Aortic Aneurysm
An aortic aneurysm is a condition where there is a balloon-like bulge that usually occurs due to weakening of the muscles in the aorta wall.
The aorta is the largest and most important blood vessel in the human body. Its function is to distribute oxygenated blood from the heart to all parts of the body.
The aorta has thick walls so it can maintain its shape even though the blood pressure inside it is relatively high.
This wall is actually strong and thick. However, in this condition, the wall becomes weak so that it is unable to withstand blood pressure.
As a result, the wall will start to enlarge. If the wall is torn or broken, this condition can cause bleeding, and can even be fatal.
Symptoms of Aortic Aneurysm
Symptoms of an aortic aneurysm can vary depending on its location. For example, in the abdominal aorta, chest (thoracic) or both (thoraco-abdominal).
However, abdominal aortic aneurysms are more common than thoracic or both locations.
In some conditions, aneurysms with small swelling or bulging usually do not show any symptoms.
However, if it gets bigger, then the sufferer will start to feel many symptoms depending on its location. For abdominal aneurysm sufferers, the symptoms that appear are:
- Prolonged pain in the inner or side of the abdomen.
- Pain in the back.
- It feels like a throbbing sensation around the navel.
Meanwhile, the symptoms that appear if you experience a thoracic or chest aneurysm include:
- Breath becomes short.
- Frequent coughing.
- The voice becomes hoarse.
- Feeling pressure and pain in the chest.
- Pain in the back.
Furthermore, symptoms that may appear if the aortic aneurysm tears or ruptures (dissection), namely:
- Severe pain that occurs suddenly in the back, chest, and abdomen.
- Difficulty breathing.
- The body feels very weak.
- My head felt like it was spinning.
- The heart beats very fast.
Make sure a ruptured aortic aneurysm is treated immediately. Otherwise, it can cause severe bleeding which can be fatal.
Risk Factors for Aortic Aneurysm
It is important to know the risk factors for aortic aneurysm, as this condition often appears during examinations for other conditions.
Well, here are the various risk factors:
- Old age
The risk of aortic aneurysm tends to increase with age. Older people have a greater chance of developing an aortic aneurysm.
- Gender
Men are at higher risk than women. However, women who have a family history of aortic aneurysm or other risk factors are also at higher risk.
- Smoking
Smoking is a major risk factor for developing an aortic aneurysm. The chemicals in cigarettes can damage the artery walls and weaken them.
- Family history
If a family member has had an aortic aneurysm, your risk of having one may increase because there are genetic factors involved.
- Hypertension and heart disease
High blood pressure can damage artery walls and increase the risk of this disease.
Some congenital heart defects or medical conditions that affect blood flow in the body can also increase the risk of an aortic aneurysm.
- History of infection and injury
Infections in the wall of the aorta, such as endocarditis (infection of the heart valves), can cause inflammation and damage the artery wall.
Injury to the chest or abdomen, such as in a car accident or other traumatic event, can cause damage to the aortic wall and trigger the formation of an aneurysm.
- Connective tissue disease
Some diseases that affect connective tissue, such as Marfan syndrome, Ehlers-Danlos, or other connective tissue diseases, can weaken the artery walls and increase the risk of aneurysm.
- Obesity
This condition can increase pressure on the arteries and worsen the risk of aneurysm.
In addition, doctors usually recommend that someone with the following criteria undergo screening:
- Aged 65 or older.
- Male gender.
- Having a bad habit of smoking.
- Have high blood pressure.
- Suffering from high cholesterol.
- The presence of diabetes mellitus.
- Having a family history of aneurysms.
- Having a genetic disorder, such as Marfan syndrome. You can read the article Marfan Syndrome for complete information on this disease.
Causes of Aortic Aneurysm
The cause of an aortic aneurysm is the weakening of one part of the blood vessel, resulting in a lump that is at risk of rupturing at any time.
The exact cause of this weakening of the blood vessels can vary from person to person, ranging from blood vessel disease, injury, to uncertain conditions.
