AORTIC
ANEURYSM
On September 11, many of us awoke with a heavy heart because
of the terrorism our country suffered two years earlier, while beloved
actor, John Ritter, woke up and had no idea that his life was about
to end. Mr. Ritter felt tired most of the day, and even took a nap
between breaks of taping his popular new sitcom, which was about to
begin its' second season. After the nap, he informed fellow actor,
Henry Winkler, that he still felt tired, and collapsed soon after.
How many of us are walking around with this
silent and mostly undetected fatal heart ailment? If undetected and allowed to rupture, more than
80 percent of all people will die. Let's look closer at this serious
health problem, which if caught in time, may be successfully corrected,
and if not, you will join the 80 percent.
What is an aneurysm? The term aneurysm comes from the Greek term aneurysma,
which means widening. The widening occurs in a blood vessel, such
as the aorta, the largest artery in the body. What actually occurs
is there is a bulge in a section of the blood vessel, which is like
a worn spot in an old inner tube of a tire. The weakened bulge, which
is under pressure from the pumping of the heart, will actually burst
causing hemorrhage and death.
How does this occur? The causes of aneurysms are numerous and may
include a hereditary component. Hereditary conditions affecting the
elasticity of the blood vessels may also be a cause. Patients that
have arteriosclerosis or "hardening of the arteries," are
at greatest risk. Additionally, many of these folks have high blood
pressure, which is also another major risk factor.
Other causes of aneurysms include a vessel that has been weakened
by infection or an inflammatory process. Anyone who has experienced
trauma to a great vessel is also a tremendous risk for development
of an aneurysm.
Who is at risk? In general, males outnumber females by a five-to-one
ratio in developing aneurysms. Age is another risk factor and most
patients are over the age of 60. If a patient has some of the risk
factors listed above, the incidence of aneurismal development is quite
high.
What are the symptoms? Some of the most common symptoms include chest
and abdominal pain that will radiate into the back. The pain can have
a sudden onset in nature and it may be very severe. Upon arrival into
the emergency department, many people are experiencing uncontrollable
pain. In extreme cases, the blood pressure may be low, which indicates
that the aneurysm has ruptured and death is imminent.
How is it diagnosed? Initially, the health care provider must consider
the history and risk factors. Aortic aneurysm should always be a consideration
in older patients with chest and abdominal pain that radiates to the
back. The evaluation includes assessment of vital signs, laboratory
studies and ultrasound. The CT scan may also be used in helping make
the diagnosis. MRI is not necessary for diagnosis.
How is it treated? The initial incidental diagnosis of an aortic aneurysm
involves close monitoring and measurement through ultrasound or CT
scan. Aneurysms that are five centimeters (about two inches) or less
are followed by radiographic testing every few months.
When the aneurysm continues to get larger, surgical correction is
necessary. Risk for dissection of the aneurysm increases with increased
size. The weakened walls of the blood vessel will allow blood to seep
in between layers of the blood vessel, which can cause narrowing of
the inner size of the vessel. This dissection can lead to rupture
and premature death.
Once diagnosed, surgeons will remove the weakened portion of the vessel
and replace it with Dacron (plastic-like) tubing, where the damaged
vessel previously existed. Recently, the use of stents has been used
to help bypass the damaged vessel. Elective surgical correction is
quite successful, but emergency surgical correction has a high mortality.
What should I do? In the event that you have risk factors and symptoms
for an aneurysm, your health care provider must evaluate you. The
provider will determine the course of action and order the appropriate
tests. Once a diagnosis is made, watchful waiting may ensue. In the
event that the aneurysm is large, your health care provider will arrange
a visit with a surgeon.
As always, prevention is essential. A healthy lifestyle will promote
healthy blood vessels. But, in the event that you have risk factors
and symptoms, a visit to your doctor is essential, as it may save
your life!
