Many doctors refer to people with aortic dissections, and especially those with large swellings in the aorta (called aneurysms), as ticking time bombs. 55 Amma did not have a large aneurysm in her aorta, but with the dissection having proceeded all the way down her descending aorta, there were significant dilations of the aorta all along. 56
Fig 19: Aortic aneurysms. An aneurysm is a bulge which could rupture, leading to death; aneurysms can happen anywhere along the aorta, but they most frequently happen on the thoracic (both ascending and descending aorta), and abdomen parts of the aorta. Albert Einstein had an abdominal aneurysm, and he in fact died from its rupture.
There is a reason why aortic aneurysms and dissections are called ticking time bombs. If the blood pressure increases to a high level for an extended period, there’s a high likelihood that the outer wall of aorta would rupture, blood would start leaking outside and chances of survival would become very low. 57
Preventing these time bombs from exploding will hence require having a tight control on blood pressure. If only that were so easy!
Sure, regular use of the right medications is an excellent way to keep blood pressure low. But poor diet control could still increase blood pressure. Stress could also result in elevated blood pressure. Thus, long and high bouts of tension could elevate blood pressures even for a person taking blood pressure medications. It is possible that a high bout of tension for amma on hearing appa’s supposed heart attack resulted in her first aortic dissection in 2011.
Even if life does not naturally present tense circumstances, humans being what we are, we will ensure we manufacture enough such bouts of tension.
Amma and I being who we were, tension was the one thing you can be sure to have in my home every day.
55. Aortic aneurysms are different from dissections. While the former is a large swelling without a tear, the latter is actually a tear in the inner wall of the aorta. Both conditions mostly result from the same underlying cause – hypertension. Doctors usually refer to aneurysms – rather than dissections – as ticking time bombs as the chances of aneurysm bursting even with BP control are higher in the first few years compared to those for dissections.
56. While both dilations and aneurysm represent expansions in the diameter of the aorta, in medical parlance, a fine distinction is made between them. A dilatation refers to an event where the dimension at a location is greater than the 95% percentile for a person in that age, sex and body mass – so, 5% of the population have a dilatation by its very definition. An aneurysm is defined as a localized dilation of the aorta whose actual diameter is one and half times or more than the expected diameter of the aorta at that location.
57. Death from severe aortic rupture can be as high as 70%. About 50% die before they arrive at the hospital and 70% die by the time the surgery is completed.
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