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Aortic aneurysm

April 29th, 2015

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Aortic aneurysm

Aortic aneurysm is swelling of the aorta. The aorta is the main artery coming directly out of the left heart. Usually, its diameter is about 2.5-3.5 cm. So it is the main pipe-line of our body.

The aorta is connected to the heart by the aortic valve which prevents oxygenated blood from going back into the heart. The aorta arches over the left side of the heart, rises a small distance towards the neck, and bends to the back left over the root of the left lung, through the diaphragm and divides at hip level into arteries that go to the legs.

At the chest (where it divides into three ways, upward, sideward and downward) and the stomach, blood will be sent to various parts of the body. It is like the main pipe that supplies the majority of blood and the pressure inside it is high. Therefore, the aortic wall has to be very strong and flexible. Unlike water, blood pressure goes up and down, so the “blood pipe” has to shoulder harder work than water pipe.

When the heart pumps blood out, the pressure in the aorta will be higher than when the heart relaxes. Therefore, the blood pressure is not stable, depending on what the heart is doing. This is why our blood pressure has two numbers.

People with high blood pressure will have higher pressure in the aorta, and the aortic wall has to work harder too. Hypertension itself does some damage to the artery wall already, both in terms of strength and flexibility. The blood vessels will become harder but more fragile. Fat and calcium build-ups will collect on the walls, like rust caking on steel.

When the blood vessel is hardened and inflexible, it still has to do its work, and the pressure of the blood flow will cause it to expand more and more. Since it is not flexible, it does not shrink back to its original size. It is like a water balloon with too much water. Eventually it will burst.

If the aortic wall has ruptured, the patient usually dies of massive and rapid blood loss. Some patients have signs before, such as a beating lump in the stomach. If the wall has started to cracked (but not yet ruptured), the patient might experience a stomach ache that radiates to the back because the artery at the stomach level is inclined backward.

For the artery in the chest, the patient might have the same feeling as myocardial infarction – tightness in the chest. One difference is that it radiates to the middle of the back.

Treatment for extreme swelling of the aorta can be done by an operation or insertion of catheter to prevent the aorta from cracking or rupturing. If the swelling is not severe, it is important to maintain healthy blood pressure so that the walls do not expand more than they already have. Other factors that can cause the walls to harden and weaken (sounds ironic, doesn’t it? The harder, the weaker!) include smoking, diabetes and high cholesterol level.

A 60-year-old patient came to see me recently. He smoked, had diabetes, high cholesterol level and high blood pressure. He had had an angioplasty 10 years ago, but had not been taking medicine continuously. He never watched his diet or stopping his smoking habits and he did not exercise. His was also overweight.

We met again when he came to see me because he felt tight in the chest and stomach. After examination and heart check-up, plus Color Doppler test, I found narrowed arteries as well as swelling at the artery in the stomach.

He had a coronary stent angioplasty and catheter insertion for the artery in the stomach, which was not a difficult process. However, he seriously had to change his lifestyle and eat proportionately. Even if he ate the good food, too much of a good thing will still be an excess, and this is the result of 10 years’ worth of too much good food.

Prof Nithi Mahanonda is consultant cardiologist and interventionist, Perfect Heart Institute.

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