Disease: Thoracic aortic aneurysm
A thoracic aortic aneurysm is a weakened area in the upper part of the aorta. The aorta is the major blood vessel that feeds blood to the body.
A thoracic aortic aneurysm may also be called thoracic aneurysm and aortic dissection (TAAD) because an aneurysm can lead to a tear in the artery wall (dissection) that can cause life-threatening bleeding. Small and slow-growing thoracic aortic aneurysms may not ever rupture, but large, fast-growing aneurysms may rupture.
Depending on the cause, size and growth rate of your thoracic aortic aneurysm, treatment may vary from watchful waiting to emergency surgery. Ideally, surgery for a thoracic aortic aneurysm can be planned if necessary.
Thoracic aortic aneurysms often grow slowly and usually without symptoms, making them difficult to detect. Some aneurysms will never rupture. Many start small and stay small, although many expand over time. How quickly an aortic aneurysm may grow is difficult to predict.
As a thoracic aortic aneurysm grows, some people may notice:
- Tenderness or pain in the chest
- Back pain
- Shortness of breath
Aortic aneurysms can develop anywhere along the aorta, which runs from your heart through your chest and abdomen. When they occur in the chest, they are called thoracic aortic aneurysms. Aneurysms can occur anywhere in the thoracic aorta, including the ascending aorta near the heart, the aortic arch in the curve of the thoracic aorta and the descending aorta in the lower part of the thoracic aorta.
Aneurysms that form in the lower part of your aorta â called abdominal aortic aneurysms â are more common than thoracic aortic aneurysms. An aneurysm can also occur in between the upper and lower parts of your aorta. This type of aneurysm is called a thoracoabdominal aneurysm.
When to see a doctor
Most people with aortic aneurysms do not have symptoms unless a tear (dissection) or rupture occurs. A rupture or dissection is a medical emergency. Call 911 or your local emergency number for immediate assistance.
If an aneurysm ruptures or one or more layers of the artery wall splits (dissection), you may feel:
- Sharp, sudden pain in the upper back that radiates downward
- Pain in your chest, jaw, neck or arms
- Difficulty breathing
If you have a family history of aortic aneurysm, Marfan syndrome or other connective tissue disease, or bicuspid aortic valve, your doctor may recommend regular ultrasound or radiology testing such as computerized tomography (CT) scan or magnetic resonance imaging (MRI) exams to screen for aortic aneurysm.
Factors that can contribute to an aneurysm's development include:
- Hardening of the arteries (atherosclerosis). As plaque builds up on your artery walls, they become less flexible, and the additional pressure can cause them to weaken and bulge. High blood pressure and high cholesterol are risk factors for hardening of the arteries. This is more common in older people.
Genetic conditions. Aortic aneurysms in younger people often have a genetic cause. People who are born with Marfan syndrome, a genetic condition that affects the connective tissue in the body, are particularly at risk of a thoracic aortic aneurysm. Those with Marfan syndrome may have a weakness in the aortic wall that makes them more susceptible to aneurysm. People with Marfan syndrome often have distinct physical traits, including tall stature, very long arms, a deformed breastbone and eye problems.
Besides Marfan syndrome, Ehlers-Danlos, Loeys-Dietz and Turner syndromes, and other family-related disorders can cause an aortic aneurysm. Ehlers-Danlos syndrome causes your skin, joints and connective tissue to be fragile and makes your skin stretch easily.
- Other medical conditions. Inflammatory conditions, such as giant cell arteritis and Takayasu arteritis, may cause thoracic aortic aneurysms.
- Problems with your heart's aortic valve. Sometimes people who have problems with the valve that blood flows through as it leaves the heart (aortic valve) have an increased risk of thoracic aortic aneurysm. This is mainly true for people who were born with a bicuspid aortic valve, meaning the aortic valve has only two cusps instead of three.
- Untreated infection. Though it is a rare cause of thoracic aortic aneurysm, it's possible to develop this condition if you've had an untreated infection, such as syphilis or salmonella.
- Traumatic injury. Rarely, some people who are injured in falls or motor vehicle crashes develop thoracic aortic aneurysms.
An aortic aneurysm is different from an aortic dissection. Aortic dissection can occur in the same place many aneurysms occur. In aortic dissection, a tear occurs in the wall of the aorta. This causes bleeding into and along the aortic wall and, in some cases, completely outside the aorta (rupture).
An acute aortic dissection is a potential life-threatening emergency, depending on where in the aorta it occurs. It's important to treat an aortic aneurysm to try to prevent dissection. If dissection occurs, people can still be treated with surgery, but they will have a higher risk of complications.
Thoracic aortic aneurysms are often found during routine medical tests, such as a chest X-ray, CT scan, or ultrasound of the heart or abdomen, sometimes ordered for a different reason.
If your doctor suspects that you have an aortic aneurysm, specialized tests can confirm it. These tests might include:
Your doctor may first suspect you have a thoracic aortic aneurysm by looking at chest X-ray images. Your doctor may discover a thoracic aortic aneurysm on X-ray images ordered to check for another condition.
Thoracic aortic aneurysms may be diagnosed by echocardiogram, and this technique is often used to screen family members of those with thoracic aortic aneurysm. An echocardiogram uses sound waves to capture real-time images of your heart and the ascending aorta.
Echocardiograms show how well your heart chambers and valves are working. Occasionally, to better see your aorta, your doctor may recommend a transesophageal echocardiogram â in which the sound waves are generated from within your body by a device threaded down your esophagus.
