ECG signs of aortic aneurysm. Clinical diagnosis of dissecting aortic aneurysm. Signs of thoracic aortic aneurysm

An aortic aneurysm is usually called a lumen formed in it that is twice (or more) the normal diameter of the vessels. The defect appears as a result of the destruction of the elastic fibers (filaments) of the central shell, as a result of which the remaining fibrous tissue elongates, thereby expanding the diameter of the vessels and leading to tension in their walls. As the disease progresses and the size of the lumen subsequently increases, there is a possibility of rupture of the aortic aneurysm.

Classification of aortic aneurysm

In surgery, several classifications of aortic aneurysm are considered: depending on the origin, localization of segments, the nature of the clinical course, the structure of the aneurysmal sac and shape.

Based on location, the following types of thoracic aortic aneurysm are distinguished:

• aneurysm of the ascending aorta;
• sinus of Valsalva;
• arc areas;
• descending part;
• abdominal and thoracic regions.

It should be noted that the diameter of the ascending aorta should normally be about 3 cm, and the descending aorta should be 2.5 cm. The abdominal aorta, in turn, should be no more than 2 cm. The dimensions of the aortic aneurysm are considered critical if they exceed normal values ​​by almost 2 times.

Based on the location of the abdominal aortic aneurysm, there are:

• suprarental aneurysms (belong to the upper part of the abdominal aorta with outgoing branches);
• infrarenal aortic aneurysm (without dividing the aorta into common iliac arteries);
• total.

Depending on the origin, the following are considered:

• acquired aneurysms (non-inflammatory, inflammatory, idiopathic);
• congenital.

Classification of aneurysm by shape:

• saccular – presented in the form of a limited bulging of the wall (does not occupy even half of the aortic diameter);
• are divided into iliac, lateral, spreading and descending arteries into the pelvic region;
• fusiform aortic aneurysm - occurs as a result of stretching of the aortic wall along the entire circumference or part of its segment;

The structure of the aneurysm sac differs:

• false aortic aneurysm, or pseudoaneurysm (the wall consists of scar tissue).
• true (the structure of such an aneurysm resembles the structure of the wall itself).

Depending on the clinical course, the following are considered:

• dissecting aortic aneurysm;
• aneurysm is asymptomatic;
• complicated;
• typical.

The term “complicated aneurysm” means rupture of the sac, which, as a rule, is accompanied by heavy internal bleeding and subsequent formation of hematomas. In this situation, thrombosis of the aneurysm, which is characterized by a slowdown or complete cessation of blood flow, cannot be excluded.

One of the most dangerous phenomena is a dissecting arterial aneurysm. In this case, blood passes through the lumen in the inner membrane, which penetrates between the layers of the aortic walls and spreads through the vessels under the influence of pressure. As a result of this process, dissection of the aortic aneurysm occurs.

What you need to know about aortic aneurysms?

As mentioned earlier, all aneurysms are divided into congenital and acquired. The development of the former is characterized by diseases of the aortic walls of a hereditary nature (fibrous dysplasia, Marfan syndrome, Ehlers-Danlos syndrome, congenital elastin deficiencies and Erdheim syndrome).

Acquired aneurysms arise as a result of ongoing inflammatory processes associated with specific (syphilis, tuberculosis) and nonspecific aortitis (streptococcal infection and rheumatic fever), as well as as a result of fungal infections and infections that arise after surgery.

As for non-inflammatory aneurysm, the main reasons for its occurrence are the presence of atherosclerosis, previous prosthetics and defects formed after suturing.

There is also a possibility of mechanical damage to the aorta. In this case, aneurysms of a traumatic nature occur.

You should not ignore the person’s age, the presence of arterial hypertension, alcohol abuse, and smoking. In this case, the likelihood of developing a vascular aneurysm is also high.

Description of abdominal aortic aneurysm

Abdominal aortic aneurysm is most often observed in men over 60 years of age. In particular, the risk of developing the disease increases with regular increases in blood pressure and smoking.

