Just hours earlier, Matthew York had been a happy groom vowing to honor his new wife Evelyn. By 5am of the following morning, he was reaching out to her as she slept by his side, pleading that she save his life.
"I woke up and my jaw locked open," remembered York, who was 56 at the time of the eventful weekend in summer 2016. "The pain from my jaw to my heart to my left arm was unimaginable. Within five seconds, I told my wife 'Call 911—I'm having a heart attack.'"
York was right that his cardiovascular system was in immediate danger, but the long-time railroad worker soon learned that he wasn't having a heart attack. The problem was in his aorta, the main artery that distributes blood throughout the body. York needed surgery as quickly as possible and was transported by AirMed from his hometown in Wyoming to University of Utah Health for treatment.
York's aorta had become "dissected" in a very important spot called the ascending aorta, the area where fast-moving blood exits the heart before maneuvering around the tight corner of the aortic arch.
"To handle the pressure, the aorta is very thick and has three layers of tissue that are laminated together like plywood," said U of U Health cardiothoracic surgeon Dr. Jason Glotzbach, who explained that dissection occurs when a tear in the innermost layer of the aortic wall causes blood to flow into the middle layer.
"The tissue on the inside of the aortic wall isn't meant to withstand high pressure — it's soft and spongy — so when the blood travels through the entry tear inside the aorta, it splits apart the components of the wall," Glotzbach said.
A dissected aorta is a time-sensitive emergency because each heartbeat causes more misrouted blood to stream into the aortic wall itself, further damaging the largest artery in the body that extends from the heart's left ventricle all the way down into the abdomen where it splits into two smaller arteries. The general rule, Glotzbach said, is that with each hour that passes with an untreated aortic dissection, patient mortality increases by one percent. So after 48 hours, only half of patients with aortic dissection will survive.
"It's not as common or well-known as heart attack or stroke but it's a devastating problem when it happens," said Glotzbach, one of the experts who make up U of U Health's Aortic Disease Program, which keeps a close watch on patients with acute aortic syndrome, a term that refers to a range of potentially life-threatening abnormalities in the body's main artery.
Aortic dissection, which affects between 4 and 10 out of every 100,000 people per year, can arise from the same chronic health conditions that increase the likelihood of heart attack and stroke, including smoking, high blood pressure, high cholesterol and diabetes. Genetic disorders such as Marfan syndrome and Ehlers-Danlos syndrome also raise the risk of aortic problems.
"It was kind of my fault," acknowledged York, who is feeling like his old self again after recovering from surgery and has even returned to work where he slings a sledgehammer every day. "The No. 1 cause of aortic dissection is untreated high blood pressure. I had received an honorable discharge from the Coast Guard in [the late '70s] for high blood pressure. Being young and smart and thinking I knew everything, I said 'I'm not going to take pills for the rest of my life.'"
Despite untreated hypertension, York had lived an otherwise fairly healthy life that included a 30-year career as a competitive soccer player. But decades of high-powered blood pounding against York's aorta caught up with him in one sudden, early-morning breach. Up until that moment, he'd felt fine.
"I'm very lucky," York said. "There's not many people who live through that. I hate to say that it was a wonderful experience, but it was a wonderful experience because they took such great care of me."
Now that York has come to the attention of the U's aorta experts, Glotzbach said York will be closely monitored in the future.
"That's what we do here at the Aortic Disease Program," Glotzbach said. "We are a multidisciplinary group of providers who take care of patients with all manner of aortic problems. We are going to be following Mr. York for the rest of his life. If things change and he needs another procedure, we'll do it for him. If not? Great. I expect him to have many, many years to live."