The aortic tear that likely caused the sudden death of Sen. Lindsey Graham is a medical emergency that can rapidly kill.
"It's not something that is slowly progressing over time," said Dr. Barbara Hamilton, an aortic surgeon specializing in aortic disease at the University of Michigan. "There isn't this insidious, creeping, on-off chest pain that's been lingering. When it hits, it's usually a 10 out of 10 pain."
Aortic dissection affects an estimated 5 to 30 people per million each year, according to American Heart Association president Dr. Manesh Patel.
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That's uncommon, especially compared with heart attacks or strokes, although Graham is not the first prominent figure to die because of it. Others include actors Lucille Ball (1989), John Ritter (2003) and Alan Thicke (2016), and Grant Imahara (2020) of the TV series "Mythbusters."
The aorta is our largest artery, like a highway that arches up from the heart and then curves back down through the abdomen — carrying oxygen-rich blood to the rest of the body as other arteries branch off from it.
What doctors call an aortic dissection happens when a tear in its inner lining lets blood rapidly leak between its other layers, according to the American Heart Association. That reduces blood flow to vital organs, and sometimes can lead to a rupture that pours blood into surrounding tissues. It often can be caused by an aortic aneurysm, a weakened spot on the artery that can bulge like a balloon.
A primary risk factor is high blood pressure, which can batter the inner lining of the aorta and cause it to wear down over time and with each heartbeat.
"About 75 percent of people with an aortic dissection have underlying hypertension... they don't have to have severe, uncontrolled hypertension. Just the presence of hypertension ... can affect the architecture of the aorta," Dr. Alan C. Braverman, one of the country's leading experts on aortic disease, told the website Diagnostic Imaging.
Others risks include high cholesterol that in turn stiffens arteries — called atherosclerosis — and smoking. It's more common in older people, but also can be caused by certain genetic conditions in younger people.
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Symptoms tend to be sudden, with severe stabbing-like pain, often in the chest or back but sometimes in the neck, jaw or abdomen depending on where in the aorta the tear happened.
According to the heart association, people also may suddenly lose consciousness, have clammy or sweaty skin, experience stroke-like symptoms such as sudden weakness on one side of the body, or show signs of shock, including rapid heart rate or confusion.
“An aortic dissection is a life-threatening condition that requires rapid diagnosis, as emergent surgery can be necessary. Subsequent decision-making is based on the location of the tear in the aorta and any associated poor blood flow to organs," Dr. Roberto Aru, an assistant professor of vascular surgery at Thomas Jefferson University, told ABC News.
Graham, the senior senator from South Carolina, died Saturday night after what a preliminary report from the Washington, D.C., medical examiner’s office said was a tear in his aorta stemming from the hardening of his arteries. He was 71.
WUSF's Rick Mayer contributed to this report.
