Aortic Aneurysm
Your heart pumps blood into your aorta—the largest artery in your body. The aorta carries oxygen-rich blood from the heart to your entire body.
Sometimes the wall of the aorta can weaken. If this happens, the wall expands because of the constant pressure of blood flowing against it and may bulge or balloon out. This condition is called an aortic aneurysm. It can happen in your chest (thoracic aortic aneurysm) or abdomen (abdominal aortic aneurysm).
If you’ve been told you have an aortic aneurysm, it probably took you by surprise. Usually there are no symptoms. The aneurysm is often found by chance on imaging tests that were ordered to rule out other problems. Still, it can be a scary diagnosis. As the aneurysm gets bigger, it can burst, causing internal bleeding that is nearly always fatal. But through careful monitoring, you and your health care team can keep close tabs on the aneurysm to figure out the best course of action—one that helps you live a long, active life.
Treatment depends on the location, size and cause of the aneurysm and how fast it is growing. Treatment may include careful monitoring, surgery, medications, and/or lifestyle changes. Use this condition center to learn more about living with aortic aneurysm. You can also read about the latest research, create a list of questions to ask your doctor and much more.
Questions to Ask Your Doctor
If you've been diagnosed with aortic aneurysm, there are several key questions that you should ask your cardiologist during your next visit. These questions will ensure that you and your doctor have discussed your major risk factors so that you can become or stay as healthy as possible.
- What risk factors are associated with the development of an aortic aneurysm?
- What symptoms of aortic aneurysm should prompt me to seek medical attention?
- When should an aortic aneurysm be repaired?
- Who should be screened for aortic aneurysms?
- How often should my doctor order tests to monitor the size of my aortic aneurysm?
- Are aortic aneurysms hereditary?
- Are aortic aneurysms associated with other medical conditions?
- If I need to have my aortic aneurysm repaired, should I undergo an open-repair or an endovascular repair?
- Should I be screened for aneurysms in other parts of my body?
- Are there any restrictions to my exercise program because of aortic aneurysm?
Overview
An aortic aneurysm occurs when a section of the aorta, the body's main artery, becomes enlarged. The aorta carries blood and nutrients (fuel) from the heart (the engine of the body) to the rest of the body.
Because the aneurysm can stretch and weaken like a balloon, it can burst. If the aorta bursts, it can cause serious internal bleeding that can be fatal.
The aorta looks like a walking cane. The first part is the ascending aorta. The second portion is the arch. The third portion is the descending aorta. Aneurysms can form in any section of the aorta.
When one forms in the belly area—the most common location—it is called an abdominal aortic aneurysm. When one forms in the upper body, it is called a thoracic aortic aneurysm.
Causes
The wall of a normal aorta stretches like a balloon. It can expand and contract depending on blood flow. The wall of your aorta can become stiff because of hardening of the arteries (atherosclerosis) often caused by high blood pressure, cholesterol, or age. These conditions also can weaken the aorta wall and cause it to bulge.
Other less common causes of aortic aneurysm include:
- People who have problems with the structure of the aortic wall that are inherited (for example Marfan syndrome and other less common diseases)
- People born with a bicuspid aortic valve (they have two aortic valve leaflets instead of the normal three), which is associated with aortic aneurysms
- Syphilis
- Turner syndrome (genetic disease)
- Inflammation of the wall of the aorta (aortic arteritis)
- Aortic dissection
- Trauma, such as a hard hit to the chest that damages the aorta
Signs and Symptoms
Most people with aortic aneurysms do not show signs or feel an aortic aneurysm. Usually, the aneurysms are found when exams or tests, such as a CT scan or echocardiogram, are done for other reasons.
For example, if a murmur is heard on exam, your health care professional may order an echocardiogram for the murmur and discover an ascending thoracic aortic aneurysm. Patients with an aortic aneurysm also may show signs of congestive heart failure.
In the rare cases people do report symptoms, the issues are often related to the aneurysm pushing against:
- Windpipe (trachea) causing trouble breathing, wheezing coughing or recurrent pneumonia
- Nerve to the vocal cord (laryngeal nerve) causing a hoarse voice Esophagus making it difficult to swallow
The symptoms may occur once in a while or stay constant. Belly, chest or back pain is less common but may indicate an emergency. The feared result is a tear in the aortic wall (dissection) or rupture, which can cause severe pain, internal bleeding and can lead quickly to death.
