Aortic Aneurysm

An aortic aneurysm may not cause any symptoms. The types of symptoms you have will depend on the location of the aneurysm and whether it has become large enough to affect other parts of your body. If you do have symptoms of an aortic aneurysm, they may include:  

• Pain in the neck, jaw, back, chest, stomach area or shoulder, depending on where the aneurysm is located
• Swelling of the face, neck or arms if the aneurysm pushes on the superior vena cava, the main vein returning blood from your upper body to your heart
• Difficult or painful swallowing if the aneurysm pushes on your esophagus, the tube that connects your mouth and your stomach
• Difficulty breathing if it pushes on your trachea or windpipe
• Hoarseness
• Shortness of breath if the aneurysm presses on your lung
• Feeling full after not eating very much
• A pulsating or throbbing feeling in your stomach area

Because of the enlargement of the aorta and weakening of its walls, aortic aneurysms can tear or even rupture and both are life-threatening emergencies. If you know you have an aortic aneurysm, it is important to know the symptoms of a tear or rupture since quick treatment may save your life. Symptoms of a tear or rupture may include:

• Sudden, severe pain in your stomach area, chest or back
• Light-headedness dizziness and vision changes
• Rapid heart rate 

You may have an increased risk of developing an aortic aneurysm because of your age, family history, genes, lifestyle habits, medical conditions or sex.

Age and family history

• Age: Your risk for aortic aneurysms goes up as you age. Abdominal aortic aneurysms are most common in adults after age 65.
• Family history and genetics: One in 10 people with abdominal aortic aneurysms have a family history of them. The chance of developing an abdominal aortic aneurysm is 1 in 5 for people who have a parent, brother, sister or child with the condition, what is known as a first-degree relative.
• Sex: Men are more likely than women to develop aortic aneurysms. However, an existing aneurysm is more likely to rupture at a smaller size in women than in men.
• Race and ethnicity: Aortic abdominal aneurisms are less common in Hispanics, African Americans and Asian Americans. 

Lifestyle habits

Some lifestyle habits increase your risk of having an aortic aneurysm. These include:

• Cigarette smoking is one of the main factors that increases your risk for an aortic aneurysm, especially an abdominal aortic aneurysm. If you are a current smoker, an abdominal aortic aneurysm may grow more quickly and be more likely to burst.
• Stimulants such as cocaine, increase your blood pressure and your risk for an aortic aneurysm.

Medical conditions

Medical conditions that are risk factors for aortic aneurysms include:

• Aneurysms of blood vessels in other parts of your body
• Chronic obstructive pulmonary disease (COPD)
• Cardiovascular conditions, such as atherosclerosis, coronary heart disease and peripheral artery disease
• Unhealthy blood cholesterol level
• High blood pressure, which is the leading risk factor for thoracic aortic aneurysms but also a risk factor for abdominal aortic aneurysm
• Bacterial infections, which are a risk factor for thoracic aortic aneurysms.
• Kidney conditions, such as renal failure, chronic kidney disease and polycystic kidney disease
• Obesity
• Pheochromocy, a rare tumor of the adrenal gland that can lead to high blood pressure
• Trauma, such as from car accidents or falls, which is a risk factor for thoracic aortic aneurysms
• Vasculitis

To diagnose an aortic aneurysm, your healthcare provider will do a physical exam and an imaging test. The normal diameter of the thoracic aorta depends on your age, your sex and which part of the thoracic aorta is measured. An abdominal aortic aneurysm is diagnosed when your abdominal aorta is three centimeters or greater in diameter.  

Physical exam

During a physical exam, your provider may do a few basic steps to look for an aortic aneurysm.  

• Listen to your heart for a heart murmur, softer heart sounds or other changes in your blood flow that could be a sign of an aneurysm.
• Check your pulse in your arms and legs to see whether it feels weaker than normal.
• Feel your stomach area.
• Look for symptoms of medical conditions that are risk factors for an aortic aneurysm, such as Marfan or Ehlers-Danlos syndromes. This may include looking at your skin, muscles and bones, eyes, head and face and heart.

Screening and Diagnostic Tests

There are certain groups of people who may be screened for abdominal aortic aneurysm:

• Men 65 to 75 years old who have ever smoked or who have a first-degree relative with the condition  
• Men 65 to 75 years old who never smoked but have other risk factors, such as a family history, other vascular aneurysm or coronary heart disease
• Men and women more than 75 years old who are in good health, who have ever smoked or who have a first-degree relative with the condition
• People who have peripheral artery disease, regardless of age, sex, smoking history or family history

Diagnosing an aortic aneurysm is typically done with ultrasound. This test uses sound waves to look directly at the aorta and shows if the diameter is bigger than it should be. If it is larger than normal, your provider may recommend follow up testing later to check for growth. To make the diagnosis your provider may order some other tests.

• Ultrasound provides information about the size of the abdominal aortic aneurysm and monitors the aorta over time. If you have abdominal or back pain, an ultrasound can check for an abdominal aortic aneurysm or other possible causes of your pain. Once an aortic aneurysm is seen or suspected on ultrasound, you may have a CT scan or an MRI to provide more details about the shape or location of the aneurysm.
• Echocardiography provides information about the size of the aortic aneurysm and about the thoracic aorta that are attached to and closest to the heart. Other parts of the aorta are better seen with other imaging studies such as CT or magnetic resonance imaging (MRI).
• CT scans and MRI allow for direct imaging of the aorta and provide information about the exact location, size and shape of the aneurysm. 

Treatment for your aortic aneurysm will depend on its size, location and the factors that put you at risk. Small aortic aneurysms may be managed with healthy lifestyle changes. The goal is to slow the growth of the aneurysm and lower the chance of rupture or dissection. Your healthcare provider may treat other medical conditions that raise your risk for rupture or dissection, such as high blood pressure, coronary heart disease, chronic kidney disease and high blood cholesterol. Surgery may be recommended to repair large aneurysms.

If you have risk factors for developing an aneurysm, your provider may recommend heart-healthy lifestyle changes to help prevent the condition, including:

• Quit smoking, especially cigarette smoking, a leading risk factor for developing an aortic aneurysm. We understand how challenging it can be to break free from the grip of tobacco and nicotine addiction. That’s why we offer free support and resources to help you quit smoking and using other tobacco products. Learn more about our free tobacco cessation program, including our free nicotine replacement therapy.
• Heart-healthy eating
• Get physical activity. Studies show that moderate physical activity does not raise the risk of rupture or growth of the aneurysm and can have health benefits. Talk to your provider to learn which level of physical activity is right for you.
• Manage stress, which can help lower high blood pressure
• Avoid stimulants, especially recreational drugs such as cocaine or amphetamines.