An abdominal aortic aneurysm manifests itself in the form of dull, aching and gradually increasing pain in the abdomen. Unpleasant sensations, as a rule, occur to the left of the navel and radiate to the back, sacrum and lower back. If such symptoms are detected, you should consult a doctor, otherwise the abdominal aortic aneurysm may rupture.

Indirect symptoms include:

• sudden weight loss;
• belching;
• constipation lasting up to 3 days;
• urinary disturbance;
• attacks of renal colic;
• motor disorders in the limbs.

Also, with an abdominal aneurysm, problems with gait may occur due to poor circulation.

Aneurysm of the thoracic aorta. Description of the disease

With an aneurysm of the ascending aorta, patients complain of severe pain in the chest and in the heart. If the lumen has increased significantly, then there is a possibility of compression of the superior vena cava, which may result in swelling in the face, arms, neck, as well as migraine.

An aortic arch aneurysm has slightly different symptoms. The pain is localized in the area of ​​the shoulder blades and behind the sternum. Aneurysm of the thoracic aorta is directly related to compression of nearby organs.

Wherein:

• there is strong pressure on the esophagus, which disrupts the swallowing process and causes bleeding;
• the patient feels shortness of breath;
• there is profuse salivation and bradycardia;
• compression of the recurrent nerve is characterized by a dry cough and the appearance of hoarseness in the voice.

When the cardiac part of the stomach is compressed, pain appears in the duodenum, nausea, profuse vomiting, discomfort in the stomach, and belching.

Aneurysm of the descending aorta is accompanied by severe pain in the chest, shortness of breath, anemia and cough.

Where to go and how to identify the disease?

Aortic aneurysm is diagnosed using several methods. One of the most used is radiography. The procedure is carried out in 3 stages. The main thing when performing radiography is a complete display of the lumen of the esophagus. In the image, the aneurysm of the descending artery protrudes into the left lung.

It should be noted that in most patients a slight displacement of the esophagus is detected. In the rest, calcification is observed - a local accumulation of calcium in the form of salts in the aneurysmal sac.

As for the abdominal aneurysm, in this case, radiography shows the presence of calcification and Schmorl's hernia.

Ultrasound of the aorta of the heart is also important when diagnosing an aneurysm. The study allows us to identify the size of the ascending lumen, descending lumen, as well as the aortic arch and abdominal capillaries. An ultrasound can show the condition of the blood vessels leaving the aorta, as well as changes in the wall area.

A CT scan can also determine the size of the aneurysm that has formed and identify the causes of an abdominal artery aneurysm.

The likelihood of rupture of an aortic aneurysm with a size of less than 5 cm is minimal. Typically, in this case, the disease is treated with medications that are used to treat high blood pressure. These include beta blockers. Such drugs reduce the force of heart contractions, reduce pain and normalize blood pressure.

Your doctor may also prescribe medications to treat high cholesterol. They have been proven to reduce the risk of death and stroke.

If the aneurysm has reached a size exceeding 5 cm, the doctor will most likely prescribe surgery, since there is a possibility of its rupture and the formation of thrombosis. Surgical intervention consists of removing the aneurysm and further prosthetics of the area where it is located.

If a doctor discovers an aortic aneurysm, then most likely he will recommend radically changing your usual lifestyle. First, you should give up bad habits, in particular: smoking and drinking alcohol.

Prevention of aortic aneurysm involves eating heart-healthy foods (kiwi, sauerkraut, citrus fruits) and doing physical exercises that will increase your heart rate.

Symptoms

Symptoms of an abdominal aortic aneurysm

Most often, this pathology occurs in the abdominal cavity. And the disease is mainly affected by smoking men over the age of 60 years. In complex cases, multiple aneurysms of the abdominal aorta are formed. Symptoms in this case are more pronounced.

What can a patient feel when the walls of a vessel protrude? Bloating, constipation and digestive disorders, weight loss. If the aneurysm is large, you can feel a pulsating formation in the epigastric region.

