The sudden death of Senator Lindsey Graham has brought attention to a medical emergency many people know little about.
According to preliminary findings reported after his death on July 11, 2026, the possible cause was an aortic dissection related to arteriosclerotic cardiovascular disease, commonly described as hardening of the arteries.
An aortic dissection can strike suddenly and become deadly within minutes or hours. But the damage that leaves a person vulnerable may have been developing silently for years.
The condition is considered rare, and although Sen. Graham was 71, it can affect younger people. Aortic dissection took the lives of actor John Ritter at the age of 54 and sportswriter Grant Wahl at just 49.
That raises an important question: Is there anything you or your doctor can do to spot the danger before an emergency occurs?
Let’s talk in depth about risks, including the ones you can change, warning signs and symptoms, as well as what to ask your doctor.
What happens during an aortic dissection?
The aorta is the largest artery in your body. It carries oxygen-rich blood from your heart to nearly every other area of the body.
An aortic dissection begins when a tear develops in the inner layer of the aorta. Blood is then forced through that opening and between the layers of the artery wall, causing them to separate.
The dissection can block blood flow to the heart, brain, kidneys, intestines or limbs. It can also cause the aorta to rupture, resulting in massive internal bleeding.
A Type A dissection involves the ascending portion of the aorta near the heart and generally requires immediate surgery. A Type B dissection begins farther down the aorta and may sometimes be treated initially with intensive blood pressure control, although surgery or an endovascular procedure may also be necessary.
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Why doctors may check blood pressure in both arms
Most of us are accustomed to having blood pressure measured during doctor visits. Your nurse may ask which arm you prefer, but most often it’s measured from the left arm.
However, medical guidance recommends measuring blood pressure in both arms during an initial evaluation. When a consistent difference is found, the arm with the higher reading is generally used for future monitoring.
That is important because relying on the lower-pressure arm could make a person’s blood pressure appear healthier than it really is.
A sizeable and persistent difference between the two arms may also point to an obstruction or narrowing in one of the arteries that supplies blood to the arms.
During an active aortic dissection, the tear can sometimes extend into one of these branching arteries, reducing blood flow to one arm. This may produce a lower pressure or a weaker pulse on that side.
For that reason, unequal blood pressure or pulse between the arms is one of several warning signs emergency physicians consider when evaluating someone with sudden chest or back pain.
But there is an important limitation.
A difference between your arms does not necessarily mean you have an aortic dissection, and normal readings in both arms cannot rule one out. Many people experiencing a dissection do not develop a noticeable difference.
Checking both arms is therefore not a test that can predict whether a dissection is about to happen.
What it can do is help uncover high blood pressure that has been underestimated or reveal a possible circulation problem that deserves further evaluation.
High blood pressure is the risk you can change
Although an aortic dissection may appear to come out of nowhere, uncontrolled high blood pressure is one of its most important risk factors.
Over time, excessive pressure against the inside of the aorta can damage and weaken its wall. The danger may be even greater when high blood pressure occurs alongside atherosclerosis, smoking or age-related changes in the arteries.
That makes knowing your true blood pressure one of the most practical steps you can take.
Consider asking your healthcare provider:
- Has my blood pressure ever been checked in both arms?
- Is there a consistent difference between the readings?
- Which arm should I use when checking my pressure at home?
- Is my current blood pressure putting unnecessary strain on my arteries?
- Does my health or family history suggest that my aorta should be examined?
A single unequal reading is not necessarily meaningful. Position, cuff placement, movement and the natural fluctuation of blood pressure can all affect the result. Doctors generally look for a difference that remains when the measurement is repeated correctly.
Who may need a closer look at the aorta?
Routine imaging of the aorta is not recommended for everyone. But certain people have a higher chance of developing an aortic aneurysm or dissection.
