thoracic aortic aneurysm

What Is Aortic Aneurysm?

Aortic Aneurysm

Aortic aneurysms are balloon-like bulges that occur in the aorta, the main artery carrying oxygen-rich blood to your body.

The aorta has thick walls that stand up to normal blood pressure. However, certain medical problems, genetic conditions, and trauma can damage or weaken these walls. The force of blood pushing against the weakened or injured walls can cause an aneurysm.

This health topic focuses on two types of aneurysms that affect the aorta: abdominal aortic aneurysm (AAA) and thoracic aortic aneurysms (TAA). Both types are separate conditions with different risk factors and causes.

  • Abdominal aortic aneurysm is the most common place for an aneurysm. The abdominal part of the aorta runs through the stomach area. It carries oxygen-rich blood from the heart to the tissues and organs of the abdomen and lower limbs.
  • Thoracic aortic aneurysm occurs in the chest portion of the aorta, above the diaphragm, and is less common.

Aortic aneurysms can develop and grow before causing any symptoms. If the aortic aneurysm grows large, it can burst (rupture) or tear the wall of the artery (dissection), both of which can be life-threatening. Early diagnosis and treatment may slow the growth and prevent serious or life-threatening complications.

What raises my risk for aortic aneurysms?

You may have an increased risk of developing an aortic aneurysm because of your age, family history, genes, lifestyle habits, medical conditions, or sex.

Age: Your risk for aortic aneurysms goes up as you age. Abdominal aortic aneurysms are most common in adults after age 65.

Family history and genetics: One in 10 people with abdominal aortic aneurysms have a family history of them. The chance of developing an abdominal aortic aneurysm is 1 in 5 for people who have a parent, brother, sister, or child with the condition, what is known as a first degree relative.

Several family or genetic conditions increase your risk for a thoracic aortic aneurysm. These include:

  • Ehlers–Danlos syndrome
  • Loeys–Dietz syndrome
  • Marfan syndrome
  • Turner syndrome
  • Familial thoracic aortic aneurysms
  • Bicuspid aortic valve (BAV), which is an abnormal aortic valve

Lifestyle habits: Some lifestyle habits increase your risk of having an aortic aneurysm. These include:

  • Cigarette smoking is one of the main factors that increases your risk for an aortic aneurysm, especially an abdominal aortic aneurysm. If you are a current smoker, an abdominal aortic aneurysm may grow more quickly and be more likely to burst.
  • Stimulants such as cocaine, increase your blood pressure and your risk for an aortic aneurysm.

Medical conditions: Medical conditions that are risk factors for aortic aneurysms include:

  • Aneurysms of blood vessels in other parts of your body
  • Chronic obstructive pulmonary disease (COPD)
  • Cardiovascular conditions, such as atherosclerosis, coronary heart disease, and peripheral artery disease
  • Unhealthy blood cholesterol level
  • High blood pressure, which is the leading risk factor for thoracic aortic aneurysms but also a risk factor for abdominal aortic aneurysm
  • Bacterial infections, which are a risk factor for thoracic aortic aneurysms.
  • Kidney conditions, such as renal failure, chronic kidney disease, and polycystic kidney disease
  • Obesity
  • Pheochromocytomaexternal link, a rare tumors of the adrenal gland that can lead to high blood pressure
  • Trauma, such as from car accidents or falls, which is a risk factor for thoracic aortic aneurysms
  • Vasculitis

Sex: Men are more likely than women to develop aortic aneurysms. However, an existing aneurysm is more likely to rupture at a smaller size in women than in men.

Race and ethnicity: Aortic abdominal aneurisms are less common in Hispanics, African Americans and Asian Americans.

Preventing aortic aneurysms

If you have risk factors for developing an aneurysm, your provider may recommend heart-healthy lifestyle changes to help prevent the condition, including:

  • Avoid stimulants, such as cocaine
  • Heart-healthy eating
  • Manage stress, which can help lower high blood pressure
  • Quit smoking, especially cigarette smoking, a leading risk factor for developing an aortic aneurysm

What are the symptoms of an aortic aneurysm?