Other problems can occur when clots form because of the abnormal blood flow in the bulge of the aneurysm. These clots can break off and travel to the brain (causing a stroke) or to other organs in the belly, arms or legs.
What Increases Your Risk?
Several factors can increase your risk of developing an aortic aneurysm, rupture, or dissection:
- High blood pressure: Blood pressure applies force to the wall of the aorta.
- Smoking: Tobacco use is linked with a higher risk of developing an aneurysm.
- Family history: If any of your first-degree relatives (mother, brother, father, sister or child) has a history of aneurysm, you are at a greater risk of the condition.
If you have an aortic aneurysm, multiple factors increase the risk of it bursting (rupture) or tearing (dissection). These include the size, type, and overall cause of the aneurysm as well as your blood pressure.
The size of the aneurysm is the best predictor of risk. Larger aneurysms are more likely to burst or tear. Aneurysm size relative to patient size may be an even more useful measure. Thus for the same size aneurysm, a smaller patient has a greater chance for rupture or dissection than a bigger patient. Specific types of aneurysms may be at increased risk for rupture depending on the cause, shape, size, and patient factors.
The cause of the aneurysm plays a large role in risk. Aneurysms caused by certain genetic conditions, such as Marfan Syndrome or Ehlers Danlos Syndrome, are more likely to rupture due to the weakened aortic wall. In these patients, surgery often may be recommended when the aneurysm is at smaller sizes.
When to Call a Doctor
If you have an aortic aneurysm, the symptoms may feel like those of a heart attack or stroke. The most common symptom is pain. If you know you have an aortic aneurysm, or if you have a family history of aortic aneurysm, you should call 911 if you develop chest, back, or belly pain.
Exams and Tests
What exams or tests may be used to detect an aortic aneurysm? The U.S. Public Health Service recommends a one-time screening exam of the belly, an abdominal ultrasound, in some patients. These include men older than 65 or women older than 75 who have a history of smoking.
However, there is no recommendation to test for thoracic aortic aneurysm for the general population. If you have first-degree relatives (mother, brother, father, sister or child) with a history of aneurysm, you should talk to your doctor about whether you need a screening.
If you have symptoms, such as severe chest or abdominal discomfort (see Section 1: Overview), you should seek immediate medical attention. Your health care professional likely will do some basic tests including:
- Blood pressure evaluation
- Listening to your heart
- Chest X-ray
- Electrocardiogram (ECG)
These tests are almost always done but are not enough to fully identify an aortic aneurysm or dissection (tear).
The most common emergency test for aortic aneurysm involves a computed tomography (CT) scan of the chest, and possibly abdomen and pelvis, depending on the case. A CT scan is considered a very safe procedure and generally involves only a small amount of X-ray radiation exposure. Also, an imaging contrast agent is given to the patient through a vein.
Another test may include a transthoracic echocardiogram (TTE), which is an ultrasound placed on the chest to view the heart, similar to an ultrasound of a baby. A TTE can identify an aneurysm in the abdominal aorta and the beginning of the thoracic aorta. However, it may not be able to see important sections of the aortic arch and further along the thoracic aorta.
A TTE is more limited than a CT scan. However, a TTE can detect complications related to an aneurysm dissection, including problems with heart valves, fluid around the heart, or a heart attack from a tear of important blood vessels or loss of blood.
Another test you may have is a transesophageal echocardiogram (TEE). This test can evaluate the entire aorta as effectively as a CT scan. A TTE may, however, miss certain sections of the aorta. This test also requires the patient to be sedated and may cause a patient's blood pressure to drop lower, which is not desirable. However, a TEE may be useful for certain patients, including those who are on a breathing machine or in the intensive care unit.
Finally, a magnetic resonance imaging (MRI) scan may be performed. For patients with long-term, stable aneurysm, an MRI may be useful. However, MRI is not commonly used for emergency cases.
Treatment
If you have an aortic aneurysm, treatment depends on the location, size and cause of the aneurysm, and how fast it is growing. Treatment may include careful monitoring, surgery, medications, and/or lifestyle changes. If your doctor has recommended watching the progression of your aneurysm, read Living With an Aortic Aneurysm to learn more.
