Aortic Aneurysm Of The Heart - What Is It? Dangers And Consequences

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Aortic aneurysm

Aortic aneurysm of the heart - what is it?

Aortic aneurysm of the heart is a pathological expansion of one of the sections of the largest artery in the human body. The reason for the development of pathology is the weakness of the arterial wall. The formation of an aortic aneurysm is irreversible, so this disease requires surgical intervention.

The thoracic aorta most often suffers from aneurysms. It accounts for about 2/3 of all cases. According to the postmortem autopsy data, aortic aneurysm is found in 0.6-6.5% of patients. At the same time, any expansion of the lumen of the vessel, exceeding its normal diameter by 2 times, can be considered an aortic aneurysm. As for the age of patients with aortic aneurysm, it mainly develops in the elderly against the background of hypertension and atherosclerosis.

Aortic aneurysm is a life-threatening disease. A person with such a diagnosis risks his life every minute. A ruptured aneurysm can happen at any time, which will provoke severe internal bleeding. Against the background of such a serious complication, up to 40% of patients die, despite the fact that they will be taken to the hospital on time.

Content:

• Varieties of aortic aneurysm of the heart
• Why is an aortic aneurysm of the heart formed?
• How does an aortic aneurysm manifest itself?
• Why is aortic aneurysm of the heart dangerous?
• How can an aortic aneurysm be detected?
• Treatment methods
• Disease prognosis

Varieties of aortic aneurysm of the heart

There are several classifications of aortic aneurysm of the heart. Each of them is based on one or another feature.

1. Types of aortic aneurysm of the heart, depending on its segmental localization.

   • Aneurysm of the aortic arch - this pathology, according to various sources, occurs 3-7 times more often in the male population (mortality 5 years after its detection reaches 65%);
   • Descending aneurysm (men suffer more often than women 3-5 times) and ascending thoracic aorta;
   • Valsalva sinus aneurysm;
   • An aneurysm of the abdominal aorta (this aneurysm is prone to rapid progression and in just a year it increases in diameter by 10%, which most often ends in rupture);
   • Aneurysm of the thoracoabdominal part of the aorta.
2. Types of aneurysm of the aorta of the heart, depending on its structure. In this case, a false and true aneurysm is distinguished.
3. A true defect is characterized by bulging of the aortic wall in different directions. Syphilitic and atherosclerotic true aneurysms are distinguished.
4. The pseudo-aneurysm is limited by the hematoma's connective tissue wall. The aortic tissue itself is not directly involved in the formation of a false aneurysm. However, this does not diminish the danger posed by a false aneurysm.
5. Types of aortic aneurysm of the heart, depending on its shape.
6. A saccular aortic aneurysm, in which the vessel wall stretches to form a container filled with blood. This aneurysm most often affects the ascending aorta and is more prone to rupture.

7. Fusiform aortic aneurysm. This defect is characterized by diffuse protrusion of the aorta along its entire diameter. Such aneurysms can reach impressive sizes and provoke the appearance of symptoms of compression.

Why is an aortic aneurysm of the heart formed?

Aortic aneurysm of the heart can be congenital and acquired. Congenital aneurysms occur due to the presence of a hereditary disease in the fetus - Mafan Syndrome, fibrous dysplasia, connective tissue disease, etc. Also, various diseases of a woman suffered during pregnancy can lead to the formation of an aortic aneurysm in a child. The prognosis is not favorable, as the child will need complex heart surgery immediately after birth.

As for acquired aortic aneurysms of the heart, the causes of their occurrence can be multiple:

• Atherosclerotic lesion of the vascular wall (up to 80% of all cases of aortic aneurysm are provoked by atherosclerosis). Degenerative processes begin to occur under the cholesterol plaque that forms on the aorta. They weaken the vessel wall, which loses its elasticity and begins to bulge gradually. Thus, an aneurysm is formed.
• Syphilis at a late stage of its development. In this case, pathogenic bacteria enter the aortic wall with blood flow and begin to destroy it. This reason at this point in time does not often provoke the formation of an aneurysm, since syphilis is successfully diagnosed and treated.
• Injuries. They can be obtained as a result of surgical intervention on the heart, during coronography, coronary angioplasty and other medical procedures.
• Specific and nonspecific aortitis, postoperative infections, fungal diseases of the aorta are inflammatory causes of the formation of an aneurysm of the main vessel of the heart. Sometimes an atypical localization of Mycobacterium tuberculosis, Salmonella and other pathogenic microorganisms leads to its formation.

In addition, it is possible to identify factors that can provoke the formation of an aortic aneurysm of the heart. They, in most cases, are associated with a person's lifestyle.

Among these factors are:

• Alcohol abuse, smoking.
• Nutritional bias (eating foods high in cholesterol).
• Senile age.
• Obesity.
• The presence of chronic diseases. First of all, we are talking about hypertension. It is diagnosed in 75% of patients with aortic aneurysm.

Thus, it can be concluded that aneurysm is not an independent disease. Some pathological processes in the body always lead to it. Aneurysm, in fact, acts as a formidable complication of atherosclerosis, hypertension, trauma, etc.

How does an aortic aneurysm manifest itself?

Aortic aneurysm of the heart is very dangerous because it may not manifest itself for a long period of time. The first symptoms often appear when the dilated vessel begins to press on the organs adjacent to it. In this case, the symptoms will depend on where exactly the aneurysm was formed.

If the vessel is dilated in the chest, then a person may have hemoptysis against the background of a dry, hacking cough, the voice often becomes hoarse, shortness of breath joins and pronounced painful sensations appear in the sternum.

