Aortic Aneurysm

What is an aortic aneurysm?

An aortic aneurysm is a bulge in the wall of the aorta. The aorta is the large artery that carries blood from your heart to the rest of your body. One section of the artery wall weakens and stretches outward. It looks a little like a worn spot on a garden hose. Aneurysms are named for where they sit. A thoracic aortic aneurysm forms in the chest. An abdominal aortic aneurysm, often shortened to AAA, forms in the belly. Most grow slowly and cause no symptoms. Many are found by accident on a scan ordered for something else. The concern is that a large aneurysm can tear or burst. That is a life threatening emergency. Size predicts that risk. So cardiologists measure a known aneurysm on a schedule. They also control the blood pressure and cholesterol that drive it. Smoking, older age, high blood pressure and a family history raise risk the most, according to the National Heart, Lung, and Blood Institute.

Symptoms to watch for

Most aortic aneurysms are silent. When symptoms do appear, they are often vague and easy to dismiss.

Call the office if you notice any of these:

• A deep, steady ache in your belly, side or lower back that does not go away.
• A pulsing or throbbing feeling near your navel.
• Dull pain in the chest or upper back.
• Hoarseness, a new cough or trouble swallowing, which a chest aneurysm can cause by pressing on nearby structures.

Call 911 immediately if you have any of the following. These can mean the aneurysm is tearing or has burst:

• Sudden, severe, ripping or tearing pain in the chest, back or abdomen.
• Pain with sweating, clammy skin, fainting or near fainting.
• A racing pulse with sudden weakness, confusion or shortness of breath.

A ruptured aneurysm is a true emergency. Do not drive yourself. The American Heart Association stresses that survival depends on how fast treatment begins.

How Dr. Nanavati diagnoses it

Diagnosis starts with a history and a careful exam. Imaging then measures the aorta in millimeters. That measurement drives every decision that follows.

• Vascular ultrasound is the usual first test for an abdominal aortic aneurysm. It uses sound waves, takes minutes and involves no radiation or dye.
• Arterial ultrasound looks at the arteries beyond the aorta. Aneurysm disease and blockage often travel together.
• Transthoracic echocardiography images the heart and the first portion of the aorta as it leaves the chest.
• Transesophageal echocardiography gives a more detailed look at the thoracic aorta. It is used when the standard echocardiogram view is limited.
• CT angiography of the aorta provides precise cross sectional measurements of the chest and abdominal aorta. This is a different scan from the coronary CT angiography used to image the heart arteries. A hospital imaging department arranges it.
• Ankle brachial index testing screens for peripheral artery disease, which is common in the same patients.
• Advanced lipid testing clarifies cholesterol risk beyond a standard panel.

Echocardiography, vascular ultrasound and ABI testing are all performed in the office. See the full list of cardiology services available at each location.

Treatment options

Small aneurysms are usually watched, not operated on. The plan has three layers.

Surveillance. Dr. Nanavati sets an imaging interval once an aneurysm is measured. That interval reflects its size and how fast it has changed. Keeping those appointments is the single most important thing you can do.

Risk factor control. Quitting smoking matters more here than in almost any other heart condition. Blood pressure control lowers stress on the weakened wall. The American Heart Association recommends treating elevated readings with both lifestyle and medication. Statin therapy and diet changes follow the same logic used for coronary artery disease. Cardiac rehabilitation can help you exercise safely if you also have heart disease.

Medication. Blood pressure medicines such as beta blockers and ACE inhibitors are common. Cholesterol medicines are added when lipid testing supports it.

Repair. Repair is recommended when an aneurysm reaches a threshold size, grows quickly or causes symptoms. That happens at an affiliated hospital. It is either open surgery or an endovascular repair through a small groin artery puncture. Dr. Nanavati coordinates the referral, the pre procedure workup and your follow up care.

What to expect at your visit

Bring a full list of your medications and doses. Also bring any prior imaging reports or discs and the name of your primary care physician. Your visit includes a discussion of symptoms and family history. It also includes a physical exam, blood pressure in both arms and an electrocardiogram when indicated. An ordered ultrasound is usually done in the office. For an abdominal study you may be asked not to eat beforehand, and the office will tell you when you schedule. You will leave knowing the measurement and what it means. You will also know when the next scan is due and which numbers you are working to change. Questions are welcome. The FAQs page covers what most patients ask before a first appointment.

When to see a cardiologist

Ask for an evaluation if an aneurysm was mentioned on any scan. Ask if a parent or sibling had an aortic aneurysm. Ask if you are a current or former smoker over 65. Anyone with known coronary artery disease or unexplained chest pain should also be assessed. You can request an appointment online or call the Bonita office at (619) 585-0476.

Dr. Vimal Nanavati, MD, FACC is board certified in cardiology and interventional cardiology. He has 32 years of experience. He founded Advanced Heart Care, Inc. in 1997. He sees patients at three locations. The Bonita office is in South San Diego. It serves Chula Vista, Eastlake, Otay Ranch, National City, Spring Valley, Imperial Beach, San Ysidro and Coronado. The North San Diego office at 5190 Governor Dr serves University City, La Jolla, Clairemont and Mira Mesa. The Redding office serves Shasta County, Anderson, Red Bluff, Palo Cedro and Cottonwood.

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