Case report (part 1 – diagnosis)
A 57-tear-old man made an appointment for an Athletic Heart SF screening. He was feeling well. His exercise routine included lifting weights, but also doing some light treadmill activity at the gym several times a week.
He played competitive football and basketball in high school, and played various other sports throughout his life. He played full court basketball until 4 years ago but had to stop due to mild knee arthritis. He had been coaching sports for many years. For the last 1-2 years, he had noted some mild shortness of breath walking uphill.
He had no prior history of heart disease. He was advised by his primary care physician to take blood pressure and cholesterol-lowering medications, but he declined. He had no other chronic illnesses except for mild knee arthritis and occasional tension headaches. He considered himself in good overall health.
During the Athletic Heart SF screening, we confirmed that his blood pressure was elevated. We also discovered a significant aneurysm of the ascending aorta. Left undetected and unattended, this aneurysm could rupture and lead to very serious complications: stroke, heart attack, paralysis, kidney failure, or death.
The aorta is the major blood vessel of the body, into which the heart ejects its content of fresh, oxygenated blood. The branches of the aorta supply blood to all the major organs of the body, including the heart itself, the brain, and the kidneys.
An aneurysm is an enlargement (or dilatation) of a portion of the aorta. The enlargement occurs in part because the elastic collagen fibers which form the wall of the aorta become weak. One factor that contributes to this weakening is high blood pressure. However, most patients with high blood pressure do not develop aneurysms of the aorta, so there must be other factors, probably genetic, that predispose some people to forming aneurysms.
Aneurysms typically do not cause any symptoms for years, so most people with aneurysms are completely unaware they have one. Unfortunately, when aneurysms become symptomatic, it’s usually in the setting of an impending catastrophe. That’s why it is critically important to detect them in the early stages, before a complication occurs.
The dreaded complication is the “rupture” of the aortic aneurysm, which means that the wall of the aorta tears, either partially (called a dissection), or completely. On occasion, the tear is contained and the patient may survive it. Frequently, however, the tear is not contained and patients suffer the very severe complications mentioned above.
Management of an aortic aneurysm
Once an aortic aneurysm is detected on screening, it is very important to institute measures that will minimize its growth. If the patient has high blood pressure, medications may be necessary. Activities that are known to increase the blood pressure, such as weight lifting, must be avoided.
Next, a decision must be made about whether the aneurysm should be repaired by surgery. One of the most important factors in that decision is how large the aneurysm is (its diameter). To accurately determine the extent and size of the aneurysm, special imaging tests may be needed, such as a CT angiogram.
If an aneurysm has not yet reached a size where rupture is likely, then it is very important that the patient be monitored regularly to measure its diameter and ensure that the aorta remains stable.
Case reprt (part 2 – management)
Our patient had a CT angiogram of his ascending aorta which confirmed exactly the diagnosis and measurements of the aneurysm we had made on our screening echocardiogram. He was advised to stop lifting weights and take his blood pressure medications. To help control his blood pressure, he has lost 20 pounds and is feeling well.
His aneurysm size is not at a point where surgery is advised. The patient will have close follow-ups and routine examinations of his aorta. Hopefully the aneurysm will not enlarge further, but if it does, then there will be an opportunity to repair it before a life threatening complication occurs.