Main
- Aortic rupture causes massive internal bleeding, so an ambulance is called for sudden severe pain in the chest, abdomen or back.
- Causes — atherosclerosis, heredity, high blood pressure, smoking, trauma to the chest or abdomen, infections and inflammation.
- Symptoms — pain or pulsation in the abdomen, pressure in the chest, hoarseness of voice, difficulty swallowing, back pain, shortness of breath.
- Diagnosis — ultrasound examination, computed tomography and magnetic resonance imaging, chest X-ray, blood tests.
- Monitoring is carried out by a vascular surgeon; for the thoracic section a cardiac surgeon is involved; if the risk of rupture is high, surgery is discussed.
What is an aortic aneurysm
An aortic aneurysm is a widening of a section of the body's main artery, which can enlarge over time. On its own it often causes no trouble, but if it ruptures it becomes life-threatening.
What happens in the body
An aortic aneurysm is a localised widening of a section of the main artery, through which blood travels from the heart to all the organs. The vessel wall in this place loses its strength and gradually stretches under the pressure of the blood. The widened section may show no signs of itself for a long time, and the person does not feel the changes taking place. As the wall weakens, the widening can increase, involving an ever larger area of the vessel. The wall becomes thinner and stops withstanding the load as reliably as healthy sections do. The most dangerous outcome is a rupture of the wall, which causes massive internal bleeding. That is why it is important to know about the state of the vessel in advance, so as to keep it under a doctor's supervision.
What causes it to develop
- Atherosclerosis: fatty and calcareous deposits build up on the vessel wall, causing it to lose elasticity and strength.
- Hereditary predisposition: features of the structure of connective tissue are passed down in the family, making the vessel wall weaker from birth.
- High blood pressure: constant increased pressure of the blood stretches the wall from the inside and speeds up its weakening.
- Smoking: tobacco smoke damages the inner layer of the vessel and prevents it from recovering, accelerating the wear of the wall.
- Injury to the chest or abdomen: a blow or compression can damage the vessel wall and set off its gradual widening.
- Infections and inflammatory diseases: inflammation destroys the layers of the vessel wall, and it resists blood pressure less well.
Who faces this more often
An aortic aneurysm is more often detected in older people, especially men, but it also occurs in younger people. With age, the walls of vessels lose elasticity, and the accumulated changes make them more vulnerable to stretching. In people who smoke, the risk is higher than in non-smokers, because tobacco smoke constantly damages the vascular wall. High blood pressure adds load to the weakened sections and speeds up their widening. Heredity also plays a role: if close relatives have had this condition, the likelihood increases. Injuries and past inflammatory diseases of the vessels also increase the vulnerability of the wall. That is why people in risk groups should discuss monitoring of the state of the aorta with a doctor.
What symptoms can there be?
An aortic aneurysm is often asymptomatic, and then it is found incidentally during an examination for another reason. Unpleasant sensations from the pressure of the dilated section on neighbouring organs help to suspect the problem.
How it is noticed at the very beginning
At the beginning of its development, an aortic aneurysm most often gives no sign of itself at all, so a person considers themselves healthy for a long time. When the dilated section begins to press on neighbouring organs, unpleasant sensations appear that are easily put down to fatigue or age. Some note a dull pain or pulsation in the abdomen and explain it as indigestion after a heavy supper. Others feel pressure in the chest and think they have simply overexerted themselves or slept too little. In some people the voice changes, hoarseness appears, and swallowing becomes difficult, and this too is rarely linked to the aorta. Back pain and breathlessness on usual exertion are perceived as a consequence of a sedentary job or excess weight. If such sensations persist and recur, it is sensible not to wait for them to pass on their own, but to see a vascular surgeon or cardiac surgeon as a planned visit.
Signs that occur most often
- Pain or pulsation in the abdomen: a sensation around the navel that intensifies when lying down and makes a person listen to their body.
