Thoracic Aortic Aneurysm Causes, Symptoms, Diagnosis, Treatment, Prevention, Home Remedies

Thoracic Aortic Aneurysm Causes, Symptoms, Diagnosis, Treatment, Prevention, Home Remedies


What is a thoracic aortic aneurysm?


A thoracic aortic aneurysm (TAA) is a ballooning of a portion of the aorta, the largest artery in the human body. Aneurysms are the result of weakening and thinning of the aortic wall. When a portion of it stretches and swells to more than 50 percent of the original diameter, this is called an aneurysm. Aneurysms in the thoracic or chest portion of the aorta are relatively rare.

A thoracic aortic aneurysm may also be called thoracic aneurysm and aortic dissection (TAAD) because an aneurysm can lead to a tear in the artery wall (dissection) that can cause life-threatening bleeding. Small and slow-growing thoracic aortic aneurysms may not ever rupture, but large, fast-growing aneurysms may.

Thoracic Aortic Aneurysm Causes, Symptoms, Diagnosis, Treatment, Prevention, Home Remedies


Depending on the size and growth rate of your thoracic aortic aneurysm, treatment may vary from watchful waiting to emergency surgery. Ideally, surgery for a thoracic aortic aneurysm can be planned if necessary.

Thoracic aneurysms are less common than abdominal ones. In some individuals with a thoracic aortic aneurysm, an underlying cause is Marfan’s Syndrome, a connective-tissue disorder that results in the characteristic weakening of the aortic wall. Other TAAs may be related to hypertension. In this case, the increased blood pressure is responsible for breaking down the elasticity of the aorta.

What causes a thoracic aortic aneurysm?


Thoracic aortic aneurysms are most often caused by atherosclerosis, a hardening of the arteries that damages the artery’s walls. While your arteries are normally smooth on the inside, as you age they can develop atherosclerosis. When atherosclerosis occurs, a sticky substance called plaque builds up in the walls of the arteries. Over time, excess plaque causes the aorta to stiffen and weaken.

Your risk for atherosclerosis increases if you:

  • Are a smoker
  • Have high blood pressure
  • Have high cholesterol
  • Are overweight
Have a family history of cardiovascular or peripheral vascular disease (a narrowing of the blood vessels)
Certain diseases can also weaken the layers of the aortic wall and increase the risk of thoracic aortic aneurysms, including:

  • Marfan syndrome (a genetic connective tissue disorder)
  • Other non-specific connective tissue disorders (characterized by a family history of aneurysms)
  • Presence of a bicuspid aortic valve
  • Syphilis
  • Tuberculosis
Rarely, trauma, such as a severe fall or car accident can cause a thoracic aortic aneurysm.

As you age, your risk of developing a thoracic aortic aneurysm increases. More men than women are diagnosed with thoracic aortic aneurysms, and are often affected with the condition at a younger age.

Recent research indicates that a substantial amount of aneurysms have familial patterns, or are inherited from previous generations. It is important to tell your physician if there is a history of aortic aneurysms in your family to ensure that the best preventative screenings are completed.

What are the symptoms of a thoracic aortic aneurysm?


Aneurysms develop slowly over many years. Most patients have no symptoms until the aneurysm begins to leak or expand. The aneurysm may be found only when imaging tests are done for other reasons.

Symptoms of a thoracic aortic aneurysm often begin suddenly when:


  • The aneurysm grows quickly
  • The aneurysm tears open (called a rupture)
  • Blood leaks along the wall of the aorta (aortic dissection)
If the aneurysm presses on nearby structures, the following symptoms of a thoracic aortic aneurysm may occur:

  • Hoarseness
  • Swallowing problems
  • High-pitched breathing (stridor)
  • Swelling in the neck

Other symptoms of a thoracic aortic aneurysm may include:


  • Chest or upper back pain
  • Clammy skin
  • Nausea and vomiting
  • Rapid heart rate
  • Sense of impending doom

When to see a doctor


Most people with aortic aneurysms do not have symptoms unless a tear (dissection) or rupture has occurred. A rupture or dissection is a medical emergency. Call  your local emergency number for immediate assistance.

