A deep-seated fear lives in the minds of emergency room doctors: the dread of missing a subtle sign of a catastrophic illness. As Calgary emergency physicians Dr. Eddy Lang and Dr. Niklas Bobrovitz recently noted, this fear can border on a 'practice-altering paranoia.' Few conditions embody this terror more than aortic dissection—a deadly tear in the body's main artery that can kill within minutes.
A Decade of Tragic Oversights
A stark new study has documented the grave consequences of this diagnostic challenge in Canada. Over a ten-year period, 43 cases of delayed or missed aortic dissection in Canadian emergency departments resulted in medical-legal action. The human cost was devastating: 36 of these individuals died. Even more alarming is that for 30 people, the correct diagnosis was only made after their death.
Perhaps the most chilling statistic is that 40 percent of these fatal, missed dissections occurred after the patient was sent home from the ER. This outcome represents a worst-case scenario for both patients seeking help and the physicians treating them.
What is an Aortic Dissection?
Dr. Niklas Bobrovitz, an emergency medicine resident and health services researcher at the University of Calgary, explains the mechanics of this medical crisis. 'The aorta is the major vessel coming from your heart, supplying blood to your organs and tissues,' he said. It arches upward in the chest before descending through the abdomen.
The wall of the aorta has multiple layers. A dissection occurs when a tear forms in the inner layer. 'Blood forces its way through this tear, causing the inner layer to separate from the outer layer,' Dr. Bobrovitz detailed. This process can critically reduce blood flow to vital organs like the heart, brain, and lungs, leading to rapid organ damage and death.
'It can happen fast, depending on where the tear is,' he warned. A tear close to the heart can block coronary blood flow almost instantly, causing a fatal heart attack within seconds.
The 'Great Imitator' and Its Famous Victims
Aortic dissection is notoriously difficult to diagnose because its symptoms often mimic other, less critical conditions. While some experience a classic 'tearing' chest or back pain, not everyone presents with such clear signals.
'It's very similar to a kidney stone: people can't get comfortable,' Dr. Bobrovitz described. 'They have constant pain. No position feels good. It doesn't change when they sit up, or when they lie down. They can be sweaty.' This chameleon-like nature has earned it the nickname 'the great imitator.'
This silent killer has claimed high-profile lives. In 2016, Canadian actor Alan Thicke, aged 69, died from a ruptured aorta just three hours after his dissection began. He collapsed while playing hockey with his son. American actor John Ritter also died suddenly in 2003 from a misdiagnosed thoracic aortic dissection.
The study serves as a critical reminder of the diagnostic pitfalls in emergency medicine and the relentless, high-stakes nature of identifying a condition where time is the most precious commodity.
