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Tim Logan felt just fine, thank you.
He was a youthful 44 years old, physically active, and gainfully employed with a wife and three children. No reason to think a silent killer might be lurking inside.
There had been a warning sign. High blood pressure had cropped up in his early 30s. Hypertension runs in the family so, like his relatives, Logan had sought treatment.
However, unlike his relatives, Logan had not responded well to medication. With systolic levels in the 140s and diastolic levels in the high 90s, he had stage 1 hypertension (see chart). Hypertension places people at risk for various types of cardiovascular event.
One such high-risk event—a tear in the wall of the aorta, called an aortic dissection—came calling in the early morning hours of Aug. 28, 2006.
Logan remembers an intense pain pressuring the base of his neck. The pain worsened over a period of several minutes, radiating down his left arm.
“At that point I knew something was going on,” he says. “I was alone with my kids at the time. My wife, Gail, is a staff nurse who was working the evening shift.”
Logan made two vital phone calls, one to his wife and one to 9-1-1. His wife arranged to get the children taken care of while paramedics took him to the emergency room at Mercy Hospital in Iowa City.
Mercy’s physicians evaluated him, discovered an enlargement of the aorta (aneurysm), and transferred him to University of Iowa Hospitals and Clinics. There, he was further evaluated by cardiology staff physician Dinesh Jagasia, MD, who suspected a possible aortic dissection based on the clinical presentation and available scans.
Clinical staff radiologist Brian Mullan, MD, reviewed the chest CT on an advanced imaging Vitrea workstation and confirmed the diagnosis.
Cardiothoracic surgeon Wayne Richenbacher, MD, was immediately consulted so he could start planning a major surgery that evening to repair the aortic dissection.
Aortic dissection occurs when blood from the aorta leaves its “channel” through a small tear in the aortic wall. A new channel forms between the inner and outer aortic walls. The weakened blood vessel can rupture, which usually results in death if not treated immediately.
Richenbacher repaired the dissection during an extensive procedure requiring the heart to be stopped for nearly three hours using a heart/lung machine. The procedure strengthened and repaired the aortic wall and partially replaced the vessel with artificial material.
Logan spent five days recovering at UI Hospitals and Clinics, after which he continued to recuperate at home for several months.
In April 2007 a dedicated CT scan of the heart and aorta was performed and evaluated by UI radiologist Edwin van Beek, MD, and UI Heart and Vascular Center cardiologists. The scan revealed a non-calcified high grade plaque in one of Logan’s coronary arteries. This led to the placement of a stent in the left anterior descending coronary artery by interventional cardiologist Phillip Horwitz, MD.
Since then Logan has improved considerably, thanks in part to cardiac rehabilitation through UI’s Cardiovascular Health, Assessment, Management, and Prevention Service (CHAMPS).
Van Beek says Logan’s experience demonstrates the value of integrated, multidisciplinary heart care available around the clock.
—Michael Sondergard
Blood Pressure Levels |
|
Systolic |
|
Diastolic |
Normal |
< 120 |
and |
< 80 |
Pre-hypertension |
120-139 |
or |
80-89 |
High Blood Pressure |
Stage 1 Hypertension |
140–159 |
or |
90–99 |
Stage 2 Hypertension |
160 |
or |
100 |
A high-risk condition Untreated, about half of patients with aortic dissection die within the first 48 hours. The two-week mortality rate approaches 75 percent in undiagnosed patients. The long-term follow-up for survivors involves strict blood pressure control. The risk of death is highest in the first two years, and patients should be followed closely during this time period. |
