Dissecting aortic aneurysm – causes, symptoms and treatment

To understand the causes of this defect, you need to have a good idea of ​​the structure of the vessel itself. The aortic wall has an outer membrane, muscle fibers in the middle membrane, as well as the inner membrane (intima). In the middle membrane at the level of the aortic arch there are also sensitive nerve fibers, which can cause pain.

Normally, the shells of the vessel are firmly welded together, so when the blood pressure changes, the walls stretch, and its lumen expands or narrows. Stretching occurs evenly due to the elasticity of the walls. They have the so-called elastic fibers and connective tissue, which give strength.

The formation of aneurysm is most often associated with a violation of the normal structure of the wall. Deposits of various substances, tissue destruction or inflammation cause local weakening. High blood pressure quickly creates a pathological protrusion in this place, which is an aneurysm.

There are many reasons for the damage to the walls of the aorta, but their prevalence is uneven. The vast majority of aneurysms in our time are caused by atherosclerotic processes. Half a century ago, the main cause was syphilis. Nowadays, this reason also occurs, but much less often and, as a rule, in third world countries. Other diseases that can lead to the formation of an aortic aneurysm are very rare.

The main causes of the formation of aortic aneurysms are the following diseases and pathological processes:

  • Atherosclerosis. Atherosclerosis is currently the most common cause of not only aortic aneurysms, but also many other vascular diseases. The disease boils down to metabolic disturbances, as a result of which cholesterol and a number of other substances increase in the blood. This, in turn, leads to the formation of so-called plaques in the arteries. In small vessels, this is manifested by narrowing of the lumen and obstruction of blood flow. However, the aorta is the largest vessel, so the plaque does not greatly interfere with blood flow. The problem is that degenerative processes that weaken the membranes begin in the vessel wall under the plaque. As a result, the wall loses its elasticity, and high blood pressure gradually leads to its protrusion or expansion with the formation of an aneurysm.
  • Syphilis. Syphilis is a sexually transmitted disease that used to be very common almost everywhere. In the later stages of this disease, the pathogen enters various organs with a blood stream. Often spirochetes (causative agents of syphilis) are localized precisely in the aortic wall and gradually destroy it. At a certain stage, the wall weakens and an aneurysm forms. Nowadays, this reason is becoming less common, since syphilis is usually quickly diagnosed and successfully treated. Launched same forms of the disease are not always manifested precisely by an aortic aneurysm.
  • Injury. Mechanical damage to the aortic membranes is very rare. It may be the result of certain diagnostic or therapeutic manipulations on the heart. Coronary angiography, transluminal coronary angioplasty, balloon aortic angioplasty, intra-aortic balloon counterpulsation, aortic valve prosthetics, etc. sometimes lead to accidental damage. In these cases, aneurysm begins to form several days or weeks after the procedure, but may not cause any longer symptoms.
  • Congenital diseases. There are a number of congenital diseases that affect the development and structure of connective tissue. The most common are Marfan syndrome and Ehlers-Danlos syndrome. Due to the weakness of the connective tissue fibers, the aortic wall becomes weaker and does not withstand blood pressure. Aneurysm in this case usually takes the form of a spindle. The vessel is evenly expanded. Also, with these syndromes, there is the possibility of the simultaneous formation of several aneurysms in various parts of the aorta.
  • Some inflammatory diseases. Inflammation of the aorta is called aortitis. In severe cases of the disease, irreversible stretching of the wall may occur with the formation of an aneurysm. In these cases, an aneurysm will be a consequence of aortitis. There may be many causes of aortitis. Occasionally, these are infectious agents that have infiltrated an atypical place. For example, tuberculous, salmonella or fungal aortitis are known. Non-infectious inflammation is also possible. These are autoimmune processes caused by disturbances in the body’s own immune system. As a rule, they are manifested by damage to the connective tissue in other organs (joints, heart valves, kidneys, etc.), but in rare cases, the aorta can also be affected. Examples of such diseases are Takayasu’s disease, ankylosing spondylitis, thromboangiitis obliterans. In practice, all of these causes are very rare.

There are also a large number of various predisposing factors that do not directly affect the structure of the aortic wall, but indirectly contribute to the formation of aneurysms. A detailed survey of the patient can help to identify the influence of these factors, and their elimination is important to improve the prognosis. In most cases, the effect of these factors is associated with metabolic disorders, increased blood pressure or circulating blood volume.

Predisposing factors contributing to the formation of an aortic aneurysm are:

  • Smoking. It is proved that smoking contributes to the development of atherosclerosis and through it tissue degeneration in the aortic wall. In addition, experienced smokers often develop hypertension.
  • Improper nutrition. An excess of fatty foods rich in cholesterol is an important link in the development of atherosclerosis. Excess cholesterol with food is often associated with an increased concentration of this substance in the blood. The risk of developing aneurysm, respectively, increases.
  • Elderly age. Statistically, aortic aneurysm most often affects people over 40 – 50 years old. The greater the age, the higher the risk. This is due to metabolic disorders, degeneration of connective tissue, a tendency to hypertension. In practice, in the elderly, atherosclerosis is most often responsible for the formation of aneurysm, while in young people – congenital disorders or syphilis.
  • Overweight. Obesity is also a predisposing factor to the development of atherosclerosis.
  • The presence of other chronic diseases. It has been statistically proven that a major role in the development of aortic aneurysm is played by hypertension (high blood pressure). About 75% of patients with this disease suffer from it. Chronic autoimmune diseases, chronic foci of infection, etc. can also play a role.

