Actor John Ritter died of a dissecting thoracic aortic aneurysm September 11, 2003. His family brought suit against the hospital and doctors approximately one year later. It is reported that the family was seeking more than $25 million in damages, and recently entered into a tentative settlement agreement. Although the amount is undisclosed, this and several other reports state that Ritter’s family members “are potentially receiving a large monetary settlement in this case."
The suit claimed that Ritter underwent “improper and unnecessary procedures”, and “would be alive and well today” if proper procedures had been followed. Is that fair? According to his death certificate he underwent an angiogram and a thoracotomy within a matter of hours. Those are proper procedures for aortic dissection.
The diagnosis of aortic dissection is challenging. Did Ritter have the classic symptoms and risk factors? Although aortic dissection belongs in the differential diagnosis of chest pain it is distinctly uncommon when compared to myocardial infarction and other conditions. The most characteristic feature serving to differentiate chest pain due to dissection from more common causes is that the pain of dissection is sudden and maximal at onset, usually very severe with a tearing quality. Multiple news reports describe Ritter’s condition otherwise, more suggestive of myocardial infarction. Some indicate that the first sign of anything wrong was that Ritter just didn’t feel well and retired to his dressing room. Some reports described the pain as a tightness or pressure, which would not be suggestive of dissection. Nausea and diarrhea are mentioned in some reports, more suggestive of myocardial infarction than aortic dissection.
So, perhaps the symptoms were deceptive. We don’t really know how accurate these reports are. But did he have any telltale risk factors? Marfan syndrome is perhaps the best known. There was apparently no history of that, and his body habitus would not suggest Marfan syndrome. That said it is known, though not well appreciated, that some patients with annuloaortic ectasia resembling that of Marfan syndrome do not have the typical body habitus. In those patients who do not have Marfan syndrome hypertension is an important risk factor. His death certificate lists hyperlipidemia, a risk factor for myocardial infarction, but makes no mention of hypertension.
So, although there’s a lot of room for speculation here I’m going to have to agree with Galen and Rangel in their posts from September 2004. Go and read what they had to say after the suit was announced.