Your Aortic Health

What is aortic aneurysm?

The aorta is the main vessel that sends blood away from the heart to the rest of the body. It is shaped like a candy cane and is typically about as wide as a garden hose (2.5-3.5 cm). When blood is pumped by the heart, it first travels through the aorta.  An aortic aneurysm is a widening, bulge, or ballooning out of a portion of the aorta. Aneurysms usually occur where there is a weak spot in the aortic wall.

Aortic aneurysms are the 13th leading cause of death in the United States, accounting for an estimated 15,000-20,000 deaths annually.

What is aortic dissection?

An aortic dissection is a tear in the wall of the aorta that allows blood to flow within the layers of the aorta. Early diagnosis and treatment of this illness is critical for survival. The end result of an aortic dissection is that the amount of oxygen and nutrients available for the organs of the body is decreased.

An aortic rupture occurs when the wall of the aorta tears open completely.

How are aortic aneurysms classified?

Aortic aneurysms are commonly classified according to their location. Thoracic aortic aneurysms (TAA) involve the ascending aorta, arch, or descending aorta. Abdominal aortic aneurysms (AAA) affect the aorta in the abdominal cavity. A third type of aneurysm, thoracoabdominal, involves both the descending and abdominal aorta.

What are the symptoms of an aneurysm?

Most aneurysms have NO symptoms until they dissect or get extremely large.

What are the symptoms of an aortic dissection?

Symptoms of an aortic dissection may include:

  • Sudden onset of sharp, severe chest pain (described as “sharp, tearing”)
  • Fainting
  • A sudden increase or decrease in blood pressure

For a comprehensive overview of symptoms, signs, management, and outcomes, see http://www.iradonline.org/pdf/iradjama.pdf.
(Hagan et al. The International Registry of Acute Aortic Dissection (IRAD): New Insights Into an Old Disease. JAMA. 2000;283:897-903.)

Risk Factors

Several factors increase the risk of developing an aortic aneurysm or dissection, including environmental and genetic influences.

Environmental factors that increase the chance to develop an aortic aneurysm or dissection include:

  • Uncontrolled hypertension (high blood pressure)
  • Smoking
  • Bicuspid aortic valve
  • Weight lifting (http://www.iradonline.org/articles/lifestyle_recs.html for recommendations regarding lifestyle and work)
  • Trauma to the aorta (e.g. being in a car accident)
  • Inflammatory diseases

Genetic factors also influence the risk to develop an aortic aneurysm or dissection. Thoracic aortic aneurysm and/or dissection (TAAD) has three different types of genetic risk: syndromic TAAD (associated with genetic syndromes such as Marfan syndrome), familial TAAD or FTAAD (familial predisposition to develop TAAD), and sporadic TAAD (no familial predisposition). Researchers have determined that up to 20% of patients without a genetic syndrome have a family history of TAAD. To learn more about the different types of genetic risk, visit www.JohnRitterResearchProgram.org.

How is TAA treated?

Early diagnosis can result in early intervention and dramatic improvements. If an aneurysm or dissection is suspected, an ultrasound scan of the heart (echocardiogram) is usually performed. Other scans such as computerized tomography (CT) and magnetic resonance imaging (MRI) may also be performed in order to determine the exact position of an aortic aneurysm. The treatment of an aortic aneurysm depends upon the severity of the aneurysm or dissection and may include medical management (medication) or surgery.

For some hospitals that specialize in treatment of aortic disease, please see the Resources page.

For a copy of the Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease, click here to access it in the Journal of the American College of Cardiology (JACC) or download a PDF version of the document here:  2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease.  The Guidelines document was published in 2010 by the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine.