Aneurysm Fears-Death (What, Types, Causes and Risk Factors)

Image by The Tired Mama-ph
done by Fotor

As I grow older, I'm becoming increasingly paranoid about my health. I have also taken a liking to browsing through blogs whose niche is health-specific. Yes, we all want to live a bit longer. But, what if you have a pre-existing condition that presents itself with either usual symptoms of a tummy ache, headache, or no symptoms at all? What if you have a condition that is symptomless but when it does rear its ugly head, it's fatal? This is what I'm going to write about. The dreaded aneurysm. The all known silent killer.

It comes quite a shock when a seemingly young, vibrant, health-conscious person suddenly collapses and passes away 24 hours after. That is what happened to a local celebrity here in the Philippines. She was unaware that she had an aneurysm although her father died from one several years before. She did suffer from headaches and dizziness according to her family but, treated it as a migraine. She did not know that this was already a sign of a bigger problem. If only it was diagnosed right away then maybe all wouldn't have been lost. Alas, she will surely be missed.

What is an aneurysm?

An aneurysm is a bulge or enlargement of a weakened arterial wall. This usually happens when pressure from blood passing through the blood vessel forces the weakened portion to balloon outward thus, creating the bulge. Aneurysms may occur in any of the blood vessels of the body but are more common in the stomach or chest portions of the aorta (main and largest artery of the body originating from the left ventricle of the heart that distributes oxygenated blood to all parts of the body) or in the arteries that nourish the brain. Aneurysms located in these areas are serious while aneurysms located in other parts of the body are less hazardous but, if detected will be monitored just the same.

The greatest complication of an aneurysm is the threat of rupture which may cause massive internal bleeding and/or stroke that may end in a fatality. In addition, a large aneurysm may affect your blood circulation leading to blood clots that may minimize oxygenation of organs and tissues as it forces blood away from these vital structures.

Types of Aneurysms

The heart is the most important muscle in our body and plays the most vital role of the circulatory system, pumping in deoxygenated blood and pumping out oxygenated blood to be delivered to the various parts of the body through the intricate system of blood vessels. Most aneurysms are asymptomatic until it ruptures and the first signs could be its complications. If there are symptoms that present itself, it is generally not from an aneurysm itself, but either from the cause of an aneurysm or from a rupture.

Aortic Aneurysms

There are 2 types of aortic aneurysms:

1. Abdominal Aortic Aneurysm

This is the more common aortic aneurysm and as the name implies, occurs in the portion of the aorta that runs through the abdomen that supplies blood to the abdomen, pelvis, and legs. This was found as the cause of death of Albert Einstein in 1955. This type of an aneurysm is common among men over the age of 60 and who have one or more risk factors including family medical history, hypertension (high blood pressure), emphysema, high cholesterol, obesity, and smoking.  Upon rupture, only 20% survive.

Abdominal aortic aneurysms are usually clinically silent although rapidly growing abdominal aortic aneurysms may present with some symptoms such as:

-lower back pain
-a deep pain on the side of the abdomen
-pulsating/ throbbing sensation near the navel
In case of ruptured abdominal aortic aneurysm, symptoms may present as
-feeling sick to the stomach
-nausea and vomiting

-feeling dizzy and sweaty

Risk Factors for abdominal aortic aneurysm:
• Hardening of the arteries known as atherosclerosis
• Cigarette Smoking
• Hypertension
• Genetic predisposition/family history
• Infection
• Trauma

If a patient is diagnosed with an abdominal aortic aneurysm, there is a high possibility of the presence of blood clots. Here, small clots that are formed in the abdomen, break off and flow to the legs, kidneys and other organs.

Diagnosis

Usually detected from routine tests done by a patient for another condition. Men aged 65-75 with a history of smoking are recommended to undergo an ultrasound to test the presence of abdominal aortic aneurysms. If small in size, it will be monitored by the physician and the patient will be given medication and instructions on changing lifestyle. If large, the physician may recommend surgery as a 7 cm aneurysm has a 75% probability of rupture.

Aortic Aneurysm by en:National Institute of Health (US Government)
is licensed under Public Domain

2. Thoracic Aortic Aneurysm

Less common than the abdominal aortic aneurysm as 25% of aortic aneurysms occur in the chest. This type of an aneurysm affects the aorta that runs through the chest cavity has a 50% survival rate without treatment and an 85% survival rate after surgery.

Symptoms only present itself if large or upon rupture:

-chest/back pain

-difficulty breathing or swallowing (due to pressure on throat and esophagus)

-shortness of breath

-coughing

-hoarseness (due to pressure on vocal chords)

Risk Factors for Thoracic Aortic Aneurysm
• genetic predisposition/family history
• congenital anomalies
• hypertension
• infection such as syphilis
• plaque build-up in arteries
• high cholesterol
• traumatic injury

Diagnosis

As with abdominal aortic aneurysm, thoracic aneurysms are diagnosed through routine tests of patients for another condition. If detected, it will be monitored if small. If large, surgery will be recommended.

Experts have estimated that 100000-200000 Filipinos are walking around with an aneurysm every year. Men are more predisposed to aortic aneurysms than women whose hormones shield them from cardiovascular conditions until menopause. Early detection and medical treatment reduce mortality rate of aortic aneurysms to 2%-7%.