When the expansion puts pressure on surrounding nerves and tissue, swelling, urinary tract dysfunction, and even leg paresis can occur. But most often, with an abdominal aortic aneurysm, the first signal is attacks of pain. They occur unexpectedly, often radiating to the lower back, groin area or legs. The pain lasts for several hours and is difficult to respond to medications. When the aneurysm becomes inflamed, the temperature may rise. Sometimes blueness and coldness of the fingers are observed.

Symptoms of a thoracic aortic aneurysm

It is easiest to diagnose the disease if the dilation of the vessel is localized in the area of ​​the aortic arch. In this case, the symptoms are more pronounced.

Most often, patients complain of aching, throbbing pain in the chest and back. Depending on where the aorta enlarges, the pain may radiate to the neck, shoulders, or upper abdomen. Moreover, conventional painkillers do not help relieve it.

Shortness of breath and a dry cough are also observed if the aneurysm puts pressure on the bronchi. Sometimes the expansion of the vessel puts pressure on the nerve roots. Then you feel pain when swallowing, snoring and hoarseness appear.

Due to the dilatation of the aorta and slowing of blood flow, a protodiastolic murmur is often observed with an aneurysm of the ascending aorta.

With a large aneurysm, expansion can be noticed even during visual inspection. There is a small pulsating tumor in the sternum area. Veins in the neck may also swell.

Symptoms of aortic aneurysm

Pathology of the artery in this place may not manifest itself for a long time. The patient feels infrequent pain in the heart, which is relieved with pills. Other symptoms: shortness of breath, cough and difficulty breathing can also be taken as signs of heart failure. Often the disease is diagnosed only after a severe attack of angina during an ECG.

Symptoms of cerebral aortic aneurysm

Small extensions do not manifest themselves in any way. Headaches may occur, but patients rarely see a doctor with such symptoms. The disease can be detected with a large aneurysm, when it puts pressure on surrounding nerves and tissues. In this case, the patient experiences the following sensations:

pain is localized not only in the head, but also in the eyeballs;

blurred vision may occur;

sometimes loss of facial skin sensitivity develops.

Signs of dissection or rupture of an aneurysm

In many cases, the disease is diagnosed only when complications occur. In the case of large fusiform dilatations, aneurysm dissection occurs. This often happens in the abdominal aorta. Small saccular aneurysms can rupture when blood pressure increases. What symptoms are observed with such complications?

The first sign is sharp pain. It spreads gradually from one place throughout the head or abdominal cavity. With a thoracic aneurysm, pain is often mistaken for symptoms of a heart attack.

The patient's blood pressure drops sharply. Signs of a state of shock are observed: the person turns pale, loses orientation, does not respond to questions, and begins to choke.

An aneurysm can rupture in a patient at any time. And in the absence of timely medical care, this condition often ends in the death of the patient. Therefore, any deterioration in well-being and disturbing symptoms should not be ignored.

Diagnostics

How to identify an aortic aneurysm if in some cases it develops asymptomatically and is discovered by chance during some examination or autopsy, but is not the cause of death? Some cases have specific signs of aortic aneurysm and lead to all sorts of life-threatening complications. This disease is most often observed in older people. This is caused by age-related pathologies of the vascular walls, the presence of hypertension or metabolic disorders.

There are two types of aneurysm, differing in location in the human body:

• Thoracic aortic aneurysm – located in the thoracic region;
• Abdominal aortic aneurysm is located in the abdominal cavity.

These aneurysms are distinguished by shape, parameters and complications. Signs of an aortic aneurysm determine the course of the disease and the surgical procedure. A complication in the form of internal bleeding in 2 out of 5 cases leads to death.

Establishing diagnosis

Diagnosis of dissecting aortic aneurysm is quite difficult due to several reasons:

• Signs of an aortic aneurysm are not monitored;
• Symptoms correspond to other diseases (for example, cough and discomfort in the thoracic region are observed with pulmonary diseases); Pathology is rarely encountered in medical practice.

If there are signs of the disease, you should consult a therapist or cardiologist. They will conduct an initial examination, based on the results of which examinations are prescribed. After testing, the diagnosis of aortic aneurysm is often confirmed.