Thus, we can conclude that aortic aneurysm is not an independent disease. In the vast majority of cases, it is a complication of other pathologies. The risk increases significantly when exposed to the above factors. However, these factors alone cannot damage the vessel. They only exacerbate existing damage.

Congenital aortic aneurysm is said in cases where a vessel defect was already in the body at the time of birth. This type of aneurysm may occur due to problems with fetal development (maternal illness during

etc.) or genetic diseases. In the second case, you can sometimes trace a hereditary predisposition to such problems. Blood relatives gave birth to children with similar problems;

. Adults could suffer from various cardiovascular diseases. Also, according to statistics, for a number of genetic diseases, congenital aortic aneurysm is usually found in combination with other

aortic valve, tetralogy of Fallot, etc.). The prognosis for such children is disappointing, since complex heart surgery is required. At the same time, children are usually weakened, are born with a weight below the norm.

Simptomy anevrizmy aorty po vidam - Dissecting aortic aneurysm - causes, symptoms and treatment

If a child with congenital aneurysm of the thoracic or abdominal aorta grows up, the chance of rupture is greatly reduced. Of course, the patient must comply with all the prescriptions of doctors and take preventive treatment. Most often, after stabilization in childhood or adulthood, it is still recommended to remove the aneurysm surgically.

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Types of Aortic Aneurysms

There are several criteria by which all aneurysms can be divided into types. Such a classification allows doctors to more accurately formulate the patient’s diagnosis and determine the treatment. The separation of aneurysms into types is justified, since each type has its own characteristics, occurs under certain conditions, and also requires an individual approach to treatment. The type of aneurysm is usually determined in the diagnostic process using various instrumental examination methods.

By position, all aortic aneurysms can be divided into the following types:

  • Aneurysm of the ascending aorta. It is located between the aortic valve of the heart and the aortic arch (in front of the place where the brachiocephalic shaft originates).
  • Aneurysm of the aortic arch. Located at the bend of the aorta. The bend goes from right to left, here the vessel turns 180 degrees and goes to the abdominal cavity. Aneurysms of the aortic arch often capture its large branches located on this site.
  • Aneurysm of the descending aorta. It is located on a segment from the left subclavian artery to the diaphragm. On the anterior chest wall, these aneurysms are projected approximately onto the sternum.
  • Suprarenal aneurysm. It is located in the abdominal cavity (this is a type of abdominal aortic aneurysm) in the area from the diaphragm to the place of discharge of the renal arteries.
  • Infrarenal aneurysm. It is located on the site of the abdominal aorta below the place of discharge of the renal arteries before bifurcation (bifurcation) of the aorta into two iliac arteries.

If the aneurysms are multiple, then the location of each of them is indicated. This option is quite rare. The cause is usually a congenital predisposition to the formation of aneurysms – Marfan syndrome and other serious diseases that reduce the strength of connective tissue. Multiple aortic aneurysms located in both the chest and abdominal cavity have a much more serious prognosis than single formations.

Classification

Symptoms of aortic aneurysm are almost always absent. This is the insidiousness of this disease. They appear only when the aneurysm has become huge. All disaster occurs after a break.

What symptoms arise when the aneurysm reaches a significant size? All symptoms are various signs of compression of neighboring structures by this “swollen bag”.

Aortic arch aneurysm

Symptoms are varied, due to the presence of a large number of structures:

  • there is a throbbing pain in the chest, or behind the sternum, which can radiate to the back;
  • with compression of the trachea and bronchi, a dry, painful cough occurs, with a decrease in the lumen of the respiratory tract – shortness of breath;
  • when the recurrent laryngeal nerve is involved in the process, a pronounced hoarseness of the voice occurs;
  • if the aneurysm squeezed the superior vena cava, there will be swelling and blue face, the neck veins will swell, the eyelids will swell and symptoms of intracranial hypertension will appear: headache, decreased vision;
  • with compression of the esophagus, difficulty swallowing may occur;
  • if the sympathetic nerve is compressed, then Horner’s syndrome (ptosis, miosis, enophthalmos) will develop on the compression side, that is, prolapse of the upper eyelid, constant narrowing of the pupil and reduction (retraction) of the eyeball.

Sometimes signs of aneurysm do not happen until the gap. But, depending on the location in the chest, there are:

  • severe pain between the shoulder blades and chest, throbbing;
  • frequent pneumonia with compression of their departments;
  • the appearance of bradycardia;
  • with compression of the vessels of the spinal cord, the development of distant symptoms is possible – paralysis and paresis in the legs, sensitivity disorders, urinary incontinence;

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Abdominal aortic aneurysm is often manifested by abdominal pain. By the way, some people for some reason speak and formulate the question as “abdominal aneurysm – what is it?”. It is recommended that they open an anatomy textbook to understand that the aorta lies retroperitoneally, but not in the abdominal cavity.