Abdominal aortic aneurysm is asymptomatic in 40% of cases. Therefore, it is most often discovered by accident, during the examination of a patient for other diseases. Of the symptoms characteristic of an aneurysm located in the abdominal cavity, one can distinguish: painful sensations in the abdomen and in the back, a feeling of pulsation in the abdominal cavity. With compression of the cardiac part of the stomach and duodenum, the patient will begin to lose weight, he will be disturbed by nausea and vomiting, belching and heaviness in the epigastric region.

If a person's aneurysm reaches an impressive size, then the symptoms intensify. You may experience severe headaches and swelling of the upper body.

When an aneurysm forms on the aortic arch, the leading symptoms are increased salivation and bradycardia.

Why is aortic aneurysm of the heart dangerous?

Rupture of the aortic aneurysm of the heart is the most dangerous complication of the disease. It will be discussed below.

Also, an aneurysm threatens a person with the following health problems:

• The formation of blood clots, which occurs against the background of a violation of the normal blood flow. A thrombus can break off from the aorta and clog other vessels with a smaller diameter (cerebral artery, arteries of the liver, kidneys, arms, legs, etc.). All this leads to the death of the corresponding tissues.
• The development of pneumonia due to compression of the bronchi or trachea by an aneurysm of the thoracic aorta.
• Compression of the biliary tract with a deterioration in digestion, the development of cholecystitis, pancreatitis, diarrhea, constipation, bloating, etc.
• Violation of the heart with the formation of bradycardia, or tachycardia. Sometimes an aortic aneurysm causes permanent changes in the heart valve, which are irreversible, even after its removal.
• Ischemic disease of the legs with further formation of trophic ulcers and other soft tissue injuries.

Aortic aneurysm rupture - what is the risk?

If a person has a ruptured heart aorta, the consequences can be more than dire. Patients develop massive bleeding, against the background of which shock, coma, collapse, and the development of acute heart failure are possible.

Blood can begin to flow from a ruptured aneurysm into the esophagus, into the peritoneal cavity, into the pleural region, into the superior vena cava system, and into the pericardial region. The fatal outcome most often ends with cardiac tamponade, hemopericarditis, hemothorax, as well as massive internal bleeding.

The following factors can contribute to the rupture of the aneurysm: increased physical activity, injury, especially during a fall, severe psycho-emotional shock, taking medications that increase blood pressure.

Aortic rupture is accompanied by the following symptoms: increased weakness, lack of consciousness, the appearance of tinnitus, severe sharp pain, pallor of the skin, the formation of a dark spot in the abdomen.

To save the life of a person with a ruptured aneurysm of the aorta of the heart, it is necessary to call an ambulance as soon as possible.

How can an aortic aneurysm be detected?

Diagnosing this deadly aortic wall defect is difficult. Therefore, if there is a risk of aneurysm formation (identified atherosclerosis, hypertension, old age, etc.), it is necessary to undergo regular examinations.

Ultrasound allows you to detect aneurysm in the early stages of its formation and even when it is not yet there, but it should appear soon.

The abdominal aortic aneurysm is well visualized on an x-ray. The fact is that calcium settles on the aneurysm, which gives a shadow during the study.

If, during an ultrasound, an aneurysm is found in the patient, then he is prescribed an MRI or CT scan. These techniques allow you to collect as much information as possible about the existing defect.

Treatment methods

If the aneurysm does not progress and does not give any symptoms, then the patient is registered with a vascular surgeon. To reduce the risk of complications, the patient is prescribed anticoagulants (Aspirin, Warfarin, Clopidogrel), regulates his blood pressure (Amlodipine, Enalapril, Ramipril, etc.) and cholesterol (Simvastatin, Atoris, Fenofibrate, etc.) in the blood with the help of medicinal funds.

You can get rid of an aneurysm only with the help of an operation. The indication for its implementation is an increase in bulging by 4 cm or more for an abdominal aneurysm, by 5.5 cm for a thoracic aneurysm. Also, surgical removal of the defect is required when its growth per year exceeds the mark of 0.5 cm.

If the patient has a ruptured aneurysm, the operation will be performed as an emergency. Only in this case there is a chance to save the patient's life.

As for the surgical intervention, it can be of two types:

• Open surgery, when an artificial vessel is installed in the patient, replacing the damaged area with it.
• Stenting operation. In this case, a puncture of the femoral artery is performed along which a metal stent is led to the site of the aneurysm. Once the stent has reached the desired location, it opens and strengthens the aorta from the inside. This is a low-traumatic procedure, but it requires the clinic to have specialized equipment and a properly qualified vascular surgeon.

Disease prognosis

As for the prognosis of the disease, it largely depends on the size of the aneurysm, on the presence of atherosclerosis, on the location and type of defect. If we consider the prognosis as a whole, then it remains unfavorable, which is associated with a high risk of death of the patient from ruptured aneurysm. If the formation reaches 6 or more centimeters, then the probability that it will rupture throughout the year is 50%, and with an aneurysm of a smaller diameter, the percentage of its breakthrough decreases to 20%.

The earlier an aortic aneurysm of the heart is detected, the more favorable the prognosis that the operation will be successful and the lower the mortality rate of patients during it.

The author of the article: Molchanov Sergey Nikolaevich | Cardiologist

Education: Diploma in "Cardiology" received at the PMGMU. I. M. Sechenov (2015). Here I completed my postgraduate studies and received a diploma "Cardiologist".