What is an aortic aneurysm? Here are symptoms, risks and treatments

Soccer journalist Grant Wahl collapsed and died suddenly while covering the World Cup in Qatar. He was only 49 years old and reportedly in good health. His family announced Wednesday that Mr. Wahl had a burst blood vessel leading from his heart and his death was the result of a ruptured aneurysm.

Aortic aneurysms are rare, doctors said, but more common than people might think. About 1 to 2 percent of the US population is prone to developing them, said Dr. Eric Roselli, cardiovascular surgeon at the Cleveland Clinic. “A lot of people don’t know anything about it,” said Dr. Roselli added. “The aorta has been underrated.”

Here’s what you need to know about the disease, risk factors and treatment options.

Aneurysms, which are enlarged and weakened areas of blood vessels, can occur anywhere in the body. An aortic aneurysm is a bulge in the aorta, the main blood vessel that carries blood from the heart throughout the chest and the rest of the body.

There are two main types of aortic aneurysms: thoracic aortic aneurysms, which occur in the chest, and abdominal aortic aneurysms, which occur in the abdomen. Doctors tend to think of abdominal aortic aneurysms as a disease that occurs in older people, said Dr. Douglas Johnston, chief of heart surgery at Northwestern Medicine, but thoracic aortic aneurysms can also affect younger patients. Mr. Wahl had an ascending thoracic aortic aneurysm, according to the autopsy report.

Two main problems can arise from an aortic aneurysm: A hole can form in the enlarged aorta, allowing blood to rush into the body, or blood pumping vigorously through the artery can rupture the inner layers of the aorta. Tearing of the layers of the aorta is known as a dissection, and when blood builds up and continues to break through the artery wall, it can lead to death.

Aortic aneurysms are one of the leading causes of unexpected death in otherwise healthy people, said Dr. James Pirruccello, assistant professor of medicine and cardiovascular researcher at the University of California, San Francisco.

Many people with an enlarged aorta will not experience these complications, said Dr. Pirruccello The risk of a dissection or rupture increases as the aorta gets larger, he added. In some cases, depending on the size of the aneurysm, even patients without symptoms can have surgery to replace the segment of the aorta that is too large.

According to the Centers for Disease Control and Prevention, people with high blood pressure or high cholesterol, both of which are usually tested for during regular physical exams, are more likely to develop the disease. Hardened arteries are also a risk factor.

Having a bicuspid aortic valve, meaning your aortic valve has two leaflets instead of three, puts you at a higher risk of developing an aortic aneurysm. About 2 percent of the population has a bicuspid aortic valve, said Dr. Johnston said.

Smoking is a huge risk factor for abdominal aortic aneurysms. According to the CDC, a history of smoking accounts for about 75 percent of all abdominal aortic aneurysms.

Men may also have a higher risk of abdominal aortic aneurysms, said Dr. Eric Isselbacher, associate professor of medicine at Harvard Medical School. The US Preventive Services Task Force has recommended that men between the ages of 65 and 75 who have ever smoked should undergo an ultrasound.

Genetics also play a role, making it critical to know your family health history. If you have an immediate family member (a sibling or parent) who has or has had an enlarged aorta, you should talk to your primary care doctor about getting tested, as the condition can run in families. Certain inherited disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, can increase a person’s chances of developing an aortic aneurysm. It is crucial to know if a family member died suddenly and unexpectedly, as an aortic aneurysm could be a potential cause.

Abdominal aortic aneurysms can be detected on a physical exam, said Dr. Isselbacher: Doctors can feel enlarged aortas by pressing on the abdomen.

But the average patient walking around with an aortic aneurysm in their chest will have no symptoms. Dr. Johnston noted that some people may feel tightness in their chest or have a cough. Others may have a slight heart murmur, he added.

CT scans and MRIs can detect thoracic aortic aneurysms, but doctors generally don’t recommend them unless you have a family history or other genetic risk for an enlarged aorta. An echocardiogram, or ultrasound of the heart, can also help detect aortic aneurysms.

People with aortic ruptures or dissections may have difficulty breathing or swallowing and may experience severe chest pain that radiates to the back, said Dr. Elizabeth Ratchford, director of the Johns Hopkins Center for Vascular Medicine.

“Anyone who develops sudden chest pain should be in the hospital as soon as possible,” said Dr. Johnston said.

If a patient has access to emergency care and is correctly diagnosed, there is a high probability of survival. Doctors can perform surgery to remove the enlarged part of the aorta and help the patient recover.

Once doctors detect an aneurysm, they monitor patients closely, usually taking images every six months. said Pirruccello. “It’s not like we find it once and hope it doesn’t grow,” he said. “We are aggressive in pursuing it,” he added. “If the aneurysm reaches a critical size, a doctor may perform surgery to replace the segment of the aorta that is too large.”

But for some patients, it doesn’t get to that point. “A lot of people are just monitored and never have to do anything about it,” said Dr. Ratchford said.

To help prevent the development of an aortic aneurysm, people should be aware of monitoring their blood pressure. The basic components of cardiovascular health (diet, exercise, sleep) are critical tools for reducing your risk of developing or dying from an aortic aneurysm.

“An aneurysm is not a death sentence,” said Dr. Johnston said. If managed properly, “people have a normal lifestyle and a normal life expectancy,” he explained.

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