In addition to abdominal pain, aneurysm symptoms may include:

  • pulsation in the abdomen, or a feeling of “fullness”;
  • with compression of the duodenum 12 there may be profuse symptoms: belching, nausea and vomiting;
  • with compression of the ureter, stagnation of urine occurs in the pelvis, pyelonephritis develops, dysuric disorders occur;
  • with compression of the nerve roots there is a simulation of “chondrosis” with lower back pain;
  • finally, there is a chronic circulatory failure in the legs, intermittent claudication, trophic disturbance (skin cooling, hair loss, brittle nails).

As you can see, the symptoms of aortic aneurysm in different departments are very rich, and can lead along the wrong diagnostic path anywhere. Fortunately, the diagnosis of aneurysm, with the advent of imaging research methods (ultrasound, CT, MRI) was greatly facilitated.

Aortic aneurysms can be different in their structure and shape.

According to its pathological features, aneurysm is:

  • true – is a protrusion of the vessel wall, which is formed from all vascular layers of the aorta;
  • false (or pseudo-aneurysm) – is a protrusion of the vessel wall, which is formed from pulsating hematomas, the vessel walls consist of paraaortic connective tissue and sublayer deposits of blood clots.

In its form, an aortic aneurysm can be:

  • saccular – the cavity of the pathological protrusion of the aorta communicates with its lumen through the cervical canal;
  • spindle-shaped – occurs most often, its cavity is similar to the shape of the spindle and communicates with the aortic lumen through a w >shutterstock 468639518 - Dissecting aortic aneurysm - causes, symptoms and treatment

Stratification of the main blood vessel due to the formation of aneurysm is of several types. There are forms of the disease according to the place of its localization and the nature of the clinical picture. There are three types of abnormal process.

  1. First type. It is characterized by a rupture of the shell inside the wall in the ascending region. Stratification extends to the abdominal region. The result may be the formation of a blind sac in the distal part or rupture of the aorta in the same area.
  2. The second type. It has a similar course with the first type, but there is no rupture, and a blind sac forms in the brachiocephalic trunk.
  3. The third type. It is determined by rupture of the inner lining of the vessel in the thoracic region. As a result, a blind sac may form above the diaphragm or in the abdominal region. Dissection may also occur in other sections of the aorta and result in the formation of a sac. The greatest danger is distal fenestration.

Each type of pathology has a specific clinical picture and causes. Predictions of a violation of the full functionality of the heart vessel can be completely different. But most often they are unfavorable.

Signs and symptoms of aortic aneurysm

In most cases, aortic aneurysms, wherever they are located, are asymptomatic in the early stages of the disease. This is due to the fact that a moderate stretching of the walls, whether it is spindle-shaped or saccular, worsens the blood flow, causes turbulence, but does not stop it. In other words, the problem appears, but blood continues to flow to all organs.

the doctor may accidentally notice a shadow on the aorta.

Symptoms of aortic aneurysm, when they appear, can have two main mechanisms of origin. The first is hemodynamic disturbances. Symptoms are caused by impaired blood flow, due to which arterial blood flows worse into the branches of the aorta, and various organs and tissues suffer. These symptoms can be very diverse and depend on the location of the aneurysm.

For example, with an abdominal aortic aneurysm, the organs of the abdominal cavity suffer mainly, with aneurysm of the chest cavity – the heart, head. The second group of symptoms is symptoms of compression. They arise with large aneurysms and are associated with mechanical compression of adjacent anatomical structures. The third group includes pain.

Symptoms of a thoracic aortic aneurysm most often appear with a significant amount of education. Due to the proximity of the vessel to the heart, one can often observe a variety of disturbances in the functioning of this organ. The nature of the symptoms and their intensity depends on the location of the aneurysm, its size, as well as the disease that caused it. For example, with an aneurysm against syphilis, the patient may appear

. But skin lesions will not be directly related to aneurysm. Both of these processes will be a consequence of the activity of the causative agent of syphilis. The symptoms that the aneurysm itself causes will be described below.

With aneurysm of the thoracic aorta, the following symptoms are most characteristic:

  • Aortalgia. Pain during aneurysm may be associated with damage to nerve endings in the vessel wall or with involvement of nerves from the paraaortic plexus. Pain from aneurysm usually appears when the arms are raised up, which distinguishes it from most other diseases. It is localized behind the sternum, rarely spreads to other areas. Distribution is associated with the localization of aneurysm. In contrast to anginal (ischemic) pain, the attacks here are longer, the pain is less intense and does not respond to nitroglycerin. Sometimes the patient cannot articulate exactly what pain is bothering him. It is worth paying attention to the time of its appearance. It was noted that with aneurysm, pain often appears in the morning, when the patient washes his hair, combed his hair. These actions are associated with moderate physical exertion and raising arms up, which causes exacerbation of pain.
  • Cough. Coughing is more often associated with compression of the trachea or bronchi, as well as circulatory disorders in the small circle and worsening of the heart. All this in combination leads to the appearance of an unproductive (without sputum) cough. In some patients, it becomes paroxysmal and may even resemble a coughing attack with whooping cough (barking, prolonged), but without mucus separation at the end.
  • Heaviness behind the sternum. Heaviness behind the sternum may bother patients with symptoms of compression. They may complain of a “foreign body” or “volumetric formation”. In this case, of course, the larger the education, the more often this symptom occurs. But even with a small aneurysm, severity can also appear. The feeling is individual.
  • Dyspnea. The appearance of dyspnea is associated with impaired heart function, a change in blood pressure. The attack, as a rule, does not last long. He, like pain or cough, can be triggered by raising his arms up.
  • Dizziness. Dizziness is most often associated with hemodynamic disorders. If the aneurysm is located in the region of the brachiocephalic trunk or the left common carotid artery, blood may enter the brain worse. This causes dizziness, headaches, darkening in the eyes and some other neurological symptoms. Ears and the tip of the nose can also get cold (and sometimes even turn blue). Sometimes dizziness is also associated with a concomitant increase or decrease in pressure, which is often observed in patients with aneurysm.
  • Increased heart rate. The ejection of blood from the heart into the aorta during aneurysm may be difficult. Because of this, patients sometimes complain of tachycardia (heart palpitations) or that they feel their own heartbeat (which is also not normal).

There are also many symptoms of compression. At the same time, as a rule, the work of a certain body is disrupted, which leads to the idea of ​​problems with it.

With aneurysm of the thoracic aorta, compression of the following anatomical structures can be observed:

  • Trachea and major bronchi. With significant aneurysms, compression of these anatomical structures can cause a number of symptoms from the respiratory system. First of all, this is a cough, difficulty trying to take a deep breath, noisy breathing. With an aneurysm of the ascending aorta, the right main bronchus is more often compressed, and with aneurysm of the arch or descending aorta, the left. In rare cases, Oliver-Cardarelli’s symptom is also observed. In this case, the larynx is slightly shifted to the beat of the heartbeats. The symptom is caused by the transmission of pulsation from the aneurysm to the compressed trachea.
  • Esophagus. A major aneurysm can compress the esophagus, causing difficulty swallowing (dysphagia). Solid food is more difficult to swallow than liquid or soft food (soups, cereals). After eating, the patient often has a foreign body sensation behind the sternum, heaviness. With an aneurysm of the descending aorta, a part of the esophagus near the diaphragm can be squeezed (there is the esophagus already). After a hearty dinner, quite severe pains in the upper abdomen (in the epigastrium) may appear.
  • Left recurrent nerve. This nerve is involved in the innervation of muscles near the vocal cords. His compression is often manifested by hoarseness or hoarseness of voice.
  • Left subclavian artery and brachiocephalic trunk. More often, these vessels are compressed with large bag-shaped aneurysms of the aortic arch. During the examination, patients noted the asymmetry of the pulse on the hands (and sometimes on the carotid artery). There may also be transient visual, hearing, and other similar symptoms.
  • Left cervical sympathetic ganglion. More often, its compression takes place with large aneurysms of the aortic arch. The result of irritation of this nerve is Horner’s symptom, which consists of a triad – anisocoria (different sizes of pupils in the eyes), enophthalmos (retraction, a deeper fit of the eye compared to the norm), narrowing of the palpebral fissure.
  • Superior vena cava. This vessel receives venous blood from the head and upper limbs. It is compressed only with very large aneurysms. The result is stagnation of blood in the veins of the head and hands. Swelling of the face, cyanosis, swelling of the cervical veins, sleep disturbances, headaches may appear. Since compression occurs from the outside, as a rule, the outflow of blood is restored in a certain position (on the side, on the stomach, standing, etc.). This can be considered a hallmark of the aneurysm, since blood stasis in the superior vena cava is most often caused by heart problems. However, then it does not disappear with a change in body position.

Aneurysm of the ascending aorta is quite rare in medical practice. Some experts do not even distinguish it in the classification of this disease. In this case, problems with the vessel wall are localized immediately after it leaves the left atrium. At this level, large branches do not depart from the aorta. However, the mouths of the coronary arteries are located here. Blood flow problems in this area increase your risk.

coronary artery development

. Of the concomitant symptoms, pain can be observed behind the sternum or in the area of ​​the heart (ischemic pain associated with insufficient supply of oxygen to the heart muscle). Coronary pain occurs due to the fact that blood passes through the dilated portion of the vessel worse. That is, it becomes harder for the heart to contract.

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A muscle (myocardium) begins to consume more oxygen, and its availability is limited. It is also possible disruption of the aortic valve, increased heart rate, which the patient himself feels even at rest. However, all of these symptoms are optional. It’s just that they are more often found precisely with the localization of the aneurysm in the ascending part of the vessel.

Aortic arch aneurysm

This localization of the aneurysm in the chest is quite common in comparison with other options. Since the largest branches (the brachiocephalic trunk, the left common carotid artery and the left subclavian artery) depart precisely from the arc, such aneurysms are less asymptomatic.

