升主动脉瘤破裂报告的死亡原因美国的足球作家格兰特·沃尔-是一种罕见但致命的疾病。
49岁的沃尔是美国足球界的一名著名记者，他在12月9日报道世界杯在卡塔尔，无法恢复。周三，他的妻子塞琳·冈德博士透露瓦尔的意外死亡是由于未被发现的升主动脉瘤破裂伴心包积血所致纽约市法医办公室。
“格兰特死于一个缓慢生长的、未被发现的升主动脉瘤破裂，并伴有心包积血，”冈德在一篇文章中写道在子堆栈上发布。"再多的心肺复苏术或电击也救不了他。"
马萨诸塞州总医院胸主动脉中心的联合主任Eric Isselbacher博士告诉ABC新闻，当一个年轻而看起来健康的人突然去世时，“我们担心潜在的健康问题的可能性”。
“没有什么好办法知道，在这种情况下，直到尸检之前到底发生了什么。但我们确实看到这样的事情发生在年轻人身上，这是对主动脉瘤的清醒提醒，特别是当人们不知道它们时，因为它可能导致破裂和死亡，”他说。
什么是主动脉瘤?
主动脉是将血液从心脏输送到身体和大脑其他部分的主要动脉。主动脉瘤是主动脉中的气球状凸起。动脉瘤削弱了动脉的这一部分，允许血液剥离或分离其壁，并可能导致其破裂。升主动脉瘤是指在主动脉弯曲进入主动脉弓之前，主动脉的一部分膨胀和变弱。
心包积血意味着在心脏周围的组织中发现了很可能与主动脉瘤有关的血液。如果足够的血液进入心脏周围的组织，它会阻止心脏正常泵血。
医生说，像沃尔氏症这样随着时间推移慢慢发展的主动脉瘤可能没有任何相关症状，直到它变大、剥离或破裂。如果动脉瘤剥离或破裂，有人可能会感到剧烈的胸痛，呼吸困难，变得混乱或昏厥。
据报道，瓦尔最近出现了一些感冒症状，并接受了支气管炎治疗。
“他死前不久经历的胸部压力可能代表了最初的。症状，”Gounder还写道。
医生表示，正在生长的主动脉瘤的一些症状可能类似于呼吸道感染的症状，如咳嗽或胸部不适，但尚不清楚这是否是沃尔的情况。
在医疗紧急情况下，自动体外除颤器也不太可能挽救瓦尔的生命;只有手术才能修复破裂的主动脉瘤。
谁面临风险?
这种情况很少见。没有推荐用于升主动脉瘤的常规筛查试验。虽然还不清楚到底有多少人患有这种疾病，最近的一项研究据估计，包括上行型在内的胸主动脉瘤的患病率约为总人口的0.16%。
据报道，2019年有近1万人死于主动脉瘤或主动脉夹层美国疾病控制和预防中心。
Isselbacher说，位于主动脉下部的腹主动脉瘤有“非常明显的风险因素”——倾向于发生在60多岁和70多岁的人，吸烟者以及高血压或高胆固醇的人。他说，然而，胸部的动脉瘤，如升主动脉瘤，通常不是由那些典型的风险因素引起的，而是由出生时或遗传条件下的主动脉异常引起的。
他说:“这些方法的问题是因为它们没有典型的风险因素，人们不知道他们是否会有这些风险因素。”"但是有一些线索表明你对他们有风险."
他说，对于Isselbacher来说，了解他们的家族史很重要，包括是否有亲属患有心律问题或在年轻时死于猝死，以及如果你有二叶主动脉瓣，因为这可能会伴随着主动脉扩大。
“因为如果你能抓住这一点，你就可以做些什么，”他说。
他说，尽管“绝大多数”主动脉瘤患者是偶然从另一个原因订购的成像研究中发现它们的。
“他们咳嗽，所以做了胸部x光检查。他们是吸烟者，所以他们接受了肺癌筛查CT扫描。他们有些心悸，做了超声心动图。顺便说一句，这些研究显示主动脉增大了，”他说。
根据CDC的说法，升主动脉瘤也可能与高血压、突发损伤和遗传性结缔组织疾病有关，如马凡综合征或埃勒斯-丹洛斯综合征，尽管它们也可能发生在没有已知危险因素的人身上。目前还不知道沃尔是否被诊断患有任何相关的遗传疾病。
已知有马凡综合征或埃勒斯-丹洛斯综合征等风险因素的人通常会进行常规成像，以查看是否存在动脉瘤等潜在问题。但是也有其他人不知道他们有潜在的风险因素或动脉瘤，直到他们有这样的问题。
根据美国心脏协会的说法，如果发现主动脉瘤，何时修复的决定可能取决于相关症状、动脉瘤的大小、生长速度以及个人的潜在健康状况。两种主要的治疗方法是药物和手术。
What to know about ascending aortic aneurysm after Grant Wahl's sudden death at the World Cup
A ruptured ascending aortic aneurysm -- thereported cause of deathof Americansoccerwriter Grant Wahl -- is a rare but deadly medical condition.