Cerebral Aneurysms

Also known as intra-cerebral or intracranial aneurysms; this berry aneurysm occurs in weak blood vessels that supply blood to the brain. Again, in most cases, brain aneurysms are usually asymptomatic and only show symptoms when it ruptures. When cerebral aneurysm ruptures, the release of blood into the skull results in a subarachnoid hemorrhage stroke. This may cause brain damage or death. Cerebral aneurysms usually occur in the network of blood vessels located at the base of the brain called "the circle of Willis". About 40% of patients do not survive 24 hours while 25% die of complications within 6 months. 66% who do survive will have a neurological disability.The incidence is higher in women than in men.

Stroke hemorrhagic by National Heart Lung and Blood Institue (NIH)
is licensed under Public domain.

Symptoms may present itself if an aneurysm is large enough and is causing pressure to certain areas of the brain:

- numbness or paralysis of one side of the face
- pain above and behind the eye
- double vision/blurred vision
- a dilated pupil
- drooping of an eyelid
- speech changes

- neck pain
If cerebral aneurysm ruptures, symptoms may present as:
- sudden excruciating headache
- double vision
- nausea and vomiting
- stiff neck
- fainting or loss of consciousness
- seizures
- sensitivity to light

Risk Factors for Cerebral Aneurysms
• genetic predisposition/family history
• hypertension
• cigarette smoking
• gender- women are more likely than men to develop a brain aneurysm
• having a previous aneurysm
• aging
• ethnicity- African Americans are more likely to develop a brain aneurysm than Caucasians
• atherosclerosis
• pre-existing medical conditions such as polycystic kidney disease, arteriovenous malformations, or connective tissue disorders.

Diagnosis

Sometimes detected by diagnostic tests for another unrelated condition. For small aneurysms (less than 10mm), the physician will monitor, and recommendations for changes in lifestyle and managing hypertension will be issued. If large, symptoms are present and also had a previous aneurysm, the doctor may recommend surgery.

This type of an aneurysm affects 5% of the population.

Peripheral Aneurysms

Occurs in peripheral arteries and include the following:

Popliteal aneurysm- occurs behind the knee and is the most common peripheral aneurysm.

Splenic artery aneurysm- occurs near the spleen

Mesenteric artery aneurysm- affects the artery that supplies the intestines

Femoral artery aneurysm- occurs in the groin

Carotid artery aneurysm- in the neck

Visceral aneurysm- affects the blood vessels that supply the kidney and bowels.

Less serious and are less likely to rupture than an aortic aneurysm.

Ventricular Aneurysm

This occurs in the wall of the heart and the most common cause is a previous heart attack although in some cases, a severe chest injury may lead to this type of an aneurysm.

Screening and Early Detection

There are ways to detect aneurysms and to catch it when it is still small. It is prudent for each individual to recognize symptoms if any symptoms are felt. As a rule, if 2 members of your family have been diagnosed or have passed away from an aneurysm, chances are you may be walking around with one too. If this is the case, you must see your doctor for screening.

Your doctor may recommend that you undergo a series of routine diagnostic tests such as an ultrasound, CT (Computed Tomography) scan or MRI. Cerebral angiograms may be also done, although the procedure may carry some risks as a catheter is inserted through a blood vessel but, it is the best way to detect small (>5cm) brain aneurysms. In addition, advancements in diagnostic tests such as CTA(Computed Tomography Angiogram) scan and MRA(Magnetic Resonance Angiogram) scan are now in use to detect aneurysms.

If an aneurysm is detected, do not fret. Others have gone on to live fruitful lives with a clipped aneurysm. Some manage through healthy living, stress management, and with prescribed medication to keep their blood pressure in check. What is important is you are aware and will not succumb to death from this silent killer.

PREVENTION

Some risk factors may be controlled, unfortunately, some cannot as some are congenital if not hereditary. Lifestyle changes and the elimination of behavioral risks can help prevent the occurrence of an aneurysm. Managing metabolic disorders and environmental risks can also decrease the prevalence of the disease or its fatality.

1. Quit smoking/don't smoke/inhibit tobacco use.

2. Based on family history- if 2 members of your family have died from an aneurysm or have been diagnosed with an aneurysm, get yourself screened.

3. Avoid straining. Constant heavy lifting causes pressure.

4. Limit caffeine intake.

5. Limit sodium intake.

6. Avoid the use of stimulant drugs and do not abuse prescribed medication.

7. Manage hypertension and cholesterol levels.

8. Exercising regularly, maintain a healthy weight and adopt a healthy diet.

9. Drink alcoholic beverages in moderation.

10.Manage stress. You don't want to "pop a blood vessel". Recognize the causes of your stress to help manage it.

If you recognize having any of the above symptoms, talk to your doctor right away for screening. Do not wait because it might be too late. Stay healthy and happy.

Credit to Sources:

Macgill, Markus "Aneurysms: Causes, Symptoms, and Treatments", www.medicalnews.today

"What is an Aneurysm?", www.webmd.com

Chua M.D., Philip S. "Brain Aneurysm", asianjournal.com

"Types of Aneurysm", www.heart.org

"The Silent Killer", www.pchrd.dost.gov.ph