- Pressure in the chest: a feeling of pressure behind the breastbone unrelated to exertion, unlike the usual heart pain.
- Hoarseness of the voice: the voice becomes duller and weaker, and the cause is sought in a cold or overstrain of the vocal cords.
- Difficulty swallowing: food passes with effort, although the person has no cold and has not complained of this before.
- Back pain: a pulling or aching pain between the shoulder blades and in the lower back, which is easily mistaken for sciatica.
- Breathlessness on exertion: the usual staircase or brisk walking feels harder than usual, and this is a reason for a planned visit to a doctor.
When to seek help urgently
Examinations and tests
Examination for suspected aortic aneurysm begins with a conversation and a physical examination, and the diagnosis is confirmed using imaging methods. Below is a description of exactly what is prescribed and what information each test provides.
How the examination begins
The first appointment begins with a detailed conversation, during which the doctor collects complaints and clarifies risk factors. Then they perform a physical examination, including palpation of the abdomen, to assess the condition of the abdominal aorta. This sequence makes it possible to suspect the problem even before instrumental tests and to determine their scope. To confirm the diagnosis and assess the size of the aneurysm, imaging tests are prescribed, which provide an accurate picture of the vessel. Ultrasound examination is usually performed first, as it is accessible and does not require complex preparation. Computed tomography provides a detailed image of the aorta and helps clarify the extent of the changes. Magnetic resonance imaging clarifies the condition of the vessel wall if additional data are needed. Chest X-ray may reveal widening of the aortic shadow as an indirect sign. Blood tests help assess the general condition and risk factors that influence further management. It is worth collecting all previous reports in advance so that the doctor does not re-prescribe tests that have already been done.
What is prescribed and what it shows
What is worth preparing for the appointment
- Discharge summaries from the medical history: they contain information about previous visits and help the doctor see the picture over time, not only at the moment of the visit.
- Results of previous tests: images and reports from ultrasound, tomography and X-ray show how the size of the aorta has changed over time.
- List of medications taken: a list of what you take regularly is needed to take into account the effect on the vessels and blood pressure.
- Blood pressure measurements: records of home measurements over several days give an idea of typical values outside the consulting room.
- Description of complaints: briefly write down what bothers you and when, this will help you not to forget anything at the appointment and to answer questions accurately.
- Questions for the doctor: formulate in advance what you want to clarify, so the conversation will be focused and you will leave with a clear plan.
Which doctor should I see?
If an aortic aneurysm is suspected, care is provided by a vascular surgeon and a cardiac surgeon, and the approach depends on the size, location and rate of growth of the affected segment. Below — who manages this condition, what treatment consists of, and which part of the result depends on the regularity of monitoring.
Which specialist manages this condition
Aortic aneurysm is managed by a vascular surgeon, and when the thoracic section is involved, a cardiac surgeon is brought in. At the first appointment, the doctor clarifies the complaints, history of illness and risk factors, and measures blood pressure. Then they assess the pulsation of the vessels, examine the abdomen and limbs, and compare this with the results of aortic imaging. Next, the specialist determines the size of the aneurysm, its location and rate of growth, because it is these indicators that set the approach. If the risk of rupture is high, surgery is discussed, while for small sizes monitoring is sufficient. When there is no specialist nearby, one starts with a physician or cardiologist: they will assess the condition and refer to the right specialist. This order saves time and does not allow the moment to be missed when monitoring should be replaced by active measures.
What treatment consists of
- Monitoring by a vascular surgeon or cardiac surgeon: regular examinations and monitoring of the aneurysm's size allow growth to be noticed in time and further approach to be discussed.
- Control of blood pressure and cholesterol levels: keeping these indicators within target limits reduces the load on the aortic wall and slows the change in its segment.
- Giving up smoking: without this step, the other measures work less effectively, since smoking accelerates damage to the vascular wall.
- Surgery when indicated: strengthening or replacing the aortic segment is performed when the risk of rupture outweighs the risks of the intervention itself.
- Endovascular intervention: placement of a stent-graft is performed through the vessels without major surgery, which is important in the presence of concomitant diseases.
What depends on the patient themselves
Regularity of monitoring is the part of the result that rests on the patient themselves, and not only on the doctor. If visits and examinations are missed, the growth of the aneurysm remains unnoticed until the moment when complications appear. Home monitoring of blood pressure gives the doctor a clear picture and helps adjust the approach without haste. Giving up smoking and following dietary recommendations noticeably reduce the load on the aortic wall. Records of how one feels and of the indicators should be brought to the appointment: this way the specialist sees the dynamics, rather than individual scattered values. If new or unusual sensations appear, one should not wait for the scheduled visit; they should be reported earlier. A missed appointment or measures cancelled on one's own negate the doctor's efforts. Calm and consistent following of the plan is the most reliable support in such a situation.
What helps prevent an exacerbation?
The course of an aortic aneurysm is largely influenced by what a person does every day. Below are habits, indicators for regular monitoring and the role of routine visits to the doctor.
What is changed in habits
Giving up smoking is the first thing changed with an aortic aneurysm, because tobacco accelerates damage to the vessel wall. Blood pressure control is no less important: sharp rises create additional stress on the stretched area. Maintaining a normal cholesterol level slows the deposition of plaques, because of which the wall loses elasticity. Regular physical activity without sudden jerks and heavy lifting helps keep blood pressure within calm limits. Timely treatment of infections and inflammatory diseases reduces the risk that the process will affect the vascular wall. The benefit can be noticed by how one feels: fewer episodes of rising blood pressure, a steadier pulse, calmer sleep. The practical conclusion is simple: habits should be changed gradually and each step discussed with the supervising doctor.
What should be kept under control
- Blood pressure: it is measured regularly, because a persistent rise increases the load on the aortic wall.
- Cholesterol level: the results of a blood test are used to judge the risk of deposits affecting the strength of the vessel.
- Smoking: giving it up is considered a key step, since tobacco accelerates damage to the wall.
- Physical activity: it is selected according to one's strength, avoiding sudden jerks and heavy lifting.
- Infections and inflammations: they are treated in a timely manner so that the process does not affect the vascular wall.
- Routine check-ups: they are not skipped even when one feels well, because the condition can change unnoticed.
How often to see the doctor
A regular examination by a specialist is needed even when one feels well and nothing is troubling. An aortic aneurysm can enlarge gradually and remain silent for a long time, so one is guided not by sensations but by the follow-up schedule prescribed by the doctor. At the appointment, they clarify how blood pressure and cholesterol are changing, how things are going with smoking and physical activity, and what the person has changed in their habits. If new complaints appear or something in how one feels shifts, this is reported to the doctor without waiting for the next visit. Missed check-ups lead to changes being noticed later, when it is more difficult to choose a management approach. Practical conclusion: keep the dates of visits in view and reschedule them only together with the doctor.
What is worth remembering
The discussion of aortic aneurysm should be concluded with a few takeaways that will help the reader make a balanced decision. Below is what is important to keep in mind after becoming familiar with the topic.
Main takeaways
An aortic aneurysm can remain silent for a long time, so how a person feels is not a reliable guide. A person often learns about it by chance, during an examination for another reason. Hence the first consequence: the absence of complaints does not cancel out follow-up with a specialist. The second point concerns monitoring — regular check-ups and examinations allow the doctor to keep track of the size and condition of the vessel wall. A sharp spike in blood pressure, heavy physical exertion and lifting heavy objects create extra strain on the changed area. If sudden severe pain appears in the chest or abdomen, radiating to the back, one must not wait and endure it. With an aortic aneurysm, delay in such a situation is more dangerous than any mistake. Therefore, discuss with your doctor in advance which signs require calling an ambulance.
