Aneurysm

What is an aneurysm?

An aneurysm is a bulge or ballooning of a weakened wall of a blood vessel or of the heart. If the bulge stretches too far, it may leak or tear (rupture).

Aneurysms are most common in the aorta, the main blood vessel that carries blood from the heart to the body. When a rupture occurs in the aorta, it causes heavy bleeding. The sudden heavy bleeding causes shock and often rapid death.

When an aneurysm in an artery of the brain ruptures, it causes a stroke.

How does it occur?

It is not known for sure why aneurysms occur in some people and not others. People with the greatest risk are men over age 55. Aneurysms are among the top 10 causes of death in this group. Men are 5 times more likely to have abdominal aortic aneurysms than women. Brain artery aneurysms affect men and women of all ages. Aneurysms may be caused or worsened by:

• atherosclerosis, which weakens the walls of the aorta with a buildup of fatty deposits called plaque
• birth defects that affect the aortic wall
• high blood pressure
• infection
• injuries
• smoking

Diseases such as infective endocarditis, Kawasaki's disease, Marfan syndrome, rheumatoid arthritis, Reiter's syndrome, and ankylosing spondylitis may cause aneurysms. Some types of aneurysms may run in families.

What are the symptoms?

Aneurysms do not always cause symptoms. They are often noticed during routine medical exams. Many are found during diagnostic procedures for other problems.

The symptoms depend on where the aneurysm is.

• You may feel an unusual pulsation.
• You may have pain caused by pressure on organs near the aneurysm.
• An aneurysm in the brain may cause vision problems or headaches.
• An aneurysm in the chest may make it harder to swallow or might cause chest pain if it presses on the lungs.
• An abdominal aortic aneurysm might cause pain in the back or the groin.

Most people are unaware of an aneurysm until it begins to leak or rupture, and then they describe having severe or tearing pain.

How is it diagnosed?

Several kinds of tests may be used:

• angiogram (X-rays of the inside of blood vessels)
• CT scan
• MRI scan
• spinal tap (to check for blood in the cerebrospinal fluid, which can be caused by a ruptured aneurysm in the brain)
• ultrasound scan
• X-rays

How is it treated?

A small aneurysm may be watched over time to see if it gets bigger. Your healthcare provider may prescribe high blood pressure medicine to reduce the pressure of blood against the arterial walls. If the aneurysm gets bigger, or begins to cause symptoms, your healthcare provider may want you to have surgery. A ruptured aneurysm requires emergency surgery.

How long will the effects last?

Most aortic aneurysms grow slowly. Over many years, the walls slowly stretch and enlarge like a balloon. A normal aorta is about as wide and as tough as a garden hose. If the aneurysm does not grow much, you may live with a small aneurysm for years.

The risk of rupture increases with the size of the aneurysm. An aneurysm in the aorta can grow to the size of an orange before it ruptures. One-third of aortic aneurysms that are larger than 2 inches wide will rupture within 5 years. The risk of dying from an aortic aneurysm after it ruptures is about 90%.

Successful surgery of an aneurysm before it ruptures usually results in full recovery. Aneurysms generally do not come back after surgery unless you have one of the unusual diseases that cause aneurysms in many parts of the body.

How can I help take care of myself?

Your provider will talk with you about lifestyle changes such as quitting smoking. You may need to keep taking medicines for high blood pressure. Contact your provider if you have any new symptoms.

What can help prevent an aneurysm?

• Have your blood pressure and blood cholesterol checked regularly.
• If you smoke, quit. Tell your healthcare provider if you need help quitting.
• If you are overweight, talk to your provider about losing weight.
• Exercise regularly according to the recommendations of your provider.
• Switch to a low-fat, low-cholesterol, high-fiber diet. Your provider or a dietician can tell you which foods you should avoid.
• Find ways to reduce stress.
• If your provider approves, take an aspirin a day. However, check with your provider first. There may be reasons why you should not take aspirin. Your provider may prescribe other medicines that can slow the progress of artery disease.