Dr. Wojo. Healthy Living. Simplified.

On September 11, many of us awoke with a heavy heart because of the terrorism our country suffered two years earlier, while beloved actor, John Ritter, woke up and had no idea that his life was about to end. Mr. Ritter felt tired most of the day, and even took a nap between breaks of taping his popular new sitcom, which was about to begin its’ second season. After the nap, he informed fellow actor, Henry Winkler, that he still felt tired, and collapsed soon after.

How many of us are walking around with this silent and mostly undetected fatal heart ailment? If undetected and allowed to rupture, more than 80 percent of all people will die. Let’s look closer at this serious health problem, which if caught in time, may be successfully corrected, and if not, you will join the 80 percent.

What is an aneurysm? The term aneurysm comes from the Greek term aneurysma, which means widening. The widening occurs in a blood vessel, such as the aorta, the largest artery in the body. What actually occurs is there is a bulge in a section of the blood vessel, which is like a worn spot in an old inner tube of a tire. The weakened bulge, which is under pressure from the pumping of the heart, will actually burst causing hemorrhage and death.

How does this occur? The causes of aneurysms are numerous and may include a hereditary component. Hereditary conditions affecting the elasticity of the blood vessels may also be a cause. Patients that have arteriosclerosis or “hardening of the arteries,” are at greatest risk. Additionally, many of these folks have high blood pressure, which is also another major risk factor.
Other causes of aneurysms include a vessel that has been weakened by infection or an inflammatory process. Anyone who has experienced trauma to a great vessel is also a tremendous risk for development of an aneurysm.

Who is at risk? In general, males outnumber females by a five-to-one ratio in developing aneurysms. Age is another risk factor and most patients are over the age of 60. If a patient has some of the risk factors listed above, the incidence of aneurismal development is quite high.

What are the symptoms? Some of the most common symptoms include chest and abdominal pain that will radiate into the back. The pain can have a sudden onset in nature and it may be very severe. Upon arrival into the emergency department, many people are experiencing uncontrollable pain. In extreme cases, the blood pressure may be low, which indicates that the aneurysm has ruptured and death is imminent.

How is it diagnosed? Initially, the health care provider must consider the history and risk factors. Aortic aneurysm should always be a consideration in older patients with chest and abdominal pain that radiates to the back. The evaluation includes assessment of vital signs, laboratory studies and ultrasound. The CT scan may also be used in helping make the diagnosis. MRI is not necessary for diagnosis.

How is it treated? The initial incidental diagnosis of an aortic aneurysm involves close monitoring and measurement through ultrasound or CT scan. Aneurysms that are five centimeters (about two inches) or less are followed by radiographic testing every few months.

When the aneurysm continues to get larger, surgical correction is necessary. Risk for dissection of the aneurysm increases with increased size. The weakened walls of the blood vessel will allow blood to seep in between layers of the blood vessel, which can cause narrowing of the inner size of the vessel. This dissection can lead to rupture and premature death.

Once diagnosed, surgeons will remove the weakened portion of the vessel and replace it with Dacron (plastic-like) tubing, where the damaged vessel previously existed. Recently, the use of stents has been used to help bypass the damaged vessel. Elective surgical correction is quite successful, but emergency surgical correction has a high mortality.

What should I do? In the event that you have risk factors and symptoms for an aneurysm, your health care provider must evaluate you. The provider will determine the course of action and order the appropriate tests. Once a diagnosis is made, watchful waiting may ensue. In the event that the aneurysm is large, your health care provider will arrange a visit with a surgeon.

As always, prevention is essential. A healthy lifestyle will promote healthy blood vessels. But, in the event that you have risk factors and symptoms, a visit to your doctor is essential, as it may save your life!