Why Did a Daily Exerciser in Their 60s Suddenly Collapse?

[Financial News] If you have a tearing chest pain that spreads to your back or abdomen, accompanied by cold sweats and shortness of breath, call 119 without delay. It could be an aortic dissection, in which the wall of the aorta tears.
Kim Jin-seop (a pseudonym, 67), who was confident in his health and exercised every day despite taking medication for high blood pressure, suddenly felt a squeezing pain in his chest while at work. The pain soon spread to his back, and he eventually collapsed after developing cold sweats and shortness of breath. After Kim was taken to the emergency room with help from his colleagues, medical staff suspected an acute myocardial infarction and began testing. However, an aortic CT scan showed that it was not a blockage in the heart’s blood vessels but an aortic dissection caused by a tear in the aorta.
Aortic dissection often begins with sudden, severe chest pain, making it easy to mistake for an acute myocardial infarction. But the two conditions have completely different causes and treatments. If aortic dissection is mistaken for a heart attack and treated with thrombolytics or antiplatelet drugs, the risk of bleeding and rupture may increase, so an accurate diagnosis is essential before treatment.

The aorta is the largest artery in the body, carrying blood from the heart to the rest of the body. Aortic dissection occurs when a tear forms in the inner wall of the aorta, allowing blood to force its way between the layers of the vessel wall and split them apart. High blood pressure and age are major risk factors; the risk is also higher in people with inherited connective tissue disorders such as Marfan syndrome or a bicuspid aortic valve.
Aortic dissection is broadly divided into Stanford type A and type B, depending on where it occurs. Type A, which affects the ascending aorta—the section that extends directly from the heart—can lead to life-threatening complications, including aortic rupture, bleeding around the heart, and impaired blood flow to major organs. Without treatment, the risk of death rises rapidly as time passes in the early stages of the condition, so emergency surgery is generally required.
For type B dissections that do not involve the ascending aorta, if there are no complications, doctors first monitor the patient while controlling blood pressure and pulse to reduce strain on the aortic wall. However, endovascular stent-graft treatment may be considered if a rupture or impaired blood flow to major organs occurs, the pain persists, or the aorta expands rapidly.
Treatment generally falls into two categories: surgery and stent-graft procedures. Surgery involves opening the chest or, when necessary, the abdomen and replacing the damaged vessel with an artificial graft. Surgery is usually needed for areas close to the heart, such as the aortic root or ascending aorta. In a stent-graft procedure, a device is inserted into a blood vessel and a stent graft is deployed at the damaged area to prevent blood from entering between the layers of the vessel wall.
Jeon Chang-seok, chief of Cardiovascular and Thoracic Surgery at Incheon Sejong Hospital, said, “Surgery treats the problem by directly replacing the affected blood vessel, while a stent graft seals the opening of the tear and directs blood to flow through the original vessel. We decide on the treatment by considering the location and extent of the dissection, the shape of the blood vessel, and the patient’s overall condition.”

An acute myocardial infarction occurs when a coronary artery supplying blood to the heart becomes blocked, preventing the heart muscle from receiving enough blood and oxygen. Aortic dissection, by contrast, occurs when the wall of the aorta tears.
Heart attack pain often feels like pressure or tightness in the chest. With aortic dissection, the tearing pain is usually most severe when it first begins and often moves from the chest to the back or abdomen. Blood pressure or pulse may also differ between the arms, and symptoms can include shortness of breath, fainting, abdominal pain, and changes in sensation or movement in the arms or legs.
However, many cases do not present typically, so it can be difficult to clearly distinguish the two conditions based on pain alone. If the dissection extends to the opening of a coronary artery, signs similar to those of a heart attack may also appear. For this reason, even when a heart attack is suspected, doctors should assess the timing and nature of the pain, its location, and accompanying symptoms, and use an aortic CT scan if needed to check for a possible dissection.

Aortic dissection can progress beyond a tear in the vessel wall and lead to aortic rupture or bleeding around the heart. It can also block blood flow to major organs such as the brain, kidneys, intestines, and legs.
How quickly the condition is diagnosed and treatment begins can determine whether the patient survives. Type A dissections in particular must be followed by emergency surgery as soon as they are diagnosed. In the emergency room, an aortic CT scan should be used to quickly determine the location and extent of the dissection and whether blood flow to the organs is impaired, so that the most suitable option—surgery or endovascular treatment—can be chosen.
This process requires collaboration among several departments, including Cardiovascular and Thoracic Surgery, Emergency Medicine, Radiology, Anesthesiology and Pain Medicine, and Critical Care Medicine. For the entire process to move quickly—from suspecting aortic dissection and conducting tests in the emergency room to connecting the patient with specialists and proceeding to surgery or a procedure—a system for coordination, such as a “hotline” that allows medical staff to share the patient’s condition and test results immediately, must be in place.
Chief Jeon said, “When an emergency patient with a condition such as aortic dissection arrives, medical staff must share the patient’s condition and test results and be able to proceed immediately to surgery if needed. If you have risk factors such as high blood pressure, it may also help to know in advance which nearby hospitals can perform emergency aortic surgery.” He added, “It is difficult to predict every case of aortic dissection in advance, but if sudden tearing pain begins or spreads from the chest to the back or abdomen, accompanied by fainting, shortness of breath, or symptoms affecting the arms or legs, call 119 without delay or go to an emergency medical facility.”
 


[email protected] Jeong Myeong-jin, Medical Writer Reporter