Recently, the daughter of a dear friend contacted me with a quick text, “Can aneurysms run in families?”
She explained that her father just lost three uncles and two cousins—all men between the ages of 55-65—to sudden death from aortic aneurysms. Another male cousin is about to undergo surgery to repair an aortic aneurysm, and a female cousin was just diagnosed with an aneurysm. Understandably, she was concerned for both herself and her father.
I had been down a similar road. Years ago, I lost my dad very suddenly to a thoracic aortic aneurysm we never knew he had until it ruptured. He literally died in my arms just moments after I had walked through the front door of his Long Island home to celebrate New Year's Eve with him. It was devastating to all of us.
I called her right back after receiving that text, and realized that the information I shared with her should also be shared with you.
What Exactly Is an Aneurysm?
An aneurysm (pronounced AN-u-rism) is a balloon-like bulge in an artery which carries oxygen-rich blood to your organs. You might picture it looking similar to a varicose vein. But unlike a varicose vein, our arteries are under much higher pressure from blood flow.
Our arteries are made of much thicker walls to withstand that high pressure, but there are certain areas of our arteries that are more vulnerable to aneurysm due to higher turbulence and shear force. One high risk area is the aortic arch which comes right off the high pressure of the left ventricle that ejects blood into the circulation. Areas where arteries divide are also vulnerable to aneurysms. Aortic aneurysms occur in the thorax (chest) and the abdomen.
The problem with aneurysms is that they can grow undetected. Over time, the arterial walls can become thinner and weaken, then tear apart in layers (dissect), and eventually rupture. In fact, aortic aneurysms kill about 13,000 Americans annually. That scary statistic is due to rupture or dissection, creating a massive hemorrhagic bleeding event.
What Are the Symptoms of an Aneurysm?
Most abdominal aortic aneurysms are silent, developing slowly over years. If you’re lucky enough to have warning symptoms, they can include a steady gnawing pain or throbbing sensation deep in the back or side of the abdomen—lasting hours or days. If the aneurysm ruptures, you can get clammy sweaty skin, nausea, vomiting, diarrhea, trouble with constipation and urination, lightheadedness, and a rapid heart rate upon standing.
Thoracic aortic aneurysms are even more dangerous since there may be no symptoms until they rupture, as was the case for my dear father who was the picture of health. He had just started to have severe leg pain when I heeded his call and ran up the stairs. It was so abrupt that my poor mom was totally confused when I hollered down to the kitchen to call 911 as he collapsed and I started CPR.
But symptoms of a thoracic aortic aneurysm can include coughing and hoarseness, difficulty breathing or shortness of breath, and pain in the jaw, neck, chest, or back. If my dad had those symptoms before I’d entered the house, I’ll never know. No one could have saved him that day. His undiagnosed coronary artery disease had put him at risk. So, I hope to warn anyone who might be at risk in hopes I could save them.
Are You At Risk for an Aneurysm?
It’s estimated that 1.5 million people in the United States have an undetected abdominal aortic aneurysm. Prevention and early detection are the best ways to prevent an aneurysm from rupturing. Men, especially those 65 or older, are at higher risk of developing an aneurysm. Other risk factors include:
- High blood pressure
- A history of smoking
- Coronary artery disease
- Blunt trauma to the abdomen that can injure the arteries, such as a car accident
There is also a strong genetic component. Sons and brothers of men with an abdominal aortic aneurysm have a 20% chance of developing one, and those are 65-75 years of age with a family history are at very high risk. Pregnancy is associated with thoracic aortic aneurysms for women under 40, but they are far more common for women in their 60s or 70s.
If You’re at High Risk, Screening is Critical
If you have significant risk factors for developing an aneurysm, or are age 45 or older with a family history of aneurysm, I recommend getting screened.
During a physical exam, your doctor may feel a vibration or "bruit" (pronounced BROO-eee) on physical exam in the area of an aortic aneurysm, and may also hear a rushing, turbulent sound through a stethoscope. He or she may also feel a throbbing mass in your abdomen which may, or may not, be sensitive to pressure. More often than not, aortic abdominal aneurysms are detected accidentally during testing to diagnose something else.
Even if there is no evidence of an aneurysm in a physical exam, if you’re at high risk your doctor will probably order an ultrasound or echocardiogram to screen for undetected aneurysms. Computed tomography (CT) scans and aortic angiograms, and magnetic resonance imaging (MRI) can also pinpoint location and details of an aneurysm.
If your physician detects an aneurysm, you have options. If an aneurysm is small enough, you will need regular follow up and possible medical and surgical intervention if your aneurysm grows dangerously large. You may also need to take medication to relax your blood vessels and lower the risk of rupture, and you may have physical restrictions, such as not lifting heavy objects.
If necessary, your physician may recommend a surgical intervention to either stent to support the arterial wall, or surgically open the chest or abdomen to cut out the area of aneurysm.
What’s the Best Way to Prevent an Aortic Aneurysm?
You can’t change your genetics or trauma history, but you can control your other risk factors. If you are at risk for aortic aneurysm, prevention is the same as it is for other cardiovascular concerns: follow a prudent diet, exercise, keep your weight and blood pressure levels healthy, and avoid smoking and secondhand smoke.
Medical management can also include medications to keep your heart rate and blood pressure at safe levels. If you need blood pressure management with medication, be sure to follow instructions carefully.
I'd also like to point out that it’s important to avoid emotional stress because of a case I had years ago. Imagine being coldheartedly ordered by your boss to fire your favorite employee, and then having to drive that same boss to the airport? It happened to one of my own patients.
After the unfair dismissal, he suppressed his rage on the outside as he drove that boss to the airport, but inside his aorta started to tear. Luckily, the tear was slow enough that he got to a hospital in time for emergency surgery that saved his life. We can't avoid some stressors in life, but we can remember to build outlets and coping strategies.
Remember, prevention is always better than cure, no matter what your health risk profile or your health concern. For more details on aneurysm, I recommend the National Heart, Lung, and Blood Institute website.
Now it’s your turn: Have you, or someone you know, had an aneurysm?