Double Dose with the Coopers · Episode 02 · Heart Health
Aortic Dissection and “Just Heartburn”: When Chest or Back Pain Is an Emergency
In Episode 02 of Double Dose with the Coopers, Dr. Ozita Cooper (“Dr. Z”) brings the emergency room view and Dr. William Cooper brings the heart surgeon’s view to one condition: aortic dissection. Dr. Cooper said it is the condition that has most often brought him out of bed in the middle of the night as a heart surgeon.
The episode comes in two parts. Part 01 covers what a dissection is, who is at risk and how it feels. Part 02 covers diagnosis, treatment and recovery. Along the way the conversation turned to a word people use every day: heartburn.
Watch Part 02 and the October clips
1. What an aortic dissection is
The aorta is the large blood vessel that carries blood out of the heart. Dr. Cooper compared its shape to a candy cane. Dr. Z called it “your lifeline,” because its branches carry blood to the brain, the kidneys, the arms and legs, and other organs.
The wall of the aorta has three layers. In a dissection, Dr. Cooper explained, the inside layer tears. Blood pushes into the middle of the wall, the vessel rapidly expands, and it loses much of its strength. Once that happens, there is a limited window to repair it.
Dr. Z offered a picture anyone can use: a garden hose. If the water runs between the layers of the hose instead of through the middle, it never reaches the grass. When blood cannot reach part of the body, a person may show up with a stroke, a kidney problem or even a heart attack. Doctors call this malperfusion.
Aneurysm or dissection?
An aneurysm is a section of blood vessel that has widened and weakened but has not torn. Dr. Cooper described it as a vessel more than 50% larger than its normal size. A dissection is a tear. The two can happen together, which is why you may hear the term “dissecting aneurysm.”
2. The warning signs
Dr. Cooper said patients describe a sudden pain like someone stabbing them with a knife in the back, between the shoulder blades. They tell him they have had pain before, but not like this.
Dr. Z said the emergency room rarely sees the textbook case. A dissection can look like a kidney stone, a sharp pain on the right side of the chest that feels like tearing or moves, a stroke, or sudden weakness in an arm or leg. One of the fastest checks in the ER is a blood pressure reading in both arms. Dr. Cooper explained that a difference between the two arms can point to a problem with the aorta.
Dr. Cooper also described a patient whose only complaint was a headache unlike any migraine she had ever had. A scan of her head and neck caught the top of the aorta, and a full scan confirmed a dissection.
Dr. Z’s rule is simple: “Any severe pain in any part of your body needs an explanation.”
3. Who is at risk
Dr. Cooper was clear about the most common underlying cause. “Write it down. Put it in your Bible. It’s uncontrolled high blood pressure.” He said a lot of people, especially African Americans and men, are walking around with uncontrolled high blood pressure, and many of them “don’t even know it” because they have not been checked.
Other risks the doctors named:
- An existing aortic aneurysm
- Connective tissue conditions such as Marfan syndrome and Ehlers-Danlos syndrome
- A bicuspid aortic valve, a heart valve with two flaps instead of three that some people are born with
- Cigarette smoking, which can raise blood pressure and damage the inside of blood vessels
- An injury to the chest, such as from a car crash
- A parent, brother, sister or child who had an aortic aneurysm or dissection
Family history also means paying attention to relatives who died suddenly without a clear cause. Dr. Z said aortic dissection is one of the conditions doctors think about in that situation.
4. How doctors find it and fix it
When a patient arrives with this kind of pain, Dr. Z said, the emergency team moves fast: two large IV lines, blood typed and ready for transfusion, a chest X-ray and an EKG, all while the surgeon is on the way. Dr. Cooper said a CT scan is the most common way a dissection is diagnosed. For this scan, a contrast dye goes in through an IV so the blood vessels light up on the images. An ultrasound of the heart, called an echocardiogram, can sometimes show a dissection too.
Dr. Z pointed out a trap. A CT scan for a suspected kidney stone is usually done without contrast. If the pain is severe and the first tests look normal, doctors have to keep looking. The hosts had a name for that moment: “Something ain’t right.” If you feel that way about your own body, they said, it is okay to tell your doctor exactly that.
Treatment depends on where the tear is:
- The ascending aorta, the part that rises out of the heart, needs emergency surgery. Dr. Cooper explained that the surgical team puts the patient on the heart-lung bypass machine, stops the heart, cuts out the torn section and replaces it with a synthetic graft. He tells patients the graft has the feel of a pair of jeans, only thinner and much stronger.
- The descending aorta, farther down in the chest, can sometimes be treated with a stent graft placed through the arteries in the leg. This is called endovascular repair.
- Every patient needs their blood pressure brought down and kept down.
5. Recovery and follow-up
Dr. Cooper said that surviving the surgery does not always mean avoiding complications. A stroke or kidney damage that happened before surgery may not fully go away. Even in the best circumstances, patients usually stay in the hospital about a week. After that come follow-up visits with the cardiologist, the surgeon and the primary care doctor, plus repeat scans over the following months and years.
The most important part, he said, is managing what caused the dissection in the first place, especially blood pressure. A dissection can happen again in a different part of the aorta. Still, barring the most devastating complications, he said most people do well over the long term.
Why knowing your diagnosis matters
Years ago, while building a hospital heart program, Dr. Cooper reviewed the charts of patients his team had operated on for dissection. He found it took an average of 12 hours from when patients first came in for care to when the diagnosis was made. Many of those patients already had a documented aneurysm, so his team started an aortic clinic to follow people with aneurysms more closely.
That clinic later made a difference for one patient. She had been told what a dissection might feel like. When it happened, she called EMS and told them about her aneurysm, the emergency team was ready when she arrived, and she went from first symptoms to finished surgery in about six hours.
If you have been told you have an aortic aneurysm, learn the warning signs, keep your follow-up appointments, and tell EMS and the emergency team about your aneurysm right away.
6. “Just heartburn?” When it may be your heart
Near the end of Part 01, Dr. Cooper added one more kind of pain to take seriously: heartburn. People use the word when they mean acid reflux, he said, but “it could be literally your heart burning.”
He shared that one of his brothers had what he called heartburn for many years and chewed antacids often. He also smoked and had high blood pressure for many years. It was his heart: he had a heart attack. In Part 02, Dr. Cooper added that he has had patients who were out at dinner and assumed their pain was reflux from what they ate.
Frequently asked questions
What does aortic dissection pain feel like?
It usually starts suddenly and is severe. People describe it as sharp, stabbing, tearing or ripping, often in the chest and moving to the back between the shoulder blades. It can also show up as belly pain, a stroke, or weakness in an arm or leg. Call 911.
What is the biggest risk factor for aortic dissection?
High blood pressure. Dr. Cooper called uncontrolled high blood pressure the most common underlying cause, and NHLBI calls high blood pressure the leading risk factor for aneurysms in the chest. Smoking, an existing aneurysm, a bicuspid aortic valve, Marfan or Ehlers-Danlos syndrome, and a family history of aortic disease also raise risk.
Is an aortic aneurysm the same as an aortic dissection?
No. An aneurysm is a widened, weakened section of the aorta. A dissection is a tear in the inner layer of its wall. A large aneurysm can lead to a dissection, and a dissection can make the aorta widen, so the two often come up together.
How is an aortic dissection diagnosed?
Most often with a CT scan using contrast dye. An echocardiogram, a transesophageal echocardiogram or an MRI can also show it. If you have severe pain and your first tests are normal, it is fair to ask your doctor what else could explain it.
How can I tell heartburn from a heart attack?
You cannot always tell on your own. Chest discomfort that lasts more than a few minutes or comes and goes, especially with shortness of breath, a cold sweat, nausea, light-headedness, or pain in the arm, jaw, neck or back, needs a 911 call. Frequent heartburn, more than twice a week, is worth a visit to your doctor.
Should my family get checked if a relative had an aortic dissection?
Tell your doctor. Some aortic conditions run in families, so a parent, brother, sister or child with an aortic aneurysm or dissection can raise your own risk. Your doctor can tell you whether imaging makes sense for you.
Sources
- Double Dose with the Coopers, Episode 02, Part 01 and Part 02 (YouTube, October 19, 2026), and the clips posted October 19, 2026.
- MedlinePlus (National Library of Medicine). Aortic dissection.
- National Heart, Lung, and Blood Institute (NIH). Aortic Aneurysm: Causes and Risk Factors.
- CDC. About High Blood Pressure.
- CDC. About Heart Attack Symptoms, Risk, and Recovery.
- National Heart, Lung, and Blood Institute (NIH). Heart Attack: Symptoms.
- MedlinePlus (National Library of Medicine). Heartburn.
Guidance quoted from these organizations was checked on October 26, 2026.