If an aneurysm ruptures or one or more layers of the artery wall splits (dissection), you may feel:

  • Sharp, sudden pain in the upper back that radiates downward
  • Pain in your chest, jaw, neck or arms
  • Difficulty breathing
If you have a family history of aortic aneurysm, Marfan syndrome or other connective tissue disease, or bicuspid aortic valve, your doctor may recommend regular ultrasound exams to screen for aortic aneurysm.

Who is affected by thoracic aortic aneurysms?


Thoracic aortic aneurysms affect approximately 15,000 people in the United States each year.

Up to 47,000 people die each year from all types of aortic disease; more than from breast cancer, AIDS, homicides, or motor vehicle accidents, making aortic disease a silent epidemic.

Is a thoracic aortic aneurysm serious?


A thoracic aortic aneurysm is a serious health risk because, depending on its location and size, it may rupture or dissect (tear), causing life-threatening internal bleeding. When detected in time, a thoracic aortic aneurysm can often be repaired with surgery or other less invasive techniques.

Small aneurysms place one at increased risk for:

  • Atherosclerotic plaque (fat and calcium deposits) formation at the site of the aneurysm
  • A clot (thrombus) may form at the site and dislodge, increasing the chance of strokeIncrease in the aneurysm size, causing it to press on other organs, causing pain
  • Aortic dissection, or tearing of the layers of the aorta, a potentially fatal complication and a medical emergency.
  • Aneurysm rupture, because the artery wall thins at this spot, it is fragile and may burst under stress. A sudden rupture of an aortic aneurysm may be life threatening and is a medical emergency

What is an aortic dissection?


Aortic dissection occurs when the layers of the aorta tear and separate from each other. The presence of an aortic aneurysm increases your risk of having an aortic dissection, but aortic dissection can also occur in people with a normal sized aorta.

Aortic dissection can occur suddenly, causing severe sharp, tearing pain in your chest or upper back. Yet, like all types of aneurysms, there may be no symptoms of an aortic dissection.

Most commonly associated with high blood pressure, an aortic dissection forces the layers of the wall of the aorta apart through increased blood flow. If not treated early, aortic dissection weakens the aorta and can lead to a thoracic aortic aneurysm by causing the weakened area of the aorta to bulge like a balloon, stretching the aorta.

If you do experience any symptoms of a thoracic aortic aneurysm or aortic dissection, notify your physician immediately. If left untreated, these conditions could lead to a fatal rupture.

How is a thoracic aortic aneurysm diagnosed?


Early diagnosis of a thoracic aneurysm is critical to managing the condition. The larger the thoracic aortic aneurysm, or the faster it grows, the more likely it is to rupture. The risk of rupture increases when the aneurysm is larger than about twice the normal diameter of a healthy aorta blood vessel.

Diagnosing a thoracic aneurysm is difficult because often there are no symptoms, and often the condition goes undiagnosed until a rupture occurs. If a thoracic aortic aneurysm is suspected, your physician may order the following tests:

  • Chest x-ray
  • Computed tomography (CT) scan
  • Magnetic resonance imaging (MRI)
  • Echocardiography (an ultrasound of the heart)
  • Abdominal ultrasound (to look for associated abdominal aneurysms)
  • Angiography (an x-ray of the blood vessels)

Treatments and drugs for Thoracic Aortic Aneurysm


The goal of treatment is to prevent your aneurysm from rupturing. Generally, your treatment options are medical monitoring or surgery. Your decision depends on the size of the aortic aneurysm and how fast it's growing.

Medical monitoring


If your thoracic aortic aneurysm is small, your doctor may recommend medical monitoring, which includes regular appointments to make sure your aneurysm isn't growing, and management of other medical conditions that could worsen your aneurysm.

It's likely your doctor will order regular imaging tests to check on the size of your aneurysm. Expect to have an echocardiogram at least six months after your aneurysm is diagnosed and regular exams and imaging tests after that.