How to diagnose an aortic aneurysm?

Diagnosis of dissecting aortic aneurysm is performed using certain instrumental research methods:

• A physical examination serves to collect initial data (complaints) without the use of complex examination methods. Diagnosis of an aortic aneurysm consists of external examination, percussion (tapping), palpation (palpation), auscultation (listening with a stethoscope) and pressure measurement. After detecting characteristic signs, further diagnosis of dissecting aortic aneurysm is prescribed;
• X-ray shows the internal organs of the chest and abdomen. The image clearly shows the protrusion of the aortic arch or its enlargement. To identify the parameters of the aneurysm, a contrast agent is injected into the vessel. Due to the danger and traumatic nature, such diagnosis of dissecting aortic aneurysm is prescribed for special indications;
• Electrocardiography is used to determine the activity of the heart muscle. An ECG of an aortic aneurysm will help distinguish this disease from coronary heart disease. With atherosclerosis, which causes the formation of an aneurysm, the coronary vessels suffer, which can cause a heart attack. How to detect an aortic aneurysm? On the cardiogram, you can track specific signs of an aortic aneurysm corresponding to this pathology of the cardiovascular system;
• Magnetic resonance and computed tomography make it possible to determine all the required parameters of the aneurysm - its location, size, shape and thickness of the vessel walls. The pathognomonic CT sign of a dissecting aortic aneurysm shows wall thickening and a sharp dilation of the lumen of the vessel. Based on these data, possible treatment is determined;
• Ultrasound examination – ultrasound of an abdominal aortic aneurysm is one of the most common diagnostic methods. It helps to determine the speed of blood flow and the existing turbulence that separates the walls of the vessel;
• Laboratory tests include general and biochemical blood tests, as well as urine tests. How to diagnose an aortic aneurysm using tests? They reveal the following signs of an aortic aneurysm: A decrease or increase in the number of leukocytes, characteristic of acute or chronic forms of infectious diseases that precede the formation of an aortic aneurysm. An increase in the number of unsegmented neutrophils is also observed. Increased blood clotting manifests itself in the form of an increase in platelet levels, changes in coagulation factors and indicates the probable formation of blood clots in the aneurysm cavity. High cholesterol levels indicate the presence of atherosclerotic plaques in the vessel. A urine test may show a small amount of blood.

The listed signs of aortic aneurysm are not characteristic symptoms of this disease and are not found in all patients.

Treatment

If diagnostic measures are carefully carried out and a diagnosis of “aortic aneurysm” is made, there are several options for the development of events. One option may be dynamic observation by a vascular surgeon, another option may be direct treatment of the aortic aneurysm.

Dynamic observation and x-ray examination are indicated only when the disease is asymptomatic and non-progressive, the aneurysm is small in size (up to 1-2 cm). As a rule, such a diagnosis is made as a result of passing a medical commission or a medical examination at work. This approach is possible only with constant monitoring and prevention of possible complications (antihypertensive and anticoagulant therapy). Drug treatment of aortic aneurysm is not used due to the lack of effective specific drugs.

Although there are some statements about the effectiveness of Siberian herbs, various dill infusions and other things in the treatment of aneurysms, treatment with folk remedies still remains absolutely ineffective and unproven, and can be used either in the process of postoperative rehabilitation or as an unconventional method of nonspecific prevention. To such procedures

In other cases, only surgical intervention is indicated.

When is surgical treatment not performed?

Contraindications to surgery are:

• Acute coronary circulatory disorders - a history of heart attacks that are reflected on the ECG during the last three months;
• Acute cerebrovascular accidents with the appearance of neurological symptoms - stroke and post-stroke conditions;
• Presence of respiratory failure or active tuberculosis,
• The presence of renal failure, both latent and existing.
• A person’s conscious refusal to hope to be cured without surgery.