Since blood circulation in the vessels of the head and hands often worsens with aneurysm of the arc, the symptoms can be very diverse. The patient can go around many specialists until one of them prescribes a preventive radiography of the chest cavity and finds a true problem.

Of all aneurysms of the thoracic aorta, aneurysm of the descending section is most common (according to various sources, in 50 – 70% of cases). This segment of the vessel is the longest, from the arc to the aortic opening in the diaphragm. Major aneurysms in this area often interfere with the normal functioning of the heart and

. Without even giving specific symptoms, they can cause a feeling of heaviness behind the sternum, the inability to take a deep breath. Some patients complain of a prolonged cough, the risk of it becoming

. All this is associated with compression (compression) of a particular lung department. It deteriorates ventilation and blood supply, which opens the way for infection.

According to statistics, aneurysms are formed on the abdominal aorta much more often than on the thoracic aorta. Perhaps this is due to some changes in the structure of the vessel wall. From a medical point of view, these diseases are very different. This is due primarily to the symptoms and manifestations of pathology. In the abdominal cavity are located mainly the organs of the gastrointestinal tract.

Basic views

Symptoms

Aortic arch aneurysm

The severity and nature of the signs of aortic aneurysm is determined by the place of its localization and stage of development. They are nonspecific, diverse and, especially with insufficient severity or rapid progression, are attributed to other diseases by patients. The sequence of their appearance is always determined by such pathological processes:

  • during a tear of aortic intima, the patient develops pain and blood pressure sharply decreases;
  • in the process of stratification of the aortic wall, the patient has a sharp pain of a migratory nature, repeated episodes of lowering blood pressure and organ symptoms (they are determined by the location of the aneurysm, tear of intimacy and hemorrhage);
  • during a complete rupture of the aortic wall, the patient develops signs of internal bleeding (sharp pallor, cold sweat, decreased blood pressure, etc.) and hemorrhagic shock develops.

Depending on the combination of all of the above factors, the patient may experience:

  • pain of a burning, pressing or tearing character, localized or radiating to the arm, chest, shoulder blades, neck, lower back or legs;
  • cyanosis of the upper part of the body with the development of hemopericardium;
  • fainting that develops with damage and irritation of the vessels leaving to the brain or with a sharp anemia of the patient due to massive bleeding;
  • severe bradycardia at the beginning of an intimal tear, subsequently replaced by tachycardia.

In most patients, aortic aneurysm, especially in the early stages of its development, is asymptomatic. Such a course of the disease is especially relevant when the pathological protrusion of the vessel wall in the thoracic aorta is located. In such cases, the signs of pathology are either detected by chance during an instrumental examination for other diseases, or make themselves felt more clearly if the aneurysm is localized in the area of ​​the aortic bend in the arc.

In some cases, with vascular irritation, aortic dissection in the area of ​​the coronary vessels and compression of the coronary arteries, the clinical picture of aortic aneurysm is combined with symptoms of myocardial infarction or angina pectoris. With the location of the pathological protrusion in the abdominal aorta, the symptoms of the disease are clearly expressed.

An ECG examination of a patient with aortic aneurysm may have a variable picture. In 1/3 of the cases, no deviations are found on it, and in others, signs of focal myocardial lesions and coronary insufficiency are observed. With aortic dissection, these signs are persistent and are detected on several repeatedly taken ECGs.

In a general blood test, the patient has leukocytosis and signs of anemia. With stratification of the aortic aneurysm, a decrease in the level of hemoglobin and red blood cells is constantly progressing and combined with leukocytosis.

Also, in patients with this disease, the appearance of some neurological symptoms is possible:

  • convulsions;
  • disorders during urination and defecation;
  • hemiplegia;
  • fainting conditions;
  • paraplegia.

When the femoral and iliac arteries are involved in the pathological process, signs of a violation of the blood supply to the lower extremities are observed. The patient may appear: leg pain, swelling, blanching or cyanosis of the skin, etc.

In case of separation of the abdominal aortic aneurysm in the abdomen, a pulsating and increasing in size tumor is formed, and when blood is poured out into the pleural cavity, pericardium or mediastinum, when tapping the borders of the heart, their displacement, expansion and cardiac rhythm disturbance up to cardiac arrest are observed.

In most cases, rupture of the aortic aneurysm is not accompanied by any specific symptoms. Initially, the patient may experience discomfort and non-intense pain, and at the onset of bleeding, the signs of hemorrhagic shock join the clinical picture.

In the case of massive and rapid hemorrhage, fainting and intense pain can occur in different parts of the body (if the dissection or rupture of the aorta occurs in close contact with the nerve bundle). A further prognosis of such significant blood loss depends on the total volume of blood lost.

With a stratified aortic aneurysm, characteristic signs and symptoms will be observed:

  • the patient feels a sharp attack of acute pain. It is localized in the chest area, in front, and also gives between the shoulder blades. Pain is discontinuous. Physicians can distinguish them from myocardial infarction by the strength of their manifestation, in the case of an aneurysm, the strongest sensations will be at the beginning of its development. With a concentration of pain in the thoracic aorta, stratification of the tissues of the vessel occurs. Many patients characterize such sensations as piercing and tearing;
  • impending death;
  • manifestation of stagnation in the vessels;
  • stroke development;
  • acute ischemic manifestations;
  • paralysis of immediately arms or legs;
  • violations of the right coronary artery;
  • renal impairment;
  • increased blood pressure due to a decrease in vascular lumen;
  • pain in the abdomen.

