Liv­ing with a tho­racic aneurism

Prince Albert Daily Herald - - OPINION - Keith Roach

DEAR DR. ROACH: I am an 81-year-old woman and have had high blood pres­sure and high choles­terol for 30 years (I have a strong fam­ily his­tory). I had a stroke in 2015 and, for­tu­nately, I am still in­de­pen­dent in my life. I take med­i­ca­tion on time, walk one hour ev­ery day and eat a healthy diet. I’ve tried ev­ery­thing to be “good.”

How­ever, re­cently, a chest CT re­sult showed that I have a tho­racic as­cend­ing aneurism (4.2 cm), which scares me to death. My physi­cian told me that there are many pa­tients who have the same prob­lem, and none of them need any pro­ce­dures done ex­cept to be mon­i­tored in six months to a year, and that a tho­racic aneurism is not as eas­ily rup­tured as an ab­dom­i­nal one. Well, I worry a lot about the aneurism, and re­ally want to know more about it: Is it life-threat­en­ing? How can I slow its growth? What should I do to pre­vent its rup­ture? -A.W.W.

AN­SWER: The aorta is the largest artery in the body, and it comes di­rectly off the heart, as­cends to an arch, then de­scends through the di­aphragm and into the ab­domen, where it splits around your navel into the femoral ar­ter­ies. An aneurism is a di­la­tion of all the lay­ers of the aorta.

Nor­mally, the as­cend­ing tho­racic aorta is less than 4 cm in di­am­e­ter with­out an aneurism. Sur­gi­cal re­pair is usu­ally in­di­cated if aneurism en­larges the di­am­e­ter to be­tween 5 and 6 cm.

Risk fac­tors for de­vel­op­ing a tho­racic aor­tic aneurism in­clude high blood pres­sure, smok­ing, high blood choles­terol and fam­ily his­tory. There also are ge­netic con­di­tions, es­pe­cially Mar­fan syn­drome, vas­cu­lar Eh­ler-Dan­los syn­drome and Loeys-Di­etz syn­drome, all of which in­crease risk. Peo­ple with a fam­ily his­tory of tho­racic aneurism should be con­sid­ered for test­ing for these con­di­tions, and are rec­om­mended for surgery at smaller di­am­e­ters, such as 4.5 cm.

Your doc­tor is right that many peo­ple have this prob­lem and only a few will need to have a re­pair. Reg­u­lar mon­i­tor­ing is the usual way to man­age some­one with this con­di­tion.

Hope­fully it will progress only very slowly.

It sounds like you are do­ing a lot of things right to man­age your risk. Prob­a­bly the most im­por­tant sin­gle fac­tor to man­age is your blood pres­sure. Beta block­ers are per­haps the best way to slow pro­gres­sion of aneurisms.

For the read­ers who are physi­cists and engi­neers: Beta block­ers re­duce the con­trac­tile force of the heart, so there is less in­stan­ta­neous change in pres­sure over time (dP/dt), which pro­motes ex­pan­sion of the weak­ened wall of the blood ves­sel. Other blood pres­sure agents, like di­uret­ics, can ac­tu­ally in­crease dP/dt.

Peo­ple with aor­tic aneurisms also are at high risk for block­ages in other ves­sels. You al­ready have had a stroke, which makes block­ages in the brain very likely and block­ages in the heart more likely, too: A statin cer­tainly will help pre­vent stroke and heart at­tack, and may slow pro­gres­sion of the aneurism as well.

Quit­ting smok­ing is of para­mount im­por­tance in smok­ers with any kind of vas­cu­lar dis­ease, in­clud­ing aneurism.

Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual let­ters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@ med.cor­nell.edu or re­quest an or­der form of avail­able health news­let­ters at 628 Vir­ginia Dr., Or­lando, FL 32803. Health news­let­ters may be or­dered from www.rb­ma­mall.com.

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