This condition is divided into two types, namely:
1. Abdominal aortic aneurysm
An abdominal aortic aneurysm occurs along the abdominal aorta. This type of aneurysm is the most common, accounting for about ¾ of cases.
The cause of abdominal aortic aneurysm is still uncertain, but it is likely related to atherosclerosis, smoking, high blood pressure, and genetics.
2. Thoracic aortic aneurysm
Thoracic aortic aneurysms occur along the thoracic aorta. This type of aneurysm is less common.
This condition is usually genetically related or can occur in people born with bicuspid aortic valve conditions, Marfan syndrome, and Loeys-Dietz syndrome.
Other causes that can lead to the emergence of an aortic aneurysm are high blood pressure, infection, atherosclerosis, high cholesterol, and trauma.
Diagnosis of Aortic Aneurysm
The doctor will diagnose an aortic aneurysm by conducting a physical examination, medical interview, and radiological examination.
During a physical examination, the doctor will examine the patient’s heart to detect blood flow problems. Then, the doctor will examine the legs and feet.
1. Medical interview
At this stage, the doctor will ask questions covering the symptoms experienced by the sufferer.
For example, when the symptoms started, whether the sufferer smokes or not, the patient’s and family’s medical history, and whether the patient has had a recent chest injury.
2. Radiological examination
This examination has several purposes.
Such as determining the location of the aneurysm, estimating the size of the lump, how fast it is growing, finding out if there are other blood vessels that are infected, and looking for blood clots or inflammation.
These tests include ultrasound, CT SCAN or MRA, echocardiogram, and angiogram.
3. USG
The ultrasound test aims to help doctors check the size of the aneurysm.
Additionally, doctors perform this test to follow any changes in the aneurysm and help measure the risk of rupture of the aneurysm.
4. CT scan and MRA
The doctor will perform a computed tomography (CT) and magnetic resonance angiogram (MRA) examination if a more detailed examination is necessary.
This examination aims to determine the relationship between the aneurysm and the renal blood vessels or other organs, as well as to see the growth of the thoracic aortic aneurysm.
5. Echocardiogram
An echocardiogram is an ultrasound that is used to study the heart.
In order to diagnose a thoracic aneurysm, a person may undergo one of these procedures, either a transthoracic echocardiogram (TTE) or a transesophageal echocardiogram (TEE).
6. Angiogram
An angiogram is a procedure that can help doctors determine the size of the aneurysm, check for aortic dissection or blood clots, and see if other blood vessels are involved.
Aortic Aneurysm Treatment
The main goal of aortic aneurysm therapy or treatment is to prevent the blood vessel from rupturing.
The doctor will look at the size and other possible risk factors in the sufferer to determine the type of therapy.
Here’s how to treat it based on the type of aneurysm:
1. Abdominal Aneurysm
Specifically for abdominal aneurysms, doctors usually determine the choice of therapy based on their size.
- 3-4.4 centimeters: the size is still small, so the doctor will recommend having a routine ultrasound examination every year to monitor the enlargement of the aneurysm.
- 4.5—5.4 centimeters: medium size, so you need an ultrasound examination every three months to monitor the enlargement of the aneurysm.
- 5.5 centimeters or more: size in the large category, usually requires surgery to prevent further enlargement or rupture of the aneurysm.
In addition to regular check-ups, doctors also prescribe medication to prevent or reduce the risk of a ruptured or torn aorta.
Some types of drugs include:
- Statin drugs are used to lower cholesterol levels and reduce the risk of aortic blockage due to atherosclerosis.
- Beta-blockers are a group of drugs that help lower blood pressure by slowing the heart rate.
- Angiotensin 2 receptor blocker (ARB) drugs are used to lower blood pressure if beta blocker drugs do not provide optimal results.
2. Thoracic Aneurysm
Meanwhile, in thoracic aortic aneurysm, doctors provide treatment based on the size of the aneurysm, the severity of the symptoms that appear, and the risk of surgery.