In some cases, your aorta may need to be repaired. Depending on the section of the aorta that needs to be fixed, this may be done through:
- Open surgery: Repairing the aorta with surgery involves opening the chest, usually through the sternum (called a sternotomy). The aorta is the source of blood for the heart, so repair requires the heart to be stopped and protected using a heart-lung bypass machine. If the section needing to be fixed is the ascending aorta, then open surgery is the only option. The extent of the repair affects the approach of the operation. Two main approaches are ascending or hemi-arch replacement.
- Procedure called stenting: In this procedure, metal support stents are inserted through a blood vessel without open surgery. Stenting often can be done for the abdominal aorta and the descending thoracic aorta. The structure of the ascending aorta makes it difficult to use a stent.
Living With Aortic Aneurysm
You can help slow the growth of the aneurysm and prevent complications by paying close attention to other health problems you may have and living a healthy lifestyle.
The most important way you can slow the progress of an aneurysm is to control your blood pressure. If you have high blood pressure, the extra force pushes against the walls of the aneurysm causing it to expand.
If you have been given medicine for your blood pressure, it is very important to take it exactly as instructed. Your doctor may also advise you not to lift heavy weights, which may cause sudden increases in your blood pressure.
Smoking, obesity, drinking too much alcohol, and a sedentary lifestyle all contribute to high blood pressure. At the same time, these are all bad for your overall health. If you need to have surgery or a procedure to repair your aorta, your overall health would factor into your recovery. Therefore, it is important to:
- Keep a healthy weight or have a body-mass index (BMI) of less than 30. (Calculate your BMI).
- Keep your blood pressure controlled.
- Quit smoking, if you do. There are medications and counseling options available to help you stop; 1-800-QUIT-NOW is a great resource.
- Be physically active.
Prevention
An aortic aneurysm can be caused by atherosclerosis, hardening of blood vessels from the buildup of plaque (cholesterol and fat). It is important to understand the risk factors you can control—called modifiable risk factors—that contribute to the development of the disease.
You can keep track of your modifiable risk factors if you "Know Your Numbers." These numbers refer to key markers of health such as blood pressure, cholesterol, blood sugar, body mass index (BMI) and waist circumference.
Although health care professionals check most of these numbers at annual checkups, it's important for you to know your numbers and understand what they mean. That way, you can prevent heart disease before doctors are needed to cure it. By keeping your numbers within a healthy range, you can do a lot to improve any disease caused by atherosclerosis. Here are some steps you can take:
- Follow a healthy diet. A healthy diet is a good way to prevent heart disease from the buildup of plaque (cholesterol and fat deposits), including an aortic aneurysm. This includes: three to five servings of vegetables and two servings of fruit per day; two servings of fish high in omega-3-fatty acids per week; four handfuls of almonds or walnuts per week; use of healthy oils like olive and canola; and picking whole grains over refined grains.
- Be active and maintain a healthy weight. Be physically active and keep a healthy weight. The American Heart Association recommends 40 minutes of aerobic exercise of moderate to vigorous intensity three to four times a week. Healthy weight is based on Body Mass Index (BMI), a numerical value of your weight in relation to your height. A BMI between 18.5 and 24.9 indicates a normal weight.
- Stop smoking. If you smoke tobacco, please consult with your health care professional about ways to quit. Use of any tobacco product increases your blood pressure and promotes plaque buildup within the blood vessels. There are many aids, and even apps, now available to help you quit. Avoid secondhand smoke.
- Limit alcohol. If you drink, drink in moderation. That means no more than one drink per day if you're a woman and no more than two drinks per day if you're a man.
- Control diabetes. If you are unsure whether you have diabetes, speak with your health care professional about how to find out. And, if you have diabetes, it is important to take steps to control your blood sugar. Over time, high blood sugars can damage the inside of your blood vessels and lead to atherosclerosis.
- Manage high cholesterol. Consult with your doctor to find out whether you need a lipid panel, a blood test to check your cholesterol levels. If you don't reach your goal cholesterol number despite eating a healthy diet and exercising regularly, your doctor may prescribe lipid-lowering medicine, such as statins.
- Keep your blood pressure controlled.
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