And also there is a stratification of the aortic aneurysm without the manifestation of pain. To establish a diagnosis, it is necessary to study the medical history, state of his health and lifestyle. Still, a comparison of the results of the examinations will be needed, for this, doctors are studying all the indicators of a chest examination that have been performed.

Signs of aortic dissection directly depend on the characteristic course of the disease. The severity of symptoms is affected by the extent of destruction of the blood vessel wall, the presence of a hematoma, occlusion and compression of the aorta itself, as well as possible ischemia of internal organs.

Symptoms of the disease appear in several ways:

  • the formation of a whole hematoma inside the walls;
  • stratification of tissues and rupture of aneurysms in the lumen;
  • destruction of the wall and rupture of the aneurysm in the surrounding tissue;
  • aortic tear without stratification of the walls.

An aneurysm is formed not gradually, but suddenly. Signs of pathology are similar to diseases of a neurological nature, cardiovascular system or urological abnormalities. In patients, a sharp severe pain occurs, spreading to the entire central part of the body.

Other symptoms are observed:

  • blood pressure surges;
  • different pulse on the arms and legs;
  • weakness;
  • increased sweating;
  • blue skin;
  • increased motor activity.

The stratification of an aortic aneurysm can result in other diseases associated with the work of the heart and nervous system. Some patients had myocardial ischemia, the development of aortic regulation, tamponade and hemopericardia of the heart.

The insidiousness of aortic dissection is that the pathology can be asymptomatic, and when the first signs of trouble appear, then there is extremely little time for diagnosis and treatment.

Speaking of acute stratification, they mean its duration of no more than two weeks, this is the most dangerous scenario.

Chronic stratification lasts for weeks and months.

Symptoms of aortic dissection depend on the site of damage to the vascular wall and the severity of the changes. Signs of stratification can be considered:

  1. Pain syndrome;
  2. Fainting, a sharp drop in blood pressure, shock;
  3. Heart failure, severe bradycardia;
  4. Circulatory disorders in the internal organs.

The pain is usually localized in the chest, lower back, limbs, neck. Patients describe her as unbearable, “tearing”. When the stratification extends along the vessel wall, the pain migrates, occurring in other parts of the body.

Fainting and a sharp drop in blood pressure are a direct result of a violation of the integrity of the aorta, when blood rushes into the false channels of its wall or even beyond. The internal organs are malnourished, the heart, brain, and kidneys are suffering. Some patients faint from unbearable pain.

With massive blood loss, hemorrhage in the cavity of the heart bag (cardiac tamponade), acute ischemia of organs, shock rapidly develops, the patient’s condition quickly and progressively worsens, he loses consciousness, cardiac arrest and death are possible.

Insufficiency of central blood circulation, reverse flow of blood through the aortic valve (regurgitation) contribute to acute heart failure. Many patients have bradycardia and pulse deficiency, blood pressure on the limbs can vary significantly, reflecting an extremely poor prognosis.

Violation of blood flow in the organs leads to the appearance of symptoms of myocardial infarction, stroke, acute renal failure. The patient turns pale, cyanosis occurs, shortness of breath appears, the amount of urine excreted decreases.

Stratification of the abdominal aorta is often a consequence of atherosclerosis. Against the background of circulatory disorders, ischemic damage to the intestines, kidneys, and lower extremities occurs in the lower part of the vessel. Secondary renal arterial hypertension is characteristic.

Stratification of the thoracic aorta and its ascending part leads to a rapid increase in pain, heart failure, the development of myocardial infarction and acute cerebral ischemia. Damage to these sections tends to spread rapidly to the lower fragment of the vessel. The most dangerous complications of stratification in the ascending section are pericardial hemotamponade and total rupture of the aortic wall.

Suspicion of stratification of the aortic wall requires quick action from the doctor to confirm the diagnosis and begin treatment immediately. The most informative diagnostic methods are chest x-ray, echocardiography, aortography, CT and MRI.

Diagnostics

It is very difficult to diagnose aneurysm of the thoracic or abdominal aorta at once for several reasons. Firstly, the disease is often not manifested by any symptoms, and even a preventive visit to the doctor does not always reveal any deviations. Secondly, the symptoms of an aortic aneurysm are very similar to a number of other diseases. The appearance of such general complaints as dry

or chest discomfort make, first of all, think about other pathologies. Thirdly, aortic aneurysm itself is not so common in medical practice, so many doctors simply don’t think about it when analyzing the patient’s first complaints.

If you suspect an aortic aneurysm, you should contact your family physician or cardiologist. It is they who can competently conduct an initial examination and prescribe further tests and examinations. A targeted search for aneurysm of the thoracic or abdominal aorta in most cases is successful. Doctors manage to detect the formation itself, as well as collect all the necessary data (shape, type, size, etc.).

