortic dissection. Often, aortic dissections are caused by aortic aneurysms, abnormally widened and weakened sections of a blood vessel wall.
"If they feel any symptoms at all, the most common symptom is back pain from where the aneurysm pushes on the spinal cord," said Coselli, a BCM professor and chief of cardiothoracic surgery in the Michael E. DeBakey Department of Surgery. "People might also have some difficulty swallowing if the aneurysm pushes on the esophagus."
The pressure of blood flow can cause the weakened area to enlarge like a balloon to far beyond the normal diameter of the artery. Aneurysms that rupture can cause blood to leak out of the aorta into the sack surrounding the heart. The effect squeezes the heart down and halts blood flow to the body.
“With each hour that passes, a person with an ascending aortic dissection has a one percent chance of dying,” Coselli said. “Untreated, in two days, half the people who have an aortic dissection will be dead.”
To stop the sudden escape of blood when an aneurysm in an artery tears or bursts, doctors usually surgically remove the torn aorta and replace it. In Fisch’s case, Coselli replaced the aorta with a Dacron graft, or synthetic artery---a technique that was invented at BCM by heart surgery pioneer, Michael E. DeBakey, MD. DeBakey is chancellor emeritus at BCM. Coselli has performed more than 4,000 aneurysm repairs in his career as a surgeon.
Risk factors
Fisch was surprised by his condition because heart disease does not run in his family.
“In Jedd’s case there was no physical exam that could have picked the problem up,” Coselli said. “But if you have heart disease in your family, or have relatives that have died suddenly, you should share that information with your doctor. In some cases a trained specialist can pick up the beginnings of an aortic dissection with either a chest x-ray, MRI scan, CT scan or echocardiogram.”
Risk factors for aortic dissection include high blood pressure, smoking and a family history of heart disease. People with Marfan syndrome, a connective tissue disorder that is characterized by unusually long limbs, are also at higher risk for aortic dissection.
Hope for the future
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Jedd Fisch, coach |
Nearly a year after the event that almost took his life, Fisch is living an active life. He went back to coaching and is now an offensive coach for the Baltimore Ravens, another pro team. He is engaged to his girlfriend, Amber, and has a new appreciation for life.
“I want to make sure that I never lose sight of what I went through, or lose sight of how important time is,” Fisch said.
He also has advice for athletic young men like himself.
“Be aware of your body and don’t be a superhero,” he
said. “A lot of guys said to me, ‘I can’t believe you
went into the hospital for back spasms.’ But if you hurt, don’t
just tough it out. That is one of the biggest problems guys my age have.
Now I know every part of my body and know when something is wrong and
something is right.”
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