An aortic aneurysm may not cause any symptoms. The types of symptoms you have will depend on the location of the aneurysm and whether it has become large enough to affect other parts of your body. If you do have symptoms of an aortic aneurysm, they may include:

  • Difficult or painful swallowing if the aneurysm pushes on your esophagus, the tube that connects your mouth and your stomach
  • Difficulty breathing if it pushes on your trachea, or windpipe
  • Feeling full after not eating very much
  • Hoarseness
  • Pain in the neck, jaw, back, chest, stomach area or shoulder, depending on where the aneurysm is located
  • A pulsating or throbbing feeling in your stomach area
  • Shortness of breath if the aneurysm presses on your lung
  • Swelling of the face, neck, or arms if the aneurysm pushes on the superior vena cava, the main vein returning blood from your upper body to your heart

If you know you have an aortic aneurysm, it is important to know the symptoms of a rupture, or tear in the aorta, since quick treatment may save your life. Symptoms of a rupture may include:

  • Light-headedness
  • Rapid heart rate
  • Sudden, severe pain in your stomach area, chest, or back

Diagnosis

During a physical exam, your provider may do a few basic steps to look for an aortic aneurysm.

  • Feel your stomach area.
  • Listen to your heart for a heart murmur, softer heart sounds, or other changes in your blood flow that could be a sign of an aneurysm.
  • Check your pulse in your arms and legs to see whether it feels weaker than normal.
  • Look for symptoms of medical conditions that are risk factors for an aortic aneurysm, such as Marfan or Ehlers-Danlos syndromes. This may include looking at your skin, muscles and bones, eyes, head and face, and heart.

Screening and diagnostic tests

Screening for aortic aneurysm is usually done using ultrasound. This test shows if the diameter of your aorta is bigger than it should be. If it is larger than normal, your provider may recommend another screening later to check for growth.

To make the diagnosis your provider may order some tests.

  • Ultrasound provides information about the size of the abdominal aortic aneurysm and monitors the aorta over time. If you have abdominal or back pain, an ultrasound can check for an abdominal aortic aneurysm or other possible causes of your pain. Once an aortic aneurysm is seen or suspected on ultrasound, you may have a CT scan or an MRI to provide more details about the shape or location of the aneurysm.
  • Echocardiography provides information about the size of the aortic aneurysm and about the thoracic aorta, which is close to heart. Other parts of the thoracic aorta are better seen with other imaging studies such as CT or magnetic resonance imaging (MRI).
  • MRI provides information about the size, shape, and location of the aneurysm.

Who should be screened for a thoracic aortic aneurysm?

Certain groups of people may be screened for a thoracic aortic aneurysm. They include:

  • People who have Marfan, Loeys–Dietz, Ehlers–Danlos, or Turner syndrome
  • Parents, children, and siblings (first-degree relatives) of people who have a thoracic aortic aneurysm or a bicuspid aortic valve (BAV)-associated thoracic aortic aneurysm

Who should be screened for an abdominal aortic aneurysm?

There are certain groups of people who may be screened for abdominal aortic aneurysm:

  • Men 65 to 75 years old who have ever smoked or who have a first-degree relative with the condition 
  • Men 65 to 75 years old who never smoked but have other risk factors, such as a family history, other vascular aneurysms, or coronary heart disease 
  • Men and women more than 75 years old who are in good health, who have ever smoked, or who have a first-degree relative with the condition 
  • People who have peripheral artery disease, regardless of age, sex, smoking history, or family history 
Treatment

Treatment for your aortic aneurysm will depend on its size, location, and the factors that put you at risk. Small aortic aneurysms may be managed with healthy lifestyle changes. The goal is to slow the growth of the aneurysm and lower the chance of rupture or dissection. Your healthcare provider may treat other medical conditions that raise your risk for rupture or dissection, such as high blood pressure, coronary heart disease, chronic kidney disease, and high blood cholesterol. Surgery may be recommended to repair large aneurysms.

Healthy lifestyle changes: Your provider may recommend heart-healthy lifestyle changes.

  • Quit smoking. This is the most important part of your treatment to slow the growth of the aneurysm. The risk of rupture drops after smoking stops, especially in women.
  • Heart-healthy eating helps lower high blood pressure or high blood cholesterol.
  • Manage stress to help control high blood pressure, especially for thoracic aortic aneurysms. Your provider may also suggest that you avoid heavy weightlifting and powerful stimulants, such as cocaine.
  • Get physical activity. Studies show that moderate physical activity does not raise the risk of rupture or growth of the aneurysm and can have health benefits. Talk to your provider to learn which level of physical activity is right for you.

Medicines

Your provider may recommend some medicines.

  • Aspirin, may be recommended, especially if you have other cardiovascular risks.
  • Blood pressure medicines lower blood pressure. These medicines include beta blockers, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs).
  • Statinsexternal link control cholesterol levels.

Source: https://www.nhlbi.nih.gov/health/aortic-aneurysm

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