A man powerful enough to end a war died Tuesday of a tiny tear close to his heart.
Special Envoy to Pakistan and Afghanistan Richard Holbrooke died Monday night at the age of 69 after suffering an aortic dissection, a small tear in the largest artery of the body.
Holbrooke was in a meeting with Secretary of State Hillary Clinton last Friday when he gasped and became ill. Although he was reportedly able to walk himself to the elevator, he was rushed to George Washington University Hospital, where he was diagnosed with an aortic dissection and underwent 20 hours of emergency surgery.
Aortic dissections are uncommon but often fatal, even when patients receive prompt medical attention. For patients with the most severe type A dissections, which are tears located next to the heart, the mortality rate is about 20 percent.
"It's an emergency condition that requires surgery, and the surgery itself is high risk," said Dr. Chris Malaisrie, a Northwestern University Medicine cardiac surgeon. "Left untreated, 50 percent die in 48 hours."
Aortic dissection can strike anyone, although it most often affects men in their 50s. It occurs when a small tear in the inner layer of the artery allows blood to flow into the middle layer.
"Once there's a tear and blood starts traveling, it can get bigger and bigger," said Dr. Richard Lee, a cardiac surgeon, also at Northwestern.
The fluid builds up between the layers of issue, with potential to eventually rupture into the body. Some 15,000 people die annually from aortic aneurysms in the chest, a precursor to more severe dissections, according to the Cleveland Clinic.
"This is very severe," said Malaisrie. "I've seen patients just die in front of my eyes. There's nothing you can do about it."
Symptoms of an aortic tear are similar to those of a heart attack, including severe chest pain, shortness of breath, and fainting.
While there's no one cause, high blood pressure, hardening of the arteries and genetic predisposition can put people at risk. Blunt trauma, as from a car accident, can also trigger the condition, which affects two in every 10,000 people, according to the National Institutes of Health.
Aortic dissection was thrust into the national spotlight in 2003, when it took the life of television star John Ritter. The 54-year-old actor became ill on the set of his TV show, "8 Simple Rules for Dating My Teenage Daughter," and was rushed to a Burbank, Calif., hospital where he died a few hours later.
One prominent figure to survive an aortic dissection was famed heart surgeon Dr. Michael Debakey, who pioneered a surgical procedure used to treat the condition. In 2006, at the age of 97, Debakey underwent seven hours of surgery and made a slow recovery. He died in 2008 at the age of 99.
John Ritter's family sued the hospital where he was treated and later settled over claims that he had been misdiagnosed with a heart attack and could have survived had he been correctly diagnosed.
In his memory, Ritter's widow, actress Amy Yasbeck, began the John Ritter Foundation for Aortic Health, hoping to promote awareness and raise money for research into aortic disease. The organization has released a list of "Ritter's Rules" to help laypeople identify symptoms and risk factors. High-risk individuals are encouraged to monitor the condition of their aorta through an MRI.
What's most important, though, is to seek medical attention if something feels wrong.
"All chest pain is a serious thing. Acute sudden onset chest pain or back pain is serious," said cardiac surgeon Lee. "It's common for people to feel pain, but think they're find and be moments away from dying."