What Is Aortic Disease?
The aorta is your body's largest artery, carrying oxygen-rich blood
from the heart. When your aortic valve opens and blood flows into the
aorta, the aorta and its branches deliver vital nutrients to every part
of your body, including the heart itself.
When your aorta is healthy, its elastic walls expand and contract easily.
However, when your aorta is diseased, the areas of weak, abnormal tissue
bulges or balloons out. The stress of high-pressure blood flow on this
abnormal tissue, which becomes weak and thin, puts this vital blood vessel
at risk of tearing or rupturing.
Thoracic aortic disease may be caused by several different conditions and
may occur in both males and female of any age. When the underlying cause
is genetically based, more than one family member may be affected. Thoracic
aortic disease is serious because weak, fragile aortic tissue under high
pressure may tear or rupture, causing life-threatening bleeding. Early
detection can prevent emergencies that too often result in injury or loss of life.
Types of Aortic Disease
Bulging or enlargement of a blood vessel due to weakness of vessel wall.
A tearing of the inner lining of the aortic wall, allowing blood to enter
and split the layers of the aortic wall. Blood may travel within the layers
of the aorta, creating a "false" channel, sometimes called a
Bleeding within the wall of the aorta, a variation of classic aortic dissection.
Ulceration of atherosclerotic plaque penetrates into the aortic wall.
Aortic diseases often go unnoticed because patients rarely feel any symptoms.
While only half of those with aortic disease complain of symptoms, possible
warning signs include:
- Pain in the jaw, neck, and upper back
- Chest or back pain
- Coughing, hoarseness, or difficulty breathing
Causes and Risk Factors
Several factors increase the risk of developing an aortic aneurysm or dissection,
including environmental and genetic influences.
Environmental factors that increase the chance to develop an aortic aneurysm
or dissection include:
- Uncontrolled hypertension (high blood pressure)
- Bicuspid aortic valve
- Weight lifting
- Trauma to the aorta
- Inflammatory disease
Genetic factors also influence the risk to develop an aortic aneurysm or
dissection. Thoracic aortic aneurysm and/or dissection (TAAD) can have
three different types of genetic risk:
- Familial TAAD
- Syndromic TAAD
- Sporadic TAAD
Diagnostic testing is the first step in establishing a treatment strategy.
A high degree of accuracy in the performance and interpretation of these
tests is particularly critical in the evaluation of aortic disease:
Medical treatment and lifestyle changes are specified for each individual
and will include blood pressure optimization and lifestyle recommendations.
Blood pressure medications, such as beta-blockers, ACE inhibitors, ARBs
and calcium channel blockers, are commonly prescribed. However, use of
diuretics may be beneficial in patients who are prone to weight gain as
a result of water retention. Generally, an optimal systolic blood pressure
range prior to surgery is between 105 and 110 during normal activity.
Lifestyle recommendations address diet, exercise and smoking cessation.
It is very important that those with aortic disease do not smoke either
actively or passively. A diet low in fat and carbohydrates and high in
fiber and protein is recommended. Exercise is generally extremely helpful
for aortic aneurysm patients, and they are encouraged to be active. Usually
power walks of 15 to 30 minutes two to three times daily are recommended.
However, heavy lifting, which puts pressure on the aorta, is prohibited.
When the risk of aortic dissection or rupture is greater than that associated
with surgery, elective surgery is offered to replace the diseased section
of the aorta with a Dacron graft. If necessary the aortic valve may also
be either repaired or replaced.
Saving Lives through Cardiac Research
Gina Simpson, Heart Disease