Wahl, 49, a prominent journalist in the U.S. soccer community, collapsed on Dec. 9 while covering theWorld Cupin Qatar and could not be revived. On Wednesday, his wife, Dr. Celine Gounder, revealed thatWahl's unexpected deathwas due to the rupture of an undetected ascending aortic aneurysm with hemopericardium, following an autopsy performed by theNew York CityMedical Examiner's Office.
Journalist Grant Wahl attends an awards ceremony at the World Cup,in Doha, Qatar. Nov. 2022.
FIFA via AP
"Grant died from the rupture of a slowly growing, undetected ascending aortic aneurysm with hemopericardium," Gounder wrote in apost on Substack. "No amount of CPR or shocks would have saved him."
When someone who is young and otherwise appears to be healthy dies suddenly, "we worry about the possibility of underlying health conditions," Dr. Eric Isselbacher, the co-director of the Thoracic Aortic Center at Massachusetts General Hospital, told ABC News.
"There's no good way to know, in a case like this, until the autopsy exactly what happened. But we do see things like this happening in young people and it's a sobering reminder of aortic aneurysms, particularly when people don't know about them, because it can cause rupture and death," he said.
What is an aortic aneurysm?
The aorta is the main artery that carries blood away from the heart to the rest of the body and brain. An aortic aneurysm is a balloon-like bulge in the aorta. An aneurysm weakens that portion of the artery, allowing blood to dissect or separate its walls and can cause it to rupture. An ascending aortic aneurysm is one where there is bulging and weakening of a section of the aorta before it curves into the aortic arch.
Hemopericardium means that there was blood found in the tissue surrounding the heart that is most likely related to the aortic aneurysm. If enough blood gets in this tissue around the heart, it can prevent the heart from pumping properly.
Doctors say aortic aneurysms that develop slowly over time, like Wahl's, may not have any related symptoms until it gets large, dissects or ruptures. If an aneurysm dissects or ruptures, someone may feel sharp chest pain, have trouble breathing, become confused or pass out.
It is reported that Wahl was recently experiencing some cold symptoms and was treated for bronchitis.
"The chest pressure he experienced shortly before his death may have represented the initial. symptoms," Gounder also wrote.
Doctors say it is possible that some symptoms of a growing aortic aneurysm could mimic symptoms of a respiratory infection like cough or chest discomfort, but it is not known if that is what happened in Wahl’s case.
It is also unlikely that an automated external defibrillator would have saved Wahl's life during the medical emergency; only surgery can repair a ruptured aortic aneurysm.
Who is at risk?
This condition is rare. There is no routine screening test recommended for an ascending aortic aneurysm. While it is unclear exactly how many people have this condition,one recent studyestimated the prevalence of thoracic aortic aneurysms, including the ascending type, is around 0.16% of the population.
Nearly 10,000 people died from aortic aneurysms or aortic dissections in 2019, reported theU.S. Centers for Disease Control and Prevention.
Abdominal aortic aneurysms, located in a lower section of the aorta, have "very clear risk factors" -- tending to occur in people in their late 60s and 70s, in smokers and people with high blood pressure or high cholesterol, Isselbacher said. Aneurysms that are in the chest, such as an ascending aortic aneurysm, however, are generally not due to those typical risk factors and tend to be due to an abnormality of the aorta from birth or inherited conditions, he said.
"The problem with those is because they don't have the typical risk factors, people don't know if they might have them or not," he said. "But there are a few clues that you're at risk for them."
For Isselbacher, it's important for people to know their family history, including if there is a relative with heart rhythm issues or one who died at a young age from sudden death, and if you have a bicuspid aortic valve, as that could go along with an enlarged aorta, he said.
"Because if you can catch that, you can do something about it," he said.
Though the "vast majority" of patients with aortic aneurysms detect them incidentally from an imaging study ordered for another reason, he said.
"They had a cough, so they got a chest X-ray. They were smokers, so they got a lung cancer screening CT scan. They had some palpitations, they got an echocardiogram. And then those studies, incidentally, show the enlarged aorta," he said.
According to the CDC, ascending aortic aneurysms can also be associated with high blood pressure, sudden injury and inherited connective tissue disorders likeMarfan syndromeor Ehlers-Danlos syndrome, though they can also happen in people with no known risk factors. It is not known if Wahl was diagnosed with any related genetic conditions.
People who are known to have a risk factor like Marfan syndrome or Ehlers-Danlos do often get routine imaging done to see if underlying problems like aneurysms are present. But there are others who don't know they have an underlying risk factor or an aneurysm until they have a problem like this.
According to the American Heart Association, if an aortic aneurysm is found, the decision of when to repair it can depend on related symptoms, the size of the aneurysm, how fast it grows and the person's underlying health conditions. The two main treatment options are medications and surgery.
