July 15, 2026
ByJulie Corliss,
Executive Editor, Harvard Heart Letter
- Reviewed byEric Isselbacher, MD, MSc,
Contributor
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Lindsey Graham, a Republican senator from South Carolina, is reported to have died from an aortic dissection, a tear in the inner lining of the aorta, the largest artery in the body. The classic symptoms of this uncommon, catastrophic condition are sudden, severe pain in the chest, back, or abdomen that has a ripping, stabbing, or tearing sensation. Without immediate treatment, the torn artery can rupture completely, causing massive internal bleeding, which is often fatal
Each year, about 30 in one million people have an aortic dissection. Most aortic dissections, like the one believed to have led to Senator Graham’s death, occur in the thoracic aorta, the top section of the aorta as it curves up from the heart and down through the chest. As is true for most cardiovascular problems, smoking, high blood pressure, and advancing age can leave people vulnerable to problems with their aorta. But so can genes, high cholesterol, and certain medical conditions, which can weaken the wall of the aorta. If the firm but elastic outer wall of the aorta weakens and bulges outward like a worn-out bicycle tire, it’s known as an aortic aneurysm.
“Even if your aorta is only mildly enlarged, you can have an aortic dissection. But the risk is much greater if you have an aortic aneurysm,” says Dr. Eric Isselbacher, co-director of the Thoracic Aortic Center at Massachusetts General Hospital
What is an aortic dissection?
An aortic dissection occurs when a tear develops in the inner lining of the aortic wall. The inner and outer layers peel apart, creating an extra channel for blood inside the aorta. It may do no harm, or it may allow blood to bypass the outflow to certain organs or tissues, leaving them without a blood supply. This can cause a heart attack, stroke, kidney damage, and other problems. A break in all three layers of the aortic wall is termed a rupture. Blood pours from the aorta into the chest, into the sac around the heart, or into the abdomen. This massive internal bleeding can quickly lead to shock and death.
Who is at risk for an aortic dissection?
An aortic dissection is most likely to occur in people with a thoracic aortic aneurysm (TAA), which affects an estimated one in 10,000 people. Because they are so uncommon, guidelines recommend screening tests only for people at greatest risk for a TAA. This includes people with any of the following:
A bicuspid aortic valve. About one in 100 Americans are born with an aortic valve that has two flaps (a bicuspid valve) instead of the normal three flaps (a tricuspid valve). As many as half of people with a bicuspid aortic valve eventually develop an enlarged thoracic aorta. If you have been told you have a bicuspid aortic valve, you should be checked for a TAA
Early aortic valve surgery. Failure of the aortic valve before age 70 is often due to a bicuspid valve
Certain genetic conditions. TAA is common in individuals with genetic conditions such as Marfan syndrome, Loeys-Dietz syndrome, vascular Ehlers-Danlos syndrome, Turner syndrome, and others
Family history. If you have a TAA, urge your siblings, children, or parents to be checked for one. The reverse holds as well — if a parent, sibling, or child has a TAA, you should be tested for one, too. The same is true if you have a close relative who has died of an aortic dissection or rupture or unexplained cardiac arrest before age 50
How are thoracic aortic aneurysms diagnosed?
Most TAAs are discovered on imaging tests done for other reasons, says Dr. Isselbacher. These include echocardiograms (heart ultrasounds) and CT scans of the chest. If you’re having either one of those tests, you can request that the radiologist doing the scan checks you for a TAA
“Many people are now getting coronary artery calcium scans that look for plaque buildup in their heart arteries. These scans can also reveal a thoracic aneurysm,” says Dr. Isselbacher. If you show up at an emergency room with a suspected heart attack, you may get a coronary computed tomography angiography (CCTA), a specialized CT scan that provides an even more detailed view of your arteries and heart anatomy. “A CCTA may show no coronary artery blockages, but it can pick up an aortic dissection,” he says.
Can you survive an aortic dissection?
“Many people are under the mistaken impression that thoracic aneurysms ‘pop’ and you’re a goner,” says Dr. Isselbacher. In fact, most thoracic aneurysms actually dissect rather than rupture. The death rate from a dissected aneurysm is about 1% per hour after it occurs, so if you get to a hospital and get diagnosed within several hours, chances are good that you’ll survive, he says
Image: © milorad kravic/Getty Images
About the Author
Julie Corliss,
Executive Editor, Harvard Heart Letter
Julie Corliss has been the executive editor of the Harvard Heart Letter since 2013. She also writes for the Harvard Health Letter, Harvard Women’s Health Watch, and Harvard Men’s Health Watch, as well as for Harvard …
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About the Reviewer
Eric Isselbacher, MD, MSc,
Contributor
Dr. Eric Isselbacher is an associate professor of medicine at Harvard Medical School and holds the Edmund N. Ansin Endowed Chair in Healthcare Transformation. He is also senior director of the Healthcare Transformation Lab and co-director …
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View all posts by Eric Isselbacher, MD, MSc
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