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    Aortic aneurysms: Am I at risk and what can I do to watch out for it?

    Nisha Shetty 01/26/2023
    Many people were shocked when soccer journalist Grant Wahl suddenly collapsed and died in December 2022 while covering the World Cup in Qatar. It was revealed a few days later that Wahl, 49, had died from an aortic aneurysm.
    Dr. Céline Gounder, Wahl’s wife and an infectious disease specialist, shared a statement on his Substack. “Grant died from the rupture of a slowly growing, undetected ascending aortic aneurysm with hemopericardium,” the statement said. “The chest pressure he experienced shortly before his death may have represented the initial symptoms.”
    What is an aortic aneurysm?

    An aneurysm is an enlarged area in a blood vessel, which can happen anywhere on the body. An aortic aneurysm occurs in the aorta, the largest blood vessel, which carries blood away from your heart to the rest of the body.
    When an aortic aneurysm goes undetected, it can either rupture, causing a hole in the aorta, or it can lead to blood pumping too forcefully, causing a tear, or dissection, in the layers of the aorta.

    “Think of it like a balloon,” said Dr. Lee Wagmeister, a cardiothoracic surgeon at Deaconess Heart Group. “As it gets bigger and bigger, the walls get thinner and thinner. And as they get thinner like a balloon, it can pop or dissect.”

    What are the types of aortic aneurysms?
    There are two types of aortic aneurysms: abdominal aortic aneurysms, which occur in the abdomen, and thoracic aortic aneurysms, which occur in the chest.
    Aortic aneurysms are classified further according to its shape. A fusiform aneurysm bulges outward on all sides of the blood vessel wall, a saccular aneurysm affects only one side and a mycotic aneurysm is mushroom-shaped and usually the result of an infection.

    What happened to Wahl, according to Dr. Wagmeister, was a fusiform, thoracic aortic aneurysm.

    Who is at risk for developing an aortic aneurysm? And how common is it?

    High blood pressure, high cholesterol, smoking are all major risk factors.
    People with a bicuspid aortic valve — two flaps in the aortic valve instead of three — are at a greater risk.
    Family history can also be a significant factor. If a family member has an enlarged aorta, which is typical of people who have a bicuspid aortic valve, it could run in the family. Other genetic disorders that are considered risk factors include Marfan syndrome and Ehlers-Danlos syndrome.
    Aortic aneurysms typically affect one percent of the U.S. population and can usually be managed once detected, but detection is crucial.
    Dr. Wagmeister recommends that people take the time to know their family history and talk to their primary care doctor about whether they need to get screened.

    What are the symptoms?
    Unfortunately, aortic aneurysms are largely asymptomatic.
    Large abdominal aortic aneurysms can be felt by pushing on the abdomen during a physical exam. Smaller abdominal aortic aneurysms and aortic aneurysms in the chest are usually detected through CT scans and ultrasounds, but unless an individual has family history or a genetic disorder, screening is not recommended by doctors.
    In Dr. Wagmeister’s experience, aneurysms are usually detected incidentally, when a patients comes to a hospital for a kidney stone or a heart condition and a scan picks up the aneurysm.
    The only real symptoms occur when the aneurysm has ruptured or dissected. “It's a sudden onset of the worst pain you've ever had,” said Dr. Wagmeister. “Then you get all the other symptoms associated with not feeling well. And it really is an emergency.”
    How do you treat an aortic aneurysm?

    For the majority of cases, aortic aneurysms don’t need any treatment aside from regular ultrasound monitoring and observation, unless it starts to get big. Aortic aneurysms in the chest tend to grow slowly while aortic aneurysms in the abdomen grow quickly. Keeping blood pressure under control helps decrease the rate in which some aneurysms grow.
    If the size of the aneurysm is greater than five centimeters, that’s when there is a concern that it may dissect or rupture and surgery is considered. “That's a small percentage of people that get a blood vessel that large,” said Dr. Wagmeister.
    It is an even smaller percentage of people that arrive to the hospital with the aortic aneurysm already dissected or ruptured. In that case, of course, surgery is the only option and must be done immediately.
    What happened to Wahl?
    Wahl detailed on his Substack about how he had been feeling sick for quite some time.
    “What had been a cold over the last 10 days turned into something more severe on the night of the USA-Netherlands game, and I could feel my upper chest take on a whole new level of pressure and discomfort,” he wrote. “I didn’t have Covid (I test regularly here), but I went to the medical clinic at the main media center today, and they said I probably have bronchitis. They gave me a course of antibiotics and some heavy-duty cough syrup, and I’m already feeling a bit better just a few hours later. But still: No bueno.”
    The only thing that could have saved Wahl at that stage was open-heart surgery. There is a 75 percent chance of survival if an individual has a dissecting or ruptured aneurysm, if it is caught early enough, according to Dr. Wagmeister. But, by the time Wahl collapsed, it was too late.
    Wahl had chalked up his symptoms to “three weeks of little sleep, high stress and lots of work.” Though we know now it was more complicated that that, a healthy diet, exercise and, yes, getting seven to nine hours of sleep each night plays a big role in preventing, and monitoring, an aortic aneurysm as well as preventing many other diseases.
    Doctor’s orders
    Pay attention to your symptoms and make health your first priority. Whatever else you think is important is never as important as your health.

    “If you feel something bad is happening, get it checked,” said Dr. Wagmeister. “It's not likely to be an aneurysm. It probably isn't. But on the rare case, it could be.”
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