The purpose of examining a patient is to collect information without involving additional examination methods. The doctor is trying to identify visible abnormalities and abnormalities. This examination sometimes allows with a high degree of probability to make the correct diagnosis even without attracting additional funds.

During a physical examination, the following research methods are used:

  • Visual inspection Visually with aortic aneurysms, very little information can be obtained. Any changes in the shape of the chest are extremely rare and only in those cases when the patient has lived with a large chest aortic aneurysm for at least several years. With aneurysm of the large abdominal aorta, pulsation can sometimes be observed, which is transmitted to the anterior abdominal wall. In addition, when aneurysm ruptures on the abdominal wall, violet spots can sometimes be observed – a sign of massive internal bleeding. However, this symptom almost never appears on the anterior abdominal wall (usually on the side), since the aorta is located retroperitoneally (separated from the intestine, stomach and other organs by the posterior sheet of the peritoneum), and hemorrhage occurs primarily in the retroperitoneal space.
  • Percussion. Percussion consists in tapping the body cavities to determine the boundaries of different organs by ear. With abdominal aortic aneurysm, one can determine the approximate size and location of the formation in this way. Often the area of ​​blunting of percussion sound coincides with the zone of the “vascular bundle”. Then, according to percussion, this zone will be expanded. In addition, with a large aneurysm of the thoracic aorta, the borders of the heart or mediastinum can be slightly shifted. With abdominal aortic aneurysm, percussion is less informative, since the vessel passes along the posterior wall of the abdominal cavity. Palpation in this case will be more informative.
  • Palpation. Palpation of the chest cavity is almost impossible due to the costal skeleton, so palpation is almost never used in the diagnosis of thoracic aortic aneurysm. With an aneurysm of the abdominal cavity, it is often possible to detect a pulsating heart beat. This eloquently indicates precisely the presence of aneurysm, since such formations do not occur in other diseases. In addition, pulse detection can be attributed to palpation. If the frequency or filling of the pulse is different on different hands or on the carotid arteries, this may indicate the presence of aneurysm of the aortic arch. A weakened or absent pulsation on the femoral arteries (or a different frequency on different legs) may indicate infrarenal aneurysm.
  • Auscultation. Listening with a stethophonendoscope (listening) is a very common and valuable diagnostic method. In case of abdominal aortic aneurysm, applying a stethoscope to the projection site of the aneurysm, one can hear an amplified noise of blood flow. With aneurysm of the thoracic aorta, pathological changes can be different – a metallic accent of the second tone above the aorta, systolic murmur at the point of Botkin, etc.
  • Pressure measurement. Most often, patients with aneurysm show hypertension (increased pressure). With aneurysms of the aortic arch of large sizes, the pressure on different hands can be different (the difference is more than 10 mm Hg).

If characteristic symptoms are found during a physical examination, the doctor prescribes other diagnostic measures to confirm the diagnosis.

Radiography is the most common method of imaging the organs of the abdominal or chest cavity. X-rays, passing through tissues, are delayed in different ways by them. So the borders appear in the picture. They talk about sites (organs, tissues, formations) with different densities. With thoracic aortic aneurysm, you can often see either one of the edges of the cavity of the aneurysm (for example, bulging of the aortic arch), or the entire expansion of the vessel. It depends on the quality of the image and the location of the aneurysm.

Also, with the help of x-ray radiation, a study with contrast (aortography) is possible. In this case, a special substance is introduced into the aorta, which intensively stains the vessel in the picture. Thus, the doctor receives clear boundaries of the vessel and its main branches. The shape and size of the aneurysm, its location are well defined.

In practice, however, contrast studies are rarely used. Firstly, this is an invasive (traumatic) procedure, since the introduction of a special catheter through the femoral artery is necessary. Because of this, there is a risk of bleeding, infection, etc. Secondly, in the presence of aneurysm (especially stratifying) there is a high risk of provoking a gap during the study. Therefore, this procedure is carried out only for special indications.

Ultrasound examination is based on the passage of sound waves through tissues. Reflecting, these waves are captured by a special sensor, and the computer based on the information received builds an image that is understandable to the doctor. In medical practice with aortic aneurysms, ultrasound is one of the most common diagnostic procedures. This is because in

An ultrasound machine can also measure blood flow. This information is very important in the case of aneurysms, since with them there are turbulences in the flow, and some blood vessels do not receive enough blood.

Ultrasound for patients with aortic aneurysm has the following advantages:

  • relatively low cost;
  • painless and patient-safe research;
  • immediate result;
  • the duration of the study is only 10 – 15 minutes;
  • the ability to determine the shape and size of the aneurysm;
  • the ability to detect some complications of aneurysm;
  • the ability to evaluate blood flow in the aorta and its branches;
  • the ability to detect emerging blood clots.

In general, ultrasound is more common in the diagnosis of abdominal aortic aneurysm. The abdominal wall is thinner, and the picture that the doctor receives is more accurate. When examining the thoracic aortic aneurysm, a number of

and lungs, which is also important for treatment. A method of examining the organs of the chest cavity using ultrasound waves is called echocardiography (echocardiography).