If you have high blood pressure or blockages in your arteries, it's likely that your doctor will prescribe medications to lower your blood pressure and reduce your cholesterol levels to reduce the risk of complications from your aneurysm. These medications could include:

  • Beta blockers. Beta blockers lower your blood pressure by slowing your heart rate. Examples of beta blockers include metoprolol (Lopressor, Toprol-XL), atenolol (Tenormin) and bisoprolol (Zebeta).
  • Angiotensin II receptor blockers. Your doctor may also prescribe these medications if beta blockers aren't enough to control your blood pressure or if you can't take beta blockers. These medications are recommended for people who have Marfan syndrome, even if they don't have high blood pressure. Examples of angiotensin II receptor blockers include losartan (Cozaar), valsartan (Diovan) and olmesartan (Benicar).
  • Statins. These medications can help lower your cholesterol, which can help reduce blockages in your arteries and reduce your risk of aneurysm complications. Examples of statins include atorvastatin (Lipitor), lovastatin (Mevacor), simvastatin (Zocor) and others.
Blood pressure should be less than 140/90 millimeters of mercury. The goal for cholesterol is to have low-density lipoprotein (LDL) cholesterol (the "bad" type of cholesterol) under 70 milligrams per deciliter.

If you smoke or chew tobacco, it's important that you quit. Using tobacco can worsen your aneurysm.

Surgery to prevent rupture


If you have a thoracic aortic aneurysm, surgery is generally recommended if your aneurysm is about 1.9 to 2.4 inches (5 to 6 centimeters) and larger. If you have Marfan syndrome, another connective tissue disease or a family history of aortic dissection, your doctor may recommend surgery for smaller aneurysms because you have a higher risk of having an aortic dissection.

Depending on your condition and the location of your thoracic aortic aneurysm, your doctor may recommend:

  • Open chest surgery. Open chest surgery to repair a thoracic aortic aneurysm involves removing the damaged section of the aorta and replacing it with a synthetic tube (graft), which is sewn into place. This procedure requires open abdominal or open chest surgery, and it will take you a month or more to fully recover.
  • Endovascular surgery. Doctors attach a synthetic graft to the end of a thin tube (catheter) that's inserted through an artery in your leg and threaded up into your aorta. The graft — a woven tube covered by a metal mesh support — is placed at the site of the aneurysm and fastened in place with small hooks or pins. The graft reinforces the weakened section of the aorta to prevent rupture of the aneurysm. Recovery time is generally faster with this procedure than with open surgery, but endovascular surgery can't be done on everyone. After endovascular surgery, you'll need to have regular follow-up imaging scans to ensure that the graft isn't leaking.
  • Other heart surgeries. If another condition is contributing to your aneurysm's development, such as a problem with your heart's valves, your doctor may recommend additional surgeries to repair or replace the damaged valves to stop your aneurysm from worsening.

Emergency surgery


Although it's possible to repair a ruptured aortic aneurysm with emergency surgery, the risk is much higher and there is less chance of survival.

Possible Complications of Thoracic Aortic Aneurysm


Serious complications after aortic surgery can include:

  • Bleeding
  • Graft infection
  • Heart attack
  • Irregular heartbeat
  • Kidney damage
  • Paralysis
  • Stroke
Death soon after the operation occurs in 5 - 10% of patients.

Complications after aneurysm stenting include damage to the blood vessels supplying the leg, which may require another operation.

Prevention and Home Remedies for Thoracic Aortic Aneurysm


If you've been diagnosed with a thoracic aortic aneurysm, your doctor will likely advise you to avoid heavy lifting and vigorous physical activity as these can increase blood pressure, putting additional pressure on your aneurysm. If you want to participate in a particular activity, ask your doctor if it would be possible to perform an exercise stress test to see how much exercise raises your blood pressure.

Stress can also raise your blood pressure, so try to avoid conflict and stressful situations as much as possible. If you're going through a particularly emotional time in your life, let your doctor know because your medications may need to be adjusted to keep your blood pressure levels from going too high.

There are no medications you can take to prevent an aortic aneurysm, although taking medications to control your blood pressure and cholesterol level may reduce your risk of having complications from a thoracic aortic aneurysm.

For now the best approach to prevent an aortic aneurysm or keep an aneurysm from worsening is to keep your blood vessels as healthy as possible. That means taking these steps:

  • Don't use tobacco products.
  • Keep your blood pressure under control.
  • Get regular exercise.
  • Reduce cholesterol and fat in your diet.
If you have some risk factors for aortic aneurysm, talk to your doctor. If you are at risk, your doctor may recommend additional measures, including medications to lower your blood pressure and relieve stress on weakened arteries. You may also want to consider screening echocardiograms every few years.