Surgical treatment is quite varied and directly depends on the type of aneurysm, its location, the capabilities of the cardiology hospital or center and the qualifications of the vascular surgeon. Despite the fact that there are quite a few techniques (they are described below), each patient with an aneurysm receives preoperative preparation before surgery. It is as follows: approximately 20-24 hours before surgery, specific antibiotic therapy is carried out, sensitive to staphylococci and E. coli. Also, before the operation, the patient should abstain from foods and try not to eat anything 10-12 hours before the operation.

Depending on the location, there are:

• aneurysm directly of the aortic arch (emerging from the heart cavity), thoracoabdominal aortic aneurysms,
• aneurysm of the ascending (from which the coronary arteries arise) part of the aorta,
• Abdominal aortic aneurysm. The operation of an aortic aneurysm, or rather the method of implementation, directly depends on the above classification.

Treatment of aneurysm of the thoracic and ascending aorta.

Surgical treatment of patients with aneurysm of the thoracic aorta and ascending aorta is divided into:

• Radical interventions - in the case of them, marginal resection and resection of the aneurysmal cavity are used with its replacement with a prosthesis made of synthetic materials.
• Palliative – wrapping the thoracic aorta with a prosthesis. This operation is performed only in cases where it is not possible to perform radical surgery and there is a risk of aneurysm rupture.

It should be noted that emergency operations are performed if treatment of dissecting aortic aneurysm is necessary, and urgent operations are performed when the aneurysm is complicated by melena, increased pain and the appearance of hemoptysis.

Radical marginal resection is performed for saccular (bag-like) aneurysms and provided that it occupies more than a third of the radius of the aorta. The essence of this operation is resection and removal of the aneurysm sac and suturing of the aortic wall with two-layer sutures after a temporary cessation of local blood flow.

Tangential resection does not involve stopping blood flow through the aorta - otherwise, the surgical technique is the same.

Radical resection with endoprosthetics is performed if the aneurysm is fusiform and occupies more than a third or half of the circumference of the aorta.

Its technique, in principle, does not differ from marginal resection, except for the moment that an endoprosthesis is installed in place of the resected aneurysm - after implantation of the prosthesis, the blood flow is turned on and if the patency is adequate, then the prosthesis is sutured to the wall of the aneurysm itself.

Surgery for an aneurysm of the ascending aorta is performed either simultaneously or separately in case of aortic valve insufficiency. In a one-stage operation, a biomechanical aortic valve is sutured to one end of the endoprosthesis. In cases where there is no aortic insufficiency and only the ascending aorta is affected, a specially designed prosthesis with rigid (static) frames, the so-called combined prosthesis, is used. The essence of this method is that after an incision in the aorta, such an explant is carried out to the unaffected edges of the aorta and fixed externally with specific bands. Then, over the implanted endoprosthesis, the aortic wall is tightly sutured. Its advantage is that this technique allows you to reduce the time of absence of blood flow through the main vessels by 25-30 minutes.

Treatment of abdominal aortic aneurysm.

Surgical treatment of an abdominal aortic aneurysm is used when the aneurysmal dilation of the aorta is more than doubled or with a diameter greater than 4 cm. Treatment is indicated for patients of all ages and for any location of aneurysms.

Preoperative preparation, in addition to the main stages, includes the mandatory correction of concomitant pathologies that can complicate surgical intervention (atherosclerosis, arterial hypertension, unstable angina, and others). Infrarenal aneurysms are operated on from a median laparotomy approach; for suprarenal and total aneurysms, a left-side thoracophrenolumbotomy laparotomy along the ninth intercostal space is used. The operation can be performed using several methods:

• The aneurysm is resected and the sac is removed, and then either aortic replacement or bypass surgery is performed.
• The aneurysm is resected, but the sac is not removed, and a prosthesis is installed in its place or a bypass is performed.
• Endoprosthesis replacement of an abdominal aortic aneurysm: an endoprosthesis is installed on a frame (can be combined with or without resection of the aneurysm).
• Stenting of an aortic aneurysm is used when there is an increased risk of surgery and the risk of postoperative complications. The essence of this operation is to install an open stand under local (more often) or general anesthesia, which opens when approaching the aneurysmal sac and thereby turns it off from the bloodstream.