Thoracic aortic aneurysm therapy includes:
- Routine monitoring
This type of therapy is a therapeutic option for small aneurysms that are not at risk of rupture.
Usually, the doctor will recommend a routine CT scan or MRI every 6 months (depending on the size of the aneurysm) to see if the aneurysm is enlarged.
Because it is potentially fatal, you also need to know what first aid is like when experiencing this condition.
- Conventional surgery
Doctors will recommend this procedure in cases where the aneurysm is large and at risk of rupture.
Conventional surgery is performed using general anesthesia and the installation of a special device (graft) to prevent blood flow from pressing on the aneurysm further.
- Endovascular surgery
It is a less invasive surgical procedure. This method uses a special tool that is inserted into the aorta through a small tear or through a catheter inserted into a leg vein.
After the surgical procedure, the doctor will usually ask the patient to be disciplined in adopting a healthy lifestyle and diet.
Not only does this habit help speed up the healing process, it also helps reduce the risk of aortic aneurysm rupture.
Some of the efforts that doctors recommend include:
- Do not smoke.
- Avoid excessive thoughts and anxiety that can trigger stress.
- Do not do heavy physical activities, such as weight lifting.
- Limit fat intake so that blood cholesterol levels decrease.
Complications of Aortic Aneurysm
Complications from an aortic aneurysm can be life-threatening. Some conditions that may occur include:
- Aortic dissection, which is a tear in the inner layer of the aorta wall. This condition causes blood to collect between the inner and middle layers of the aorta wall. As a result, the aorta can rupture or organs cannot get enough blood.
- Aortic insufficiency and aortic regurgitation. Both occur when the aortic valve does not close properly because the adjacent part of the aorta is enlarged. This allows some blood to flow back into the heart. As a result, the heart has to work harder, which can lead to heart failure.
- Rupture of the aorta, which causes dangerous bleeding in the body and leads to shock.
- Cardiac tamponade. This is compression of the heart due to increased fluid in the pericardium, the sac that surrounds the heart.
- Kidney failure, due to lack of blood flow to the kidneys.
- Lack of blood flow to the intestines, which causes inflammation and injury to the colon.
Aortic Aneurysm Prevention
Some efforts you can try to reduce the risk of developing an aortic aneurysm are:
- Implement a healthy diet
Consume foods that are rich in fiber, low in saturated fat, and low in salt to maintain healthy blood vessels.
Fruits, vegetables, whole grains, fish, and nuts are healthy food choices that can help maintain blood vessel elasticity.
- Control blood pressure
High blood pressure (hypertension) can increase the risk of this condition. Therefore, measure your blood pressure regularly and follow your doctor’s recommended guidelines for controlling your blood pressure.
- Stop smoking
Smoking can damage blood vessel walls and increase the risk of aneurysm.
Quitting smoking is a very important step in maintaining healthy blood vessels and heart. This is why smokers are more susceptible to aortic aneurysm disorders.
- Stay active
Exercising regularly can help maintain a healthy weight, improve blood circulation, and strengthen the heart muscle.
Try to live an active lifestyle by doing physical activities that you enjoy.
- Cholesterol control
High cholesterol levels can cause hardening of the arteries (atherosclerosis) and increase the risk of aneurysms.
Control cholesterol levels by eating low-cholesterol foods, exercising, and having regular check-ups.
- Control diabetes
Uncontrolled diabetes can damage blood vessels and increase the risk of this condition. Managing blood sugar levels well is an important step in preventing aneurysms.
- Reduce stress
Chronic stress can negatively impact heart and blood vessel health. Find ways to reduce stress such as meditation, yoga, or enjoyable hobby activities.
- Routine health checks
Having regular health checks can help detect risk factors or health conditions that require early attention.
When to See a Doctor?
Immediately carry out an examination if you feel the symptoms as previously mentioned.
Also ask your doctor if you have high risk factors for this disease, such as high blood pressure, heart disease, genetics, or the bad habit of smoking.