A Heart Surgeon on Lindsey Graham's Cause of Death

**Brian Lehrer** (0:10)
It's The Brian Lehrer Show on WNYC. Good morning again, everyone. We'll call this segment, How Not to Die Like Lindsey Graham. Atherosclerosis, his reported underlying condition, is successfully managed in many people his age, which was 71, to prolong life and quality of life, much longer than that. We don't know yet if Lindsey Graham avoided the kinds of screenings or treatments that confined and minimized that plaque buildup and prevent the aorta from bursting as the medical examiner said happened to him. But because the underlying condition is so common, we thought we would do a public service announcement segment, so as many people as possible know how not to die like Lindsey Graham, or at least improve your odds. With us now, Dr. Adham Elmously, an attending surgeon in the Section of Adult Cardiac Surgery at New York Presbyterian, Columbia University Irving Medical Center. Dr. Elmously, thanks so much for some time today. Welcome to WNYC.

**Adham Elmously** (1:10)
My pleasure. Thanks for having me.

**Brian Lehrer** (1:12)
What's an aorta?

**Adham Elmously** (1:15)
So the aorta is like the big highway for blood flow in the body. It's the main artery coming out of the heart that gives blood flow to the entirety of the body. So as it leaves the heart, it first gives blood flow to the brain and the arms. Then as it goes down into the chest and belly, it gives blood flow to the liver, spleen, kidneys, and intestines.
Then it continues down to give blood flow to the legs. So it literally supplies blood from the heart to the entirety of the body.

**Brian Lehrer** (1:49)
What's your understanding from the press reports of the medical examiner's statement of how Lindsey Graham died? They say aortic tear or dissection. What does that mean?

**Adham Elmously** (2:02)
I don't know the details of this case. Obviously, we're talking about this in the setting of somebody's death, which is heavy, but we can use it as an opportunity to maybe prevent this from happening in other people and help them understand how this works. So an aortic dissection is a tear in the wall of the aorta, so that blood flow, rather than flowing in the actual lumen of the aorta, it flows in the layers of the wall. And that can separate the wall into its different components and thin it out. And the main complications that can happen from that are, number one, something called malperfusion or a lack of blood flow to critical parts of the body. And number two, a thinning of the blood vessel to the point where it has a hole and ruptures, and that can cause really rapid blood loss into the chest and death.
When there's malperfusion or a lack of appropriate blood flow, it can present in many different ways. If there's a lack of blood flow to the brain, people can have symptoms of a stroke. If there's a lack of blood flow to the heart, it can simulate a heart attack. And then if there's a lack of blood flow to the spine, people can have signs of paraplegia or leg weakness. And if there's a lack of blood flow to the intestine, people can have really severe abdominal pain.
When a rupture happens, it can be contained or uncontained. A contained rupture means there's a hole and it leaked out, but there's some tissue that's preventing it from completely being wide open. And in that case, patients can still survive and make it to the hospital and get it fixed. If it's a free rupture, the blood can basically escape at a rate that's too rapid to be able to make it to the hospital and have surgery and that can cause a very rapid death.

**Brian Lehrer** (4:07)
Listeners, we can take some heart health, most specifically aortic health questions for Dr. Adham Elmously, an attending surgeon in the Section of Adult Cardiac Surgery at New York Presbyterian, Columbia University Irving Medical Center. As we're trying to use the sudden death of Senator Lindsey Graham as a teaching moment to maybe help prevent some of you from meeting the same feed, or maybe your parents or your grandparents. 212-433-WNYC, 212-433-9692.
You can call or text with your question. Would I be right, doctor, if I say that kind of gradual weakening of the aorta to the point where it could burst and cause sudden death is something that would typically be seen developing over a period of years with some basic screening techniques?

**Adham Elmously** (5:02)
It depends on the cause. Most commonly, we associate an aortic dissection with an aortic aneurysm or an abnormal dilation or enlargement of the aorta, and in most cases, patients who have a dissection or a rupture have a dilated aorta.