Computerized tomography (CT) scan
This painless test can provide your doctor with clear images of your aorta, and it can detect the size and shape of an aneurysm. During a CT scan, you lie on a table inside a doughnut-shaped X-ray machine. CT scanning generates X-rays to produce cross-sectional images of the body. Doctors may inject a dye into your blood vessels that helps your arteries to be more visible on the CT pictures (CT angiography).
One downside of the use of CT in detecting and following aortic aneurysms is the exposure to radiation, particularly for people who require frequent monitoring, such as those with Marfan syndrome. However, newer CT scan techniques may be used to reduce your radiation exposure at some medical centers.
Magnetic resonance imaging (MRI)
An MRI is a painless imaging test that may be used to diagnose an aneurysm and determine its size and location. In this test, you lie on a movable table that slides into the tunnel (magnet). An MRI uses a magnetic field and pulses of radio wave energy to make pictures of the body.
Doctors may inject a dye into your blood vessels to help your blood vessels to be more visible on images (magnetic resonance angiography).
This test may be an alternative to CT scans for people who need frequent monitoring, to reduce their exposure to radiation.
Screening for thoracic aortic aneurysms
Conditions that cause a thoracic aortic aneurysm may run in families. Because of this, your doctor may recommend you have tests to check for thoracic aortic conditions if a first-degree relative, such as a parent, sibling, son or daughter, has Marfan syndrome or another condition that could cause a thoracic aortic aneurysm. These tests may include:
- Imaging tests. Your doctor may recommend that your first-degree relatives have an echocardiogram or another type of imaging test to check for Marfan syndrome or another thoracic aortic condition. If your doctor finds you have an enlarged aorta or an aneurysm, you'll likely need another imaging test within six months to make sure your aorta hasn't grown larger.
- Genetic testing. If you have a family history of aneurysm or another suspected genetic condition that raises your risk of thoracic aortic aneurysm, you may want to consider genetic testing. You may also want to consider genetic counseling before starting a family.
Tears in the wall of the aorta (dissection) and rupture of the aorta are the main complications of thoracic aortic aneurysm. A ruptured aortic aneurysm can lead to life-threatening internal bleeding. In general, the larger the aneurysm, the greater the risk of rupture.
Signs and symptoms that your thoracic aortic aneurysm has burst include:
- Sudden, intense and persistent chest or back pain
- Pain that radiates to your back
- Trouble breathing
- Low blood pressure
- Loss of consciousness
- Shortness of breath
- Trouble swallowing
- Weakness or paralysis of one side of the body, difficulty speaking, or other signs of stroke
Blood clot risk
Another complication of aortic aneurysms is the risk of blood clots. Small blood clots can develop in the area of the aortic aneurysm. If a blood clot breaks loose from the inside wall of an aneurysm, it can block a blood vessel elsewhere in your body, possibly causing serious complications.
Lifestyle and home remedies
If you've been diagnosed with a thoracic aortic aneurysm, your doctor will likely advise you to avoid heavy lifting and vigorous physical activity, as these can increase blood pressure, putting additional pressure on your aneurysm. If you want to participate in a particular activity, ask your doctor if it would be possible to perform an exercise stress test to see how much exercise raises your blood pressure. Moderate physical activity is generally beneficial for you.
Stress can raise your blood pressure, so try to avoid conflict and stressful situations as much as possible. If you're going through a particularly emotional time in your life, let your doctor know because your medications may need to be adjusted to keep your blood pressure levels from going too high.
There are no medications you can take to prevent an aortic aneurysm, although taking medications to control your blood pressure and cholesterol level may reduce your risk of having complications from a thoracic aortic aneurysm.
For now the most appropriate approach to prevent an aortic aneurysm or keep an aneurysm from worsening is to keep your blood vessels as healthy as possible. This means taking certain steps, including these:
- Don't use tobacco products.
- Keep your blood pressure under control.
- Get regular exercise.
- Reduce cholesterol and fat in your diet.
If you have some risk factors for aortic aneurysm, talk to your doctor. If you are at risk, your doctor may recommend additional measures, including medications to lower your blood pressure and relieve stress on weakened arteries. You may also want to consider screening echocardiograms every few years.
Coping and support
Living with a thoracic aortic aneurysm can be stressful. Try to avoid stressful situations and strong emotions such as anger, as these can increase your blood pressure.
If you have a genetic condition such as Marfan syndrome, you may feel fear, anxiety or depression. Talk to your doctor if you experience these emotions; he or she may refer you to a doctor trained in mental health conditions (psychologist).
You may find it helpful to join a support group with people who have similar conditions. Talk to your doctor about support groups in your area.
Thoracic aortic aneurysm risk factors include:
- Age. Thoracic aortic aneurysms occur most often in people age 65 and older.
- Tobacco use. Tobacco use is a strong risk factor for the development of an aortic aneurysm.
- High blood pressure. Increased blood pressure damages the blood vessels in the body, raising your chances of developing an aneurysm.
- Buildup of plaques in your arteries (atherosclerosis). The buildup of fat and other substances that can damage the lining of a blood vessel (atherosclerosis) increases your risk of an aneurysm. This is a more common risk in older people.
- Family history. People who have a family history of aortic aneurysm are at increased risk of having one. Those with a family history of aneurysms tend to develop aneurysms at a younger age and are at higher risk of rupture. This is a primary risk factor in younger people.
- Marfan syndrome and related disorders. If you have Marfan syndrome or related disorders, such as Loeys-Dietz syndrome or Ehlers-Danlos syndrome, you have a significantly higher risk of a thoracic aortic aneurysm.
- Bicuspid aortic valve. Nearly half of those who have an aortic valve with two cusps instead of three (bicuspid aortic valve) may develop an aortic aneurysm.
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