After surgery for an abdominal aortic aneurysm, patients are advised to undergo rehabilitation depending on the “malignancy” of the process, complications that arose during diagnosis and treatment, the extent of surgery and the general condition of the patient. Basically, rehabilitation consists of proper nutrition, giving up bad habits, a healthy lifestyle and moderate physical activity.

In addition to the most common localizations of aneurysms, there is another form: cardiac aortic aneurysm. Treatment for such localization is usually indicated surgically in cases of aneurysmal dilatation over 6 cm, the impossibility of conservative therapy and active progression of the process.

In cases where there is mitral valve insufficiency along with an aortic aneurysm of any location, MV repair is performed. For aortic aneurysms with such an underlying disease, the mitral valve is replaced with an artificial implant under general anesthesia. Such operations are performed using a heart-lung machine with the heart muscle turned off.

Medicines

The disease is not treated with medication, but there is prevention and rehabilitation after surgery. Some vitamins and medications are taken. Write about it. Make references to treatment through surgery.

Folk remedies

Treatment of aortic aneurysm using folk remedies

Aortic dissection and aneurysm rupture require immediate surgical intervention. At an early stage of the disease, if it proceeds without dangerous complications, prevention and treatment of abdominal aortic aneurysm with folk remedies will be effective.

Effective folk remedies

Alternative treatment for aortic aneurysm will help normalize a person’s well-being and strengthen blood vessels. Herbal infusions are very effective and tonic.

• Hawthorn is the most accessible and effective remedy. Since ancient times, mankind has known the amazing properties of this plant. The fruits and leaves of hawthorn contain many important vitamins and are also capable of removing bad substances from the body (salts, heavy metals, etc.). Hawthorn is most effective for cardiac disorders. Decoctions and infusions will help improve blood circulation and normalize blood pressure. To prepare a simple medicinal infusion, you need to pour crushed dry hawthorn berries (4 tbsp) with boiling water (3 cups) and let it brew thoroughly.
• Viburnum infusion has anti-inflammatory properties, fights shortness of breath, and is also useful for vascular spasms and hypertension. The fruits of this plant contain a huge amount of vitamin C, which is necessary for the body, especially during illness. Therefore, for such a disorder as abdominal aortic aneurysm, treatment with folk remedies must necessarily include this miraculous infusion. Of course, viburnum is not a panacea, but with complex treatment it will only bring benefits. To prepare the infusion, dry berries are poured with boiling water and infused for 3.5 hours.
• Celandine - helps well in the fight against the most common cause of aneurysm development - atherosclerosis. The leaves, stems and flowers of this plant are dried and then infused in boiling water. It is recommended to drink 50 grams of infusion daily.
• Dill infusion is no less useful. Dill helps lower blood pressure, eliminates headaches and has a beneficial effect on heart function. You can use both herbs and seeds for infusion. 1 tbsp. dill is poured with boiling water (about 200 ml) and left for an hour. Treatment of aortic aneurysm with folk remedies must be combined with a healthy lifestyle and a balanced diet. Physical as well as psychological stress should be avoided.

Before starting treatment with these methods, you should consult a doctor.

The information is for reference only and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, consult a doctor.

Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Complications of aortic aneurysm

In the absence of timely treatment, patients with an aortic aneurysm may experience the following complications:

• Blood clot formation. In the cavity of the aneurysm, whether it is spindle-shaped or sac-shaped, the normal flow of blood is disrupted. It creates turbulence, which can lead to blood clots. The thrombus in this case will be sticky platelets. Being in the cavity of the aneurysm, the thrombus does not particularly interfere with blood flow. However, after leaving the aneurysm, the clot can become stuck in vessels of smaller diameter. It is almost impossible to predict where exactly thrombosis will occur. A cerebral artery (with a picture of an ischemic stroke), an artery of the kidney, liver, or extremities may be blocked. Thrombosis stops the flow of arterial blood to the corresponding organ, which leads to rapid tissue death. Thrombosis often ends in the death of the patient. The problem is that the aneurysm may not manifest itself in any way, and the patient is not aware of the presence of the disease. At the same time, blood flow disturbances already exist, and a stroke, for example, will be the first (and often the last) manifestation of the disease.
• Pneumonia. Pneumonia can be a consequence of a thoracic aortic aneurysm if the latter compresses the bronchi or puts pressure on the trachea. Normally, the epithelium of the airways secretes a certain amount of mucus, which cleanses the bronchi and humidifies the air. Compression leads to mucus accumulating in a certain part of the lung. Here favorable conditions are created for the development of infection. If it gets in, pneumonia develops.
• Compression of the bile ducts. Aneurysms in the upper abdominal aorta are adjacent to many different organs. A large aneurysm can, for example, compress the bile ducts that run from the gallbladder to the duodenum. In this case, firstly, the outflow of bile from the gallbladder is disrupted, and, secondly, the digestion process worsens. The risk of cholecystitis and pancreatitis increases, and the patient may suffer from diarrhea, constipation, and flatulence.
• Risk of heart disease. A thoracic aortic aneurysm of significant size can compress the nerve plexuses that regulate the functioning of the heart. Because of this, patients sometimes experience persistent bradycardia or tachycardia. In addition, the pressure in the thoracic aorta itself often increases, which creates additional stress on the left ventricle. As a result, irreversible changes may occur in the aortic valve of the heart or in the heart muscle. Even after removal of the aneurysm and normalization of pressure, disturbances in the functioning of the heart may remain.
• Ischemia of the lower extremities. Ischemia is called oxygen starvation of tissues. Arterial blood may reach the lower extremities in smaller quantities due to an infrarenal aortic aneurysm (located below the origin of the renal arteries). Lack of oxygen leads to deterioration of cell recovery. The risk of frostbite, trophic ulcers (due to lack of nutrition) and other soft tissue damage increases. In this case, the aneurysm will play the role of a provoking factor.

Ruptured aortic aneurysm

Rupture of an existing aortic aneurysm can be caused by the following factors:

When an aortic aneurysm ruptures, the patient may experience the following symptoms:

• sudden weakness;
• sudden pain;
• rapid paleness of the skin;
• the appearance of a dark spot on the skin of the abdomen (with the accumulation of a large amount of blood in the abdominal or retroperitoneal cavity).

Diagnosis of aortic aneurysm

If you suspect an aortic aneurysm, you should contact your family physician or cardiologist. They are the ones who can competently conduct an initial examination and prescribe further tests and examinations. A targeted search for a thoracic or abdominal aortic aneurysm is successful in most cases. Doctors manage to detect the formation itself, as well as collect all the necessary data (shape, type, size, etc.).

When diagnosing an aortic aneurysm, the following research methods may be prescribed:

• physical examination;
• X-ray examination;
• magnetic resonance imaging (MRI) and computed tomography (CT);
• lab tests.

Physical examination for aortic aneurysm

During a physical examination, the following research methods are used:

• Visual inspection. Visually, very little information can be obtained for aortic aneurysms. Any changes in the shape of the chest are observed extremely rarely and only in cases where the patient has lived with a large aneurysm of the thoracic aorta for at least several years. With a large abdominal aortic aneurysm, pulsation can sometimes be observed, which is transmitted to the anterior abdominal wall. In addition, when an aneurysm ruptures, purple spots can sometimes be observed on the abdominal wall - a sign of massive internal bleeding. However, this symptom almost never appears on the anterior abdominal wall (usually on the side), since the aorta is located retroperitoneally (separated from the intestines, stomach and other organs by the posterior layer of the peritoneum), and hemorrhage occurs primarily in the retroperitoneal space.
• Percussion. Percussion involves tapping body cavities to determine the boundaries of different organs by ear. With an abdominal aortic aneurysm, the approximate size and location of the formation can be determined in this way. Often the area of ​​dullness of percussion sound coincides with the area of ​​the “vascular bundle”. Then, according to percussion data, this zone will be expanded. In