Risk factors include:
- Long-term or poorly controlled high blood pressure
- A known aneurysm or enlargement of the aorta
- Atherosclerosis
- Smoking
- A bicuspid aortic valve
- A close relative with an aortic aneurysm or dissection
- A family history of unexplained sudden death
- Genetic conditions such as Marfan syndrome, Loeys-Dietz syndrome or vascular Ehlers-Danlos syndrome
- Previous heart or aortic surgery
- Traumatic injury to the chest
The ACC/AHA aortic disease guideline recommends screening first-degree relatives of people with an aneurysm of the aortic root or ascending aorta, or an aortic dissection. Screening may involve genetic evaluation and imaging of the aorta.
That means it is worth telling your doctor if a parent, sibling or child had an aortic emergency, even if you feel completely well.
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The symptoms that should never be ignored
The most widely recognized symptom of an aortic dissection is sudden, severe pain in the chest or upper back.
Unlike pain that gradually builds, dissection pain is often intense from the moment it begins. It may spread into the neck, back, abdomen or legs.
Other warning signs can include:
- Fainting or sudden weakness
- Shortness of breath
- Heavy sweating
- Confusion
- Difficulty speaking
- Weakness or numbness on one side of the body
- A weak pulse in one arm or leg
- A cold, pale or painful limb
- Sudden symptoms resembling a heart attack or stroke
These symptoms do not always occur in the same combination. An aortic dissection can also be mistaken for a heart attack, stroke, digestive problem or pulled muscle.
Sudden, severe chest or back pain—especially when accompanied by fainting, breathing difficulty or stroke-like symptoms—requires an immediate 911 call.
Do not spend time repeatedly checking your blood pressure or attempting to drive yourself to the hospital. Aortic dissection is an emergency in which every minute matters.
Protecting the body’s largest artery
Not every aortic dissection can be prevented. Inherited weaknesses in the artery wall and previously undetected aneurysms can make some people vulnerable despite their best efforts.
But many of the steps that protect your heart also protect your aorta.
Keep your blood pressure under control, avoid smoking, address unhealthy cholesterol levels and follow through with recommended imaging if an enlarged aorta has already been found.
And the next time your blood pressure is checked, consider asking that they measure both arms. Be aware of other factors that can lead to inaccurate BP readings.
It is not a crystal ball for predicting an aortic dissection. But it could reveal that your blood pressure — or your circulation — deserves a closer look.
Sources:
Sen. Lindsey Graham likely died after aorta tear, medical examiner says — Associated Press
2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease — Circulation
Characteristics of the Inter-Arm Difference in Blood Pressure in Acute Aortic Dissection — Journal of Nippon Medical School
Associations Between Systolic Interarm Differences in Blood Pressure and Cardiovascular Disease Outcomes and Mortality — Hypertension
2024 ESC Guidelines for the Management of Elevated Blood Pressure and Hypertension — European Heart Journal
What Is an Aortic Dissection? — American Heart Association
Aortic Dissection: Symptoms and Causes — Mayo Clinic
FAQ: Aortic dissection risks, symptoms and blood pressure checks
Checking both arms cannot predict or rule out an aortic dissection. However, a persistent difference between the arms may reveal underestimated high blood pressure or a possible circulation problem. During an active dissection, doctors may also consider unequal arm pressures or pulses as one of several diagnostic clues.
A persistent difference of approximately 10 mm Hg or more in systolic pressure may be associated with increased cardiovascular and vascular risk. One uneven reading does not necessarily indicate a problem, so the measurements should be repeated correctly and discussed with a healthcare provider.
The most common warning sign is sudden, severe pain in the chest or upper back that is intense from the moment it begins. Other symptoms may include fainting, shortness of breath, sweating, stroke-like symptoms, abdominal pain or a weak pulse in an arm or leg.
People with a known enlarged aorta, bicuspid aortic valve, certain connective-tissue disorders or a close relative who experienced an aortic aneurysm or dissection may need imaging or genetic evaluation. A family history of unexplained sudden death or emergency aortic surgery should also be shared with a doctor.
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