Magnetic resonance imaging and computed tomography are different diagnostic methods on the principle of action, but in general they have a lot in common. Both procedures are very informative, but also expensive, so they are not prescribed to all patients. Often, these research methods are resorted to before a planned operation to remove aortic aneurysm. In this case, it is necessary to collect as much information as possible about education.

When conducting MRI, a special property of nuclear magnetic resonance is used. The image is obtained by placing the patient in a powerful electromagnetic field in which the computer picks up the movement of hydrogen nuclei. A high-precision image is formed on which not only the three-dimensional shape of the aneurysm is visible, but even the thickness of its walls.

MRI has the following contraindications:

  • ear implants and built-in hearing aids;
  • the presence of metal pins or plates after operations;
  • the presence of a pacemaker;
  • some types of prosthetic heart valves.

An important advantage of MRI is that this procedure also allows you to evaluate blood flow in individual vessels, and not just get an image of the aneurysm itself. Doctors get the opportunity to assess circulatory disorders and suspect a number of concomitant disorders.

With computed tomography, the method of obtaining images is somewhat different. As in the case of x-ray, we are talking about the difference in the absorption of x-ray radiation in different tissues of the body. In modern tomographs, the radiation source revolves around the patient, taking a number of shots. Then the computer simulates the result.

The result is a series of high-precision snapshots. Based on the results of computed tomography, an experienced doctor can not only detect changes in the structure of the aorta, but also determine their size, position and other features. The CT makes the use of contrast even more informative. The introduction of contrast medium into the vessel allows you to get a computer model of the patient’s vessels in 3D.

Electrocardiography is an inexpensive and painless research method that aims to assess the electrical activity of the heart. If a thoracic or abdominal aortic aneurysm is suspected, it is recommended to take an electrocardiogram for several reasons at once. Firstly, in patients with chest pain, this will help differentiate aortalgia from anginal pain (

), which can be easily confused. Secondly,

, which is the most common cause of aortic aneurysm, often affects coronary vessels, increasing the risk of heart attack. It is advisable to identify these abnormalities with an ECG before treatment. Thirdly, sometimes on the ECG, specific changes characteristic of the aortic aneurysm can also be noticed. Also, with the help of this study, changes in the work of the heart, which are complications of aneurysm, are sometimes found. Before the operation to remove the aneurysm and during it, the ECG is constantly removed.

Conservative treatment

Treatment for aortic aneurysms almost always involves surgery. A deformed vessel wall cannot restore its shape with the help of medications. At the same time, there is always a risk of rupture with massive internal bleeding. Therefore, at first, the patient is carefully examined, the extent and possibility of surgical treatment are assessed, and preliminary drug (conservative) therapy is prescribed.

An important part of treatment is the prevention of aneurysm rupture. It includes a change in lifestyle, nutrition, and some patient habits. Compliance with preventive measures will allow the patient to better prepare for surgical treatment (it will not be urgent about stratification or rupture, but planned).

Prevention of the formation and rupture of aneurysm includes the following recommendations:

  • smoking cessation is perhaps the most important measure both to prevent the development of aneurysm and to delay the increase in the diameter of an existing aneurysm of the thoracic aorta;
  • normalization of blood pressure (including with the help of medications);
  • normalization of body weight, if necessary, with the help of a nutritionist;
  • a low cholesterol diet for the prevention of atherosclerosis;
  • refusal of serious physical exertion;
  • prevention of psychoemotional stress (up to taking sedatives).

Given that the causes of aortic aneurysms may vary, other preventative measures may be required. They are determined and explained to the patient by the attending physician after examination.

The natural course of a disease such as aortic aneurysm is a steady and progressive increase in diameter of the aneurysm, with its subsequent rupture. At the moment, in medicine there are not enough reliable medications that could prevent the development of degenerative processes in the aortic wall and the further growth of aneurysm. Accordingly, only surgical intervention with resection (removal) of the affected area and its replacement can be an adequate treatment.

But in the following cases, it is necessary to resort to medications in order to delay the growth of the aneurysm for the longest and alleviate the symptoms of the disease:

  • With a small diameter of the pathological site in the aorta (up to 5 cm) during the period of dynamic observation of a patient with thoracic aortic aneurysm.
  • In severe concomitant diseases, when the risk from surgery exceeds the risk of rupture of the aneurysm itself. These conditions include acute disorders of coronary circulation, acute disorders of cerebral circulation, heart failure II – III degree.
  • In preparation for surgery.

For each patient, the attending physician selects their own treatment regimen depending on the type and size of the formation, as well as on the symptoms and complaints of the patient. However, there are several groups of drugs that are prescribed most often.

With aneurysms of the thoracic or abdominal aorta, medications with the following effect can be prescribed:

  • heart rate lowering drugs (heart rate);
  • drugs to lower blood pressure;
  • cholesterol lowering drugs.

Beta is most commonly used to reduce heart rate.

affecting the innervation of the heart. With contraindications to the use of beta-blockers, verapamil from the group of calcium channel blockers can be prescribed. It is necessary to slow down the heart rate to 50-60 beats per minute. This significantly reduces the load on the walls of the aorta and reduces the likelihood of complications.

Medications to lower heart rate in patients with aortic aneurysm

Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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