Aortic Aneurysm
Doctors said that aortic aneurysms are rare, but they happen more often than people might think. A heart surgeon at the Cleveland Clinic, Dr. Eric Roselli, said that between 1% and 2% of the U.S. population is more likely to get them. Dr. Roselli also said, “A lot of people don’t know anything about it.” “The aorta has not been given enough credit.”
Here’s what you need to know about the condition, what puts you at risk, and how you can treat it.
What is an Aortic Aneurysm?
Aneurysms are abnormally dilated and weak spots in blood vessels, and they can happen anywhere in the body. An aortic aneurysm is a bulge in the aorta, which is the main blood vessel that carries blood from the heart to the chest and the rest of the body.
Aortic aneurysms can affect either the chest (thoracic) or the abdomen (abdominal), the two most common locations. Dr. Douglas Johnston, the chief of cardiac surgery at Northwestern Medicine, said that doctors usually think of abdominal aortic aneurysms as a disease that affects older people, but thoracic aortic aneurysms can also affect younger people.
When an aortic aneurysm forms, what happens?
An aortic aneurysm can cause two main problems. Either a hole can form in the dilated aorta, letting blood burst into the body, or the blood can tear the inner layers of the aorta as it pumps hard through the artery. A dissection is a tear in the layers of the aorta. If blood builds up and continues to tear the artery wall, it can kill the person.
Dr. James Pirruccello, an assistant professor of medicine and cardiovascular researcher at the University of California, San Francisco, said that aortic aneurysms are a leading cause of sudden death in otherwise healthy people.
Dr. Pirruccello said that these problems don’t happen to a lot of people whose aortas are too big. He also said that as the aorta gets bigger, the chance of a tear or a split goes up. Depending on how big the aneurysm is, even people who don’t have any symptoms may need surgery to replace the part of the aorta that is too big.
Who is in danger of getting an aortic aneurysm?
The Centers for Disease Control and Prevention say that people with high blood pressure or high cholesterol, which are both checked for during regular physicals, are more likely to get the disease. Hardening of the arteries is also a risk.
Aortic aneurysms are more likely to happen if you have a bicuspid aortic valve. This means that your aortic valve only has two flaps instead of three. Dr. Johnston said that about 2% of the population has an aortic valve with two flaps.
An abdominal aortic aneurysm is very likely to happen if you smoke. The C.D.C. says that about 75% of all abdominal aortic aneurysms are caused by a history of smoking.
Dr. Eric Isselbacher, an associate professor of medicine at Harvard Medical School, said that men can also have a higher risk of abdominal aortic aneurysms. The U.S. Preventive Services Task Force says that men who have ever smoked and are between the ages of 65 and 75 should get an ultrasound.
Genes also play a role, which is why it’s so important to know about the health of your family. If a sibling or parent in your immediate family has or has had an enlarged aorta, you should talk to your primary care doctor about getting checked. This condition can run in families. Some inherited conditions, like Marfan syndrome and Ehlers-Danlos syndrome, may make it more likely for a person to get an aortic aneurysm. If a family member died suddenly and out of the blue, it’s important to find out why because an aortic aneurysm could have been the cause.
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How do you know if you have an aortic aneurysm and what are the signs?
Dr. Isselbacher said that abdominal aortic aneurysms can be found during a physical exam. He said that doctors can feel enlarged aortas when they push on the abdomen.
But most people who walk around with an aortic aneurysm in their chest won’t feel anything. Dr. Johnston said that some people might feel tightness in the chest or cough. He also said that some people might have a small heart murmur. CT scans and MRIs can find thoracic aortic aneurysms, but doctors don’t usually suggest them unless you have a family history of an enlarged aorta or another genetic risk for it. Aortic aneurysms can also be found with the help of an echocardiogram, which is an ultrasound of the heart.
Dr. Elizabeth Ratchford, who runs the Johns Hopkins Center for Vascular Medicine, said that people with aortic ruptures or dissections may find it hard to breathe or swallow, and they may feel severe chest pain that goes all the way to the back.
Dr. Johnston said, “Anyone who has sudden chest pain should go to the hospital as soon as possible.”
If a person can get emergency care and is diagnosed correctly, they have a good chance of living. Doctors can remove the part of the aorta that has grown and help the patient get better.
How can you make it less likely that an aortic aneurysm will cause problems?
Dr. Pirruccello said that once doctors find an aneurysm, they keep a close eye on the patient and usually do imaging every six months. We can’t just locate it once and cross our fingers that it doesn’t multiply, he said. “We’re very serious about doing it,” he said. When an aneurysm reaches a certain size, surgery may be necessary to repair or replace the affected section of aorta.
But it doesn’t get to that point for all patients. Dr. Ratchford emphasized that monitoring is sufficient for many patients and that they rarely require intervention.
People should keep an eye on their blood pressure to help keep them from getting an aortic aneurysm. Diet, exercise, and sleep are the basic building blocks of cardiovascular health. They are also important tools for lowering the risk of getting an aortic aneurysm or dying from one.
Dr. Johnston said, “An aneurysm is not a death sentence.” If it is managed well, “people can live a normal life and expect to live a normal life,” he said.
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