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Sen. Lindsey Graham (R-S.C.) died Saturday night at age 71; his office cited preliminary findings of aortic dissection due to arteriosclerotic cardiovascular disease. (Photo by Win McNamee\/Getty Images)<\/p>\n
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Sen. Lindsey Graham (R-S.C.) died Saturday night at his Washington, D.C. home at age 71, after what his office initially described only as a \u201cbrief and sudden illness.\u201d On Sunday, his office released<\/a> preliminary findings from the District of Columbia\u2019s chief medical examiner: aortic dissection due to arteriosclerotic cardiovascular disease. Emergency medical services had responded to a call for cardiac arrest<\/a> at the senator\u2019s home. The final death certificate remains pending until toxicology and microscopic testing are complete.<\/p>\n Graham had just returned<\/a> from his tenth wartime trip to Ukraine, and his staff reported no indication that he was feeling unwell. That combination\u2014apparently fine one moment, in cardiac arrest hours later\u2014is exactly how aortic dissection can unfold. As an ER doctor, it is a diagnoses I think about regularly when I see patients. It can kill within minutes and can masquerade as far more common problems. Here is what the preliminary finding means.<\/p>\n What Is An Aortic Dissection?<\/p>\n The aorta is the body\u2019s main artery, a garden-hose-sized vessel that carries blood out of the heart to every organ. Its wall has three layers. A dissection begins when the innermost layer tears, allowing high-pressure blood to surge into the wall itself and split the layers apart. This creates a false channel where blood flows.<\/p>\n Doctors classify dissections by location. Type A dissections involve the ascending aorta, the segment closest to the heart, and are surgical emergencies. Type B dissections are limited to the descending aorta and can often be managed with blood pressure control and, in some cases, stenting. Type A is the more lethal tyle: the tear can extend backward into the sac around the heart, causing what\u2019s called tamponade where blood compresses the heart until it cannot pump. It can also shear off the arteries that supply the heart muscle itself. Either mechanism produces sudden cardiac arrest, which matches what first responders encountered at Graham\u2019s home.<\/p>\n Why Untreated Aortic Dissection Kills So Quickly <\/p>\n An acute Type A dissection carries a mortality risk that climbs<\/a> by roughly 1% to 2% every hour after the tear occurs. When the aorta ruptures completely, death can occur in minutes\u2014often before an ambulance arrives. The classic teaching holds that about half of untreated patients die within the first 48 hours, and even when treated<\/a> about a quarter will not survive.<\/p>\n This is why many dissections are simply unsurvivable outside a hospital. When the first symptom is collapse and cardiac arrest, even perfect CPR and a rapid EMS response are frequently not enough. Nothing in the public reporting suggests any delay in Graham\u2019s care. Rather, his death illustrates the disease\u2019s most severe presentation.<\/p>\n What \u2018Arteriosclerotic Cardiovascular Disease\u2019 Means<\/p>\n The second half of the medical examiner\u2019s finding refers to the underlying condition: hardening and degeneration of the arteries from atherosclerosis. This is the same disease process behind most heart attacks and strokes. Decades of plaque buildup, inflammation and, above all, high blood pressure stiffen and weaken the aortic wall. This sets the stage for a tear. Chronic hypertension is the single biggest risk factor for dissection, and is present in the large majority of cases.<\/p>\n Graham\u2019s profile fits the classic epidemiology of the disease. Dissections most often strike men in their 60s and 70s. Family history matters too\u2014his father died<\/a> of a heart attack in his late 60s. Some outlets have noted the senator\u2019s heavy recent travel schedule, including long-haul flights back from Ukraine and a NATO summit. While fatigue and travel stress don\u2019t cause dissection, transient blood pressure surges can be the final insult to an already-diseased aorta. <\/p>\n That said, attributing his dissection to any single trigger would be speculation. The substrate of arteriosclerotic disease had likely been building for years.<\/p>\n Why Dissection Is So Hard To Catch, Even In The ER<\/p>\n Roughly 20,000 Americans experience a thoracic aortic dissection or related emergency each year, and it is one of medicine\u2019s most notorious mimics. The textbook symptom is sudden, severe, tearing pain in the chest or back, sometimes migrating as the tear extends. Yet dissections can also present as stroke symptoms, abdominal pain, fainting, a cold pulseless limb, or as happened here, immediate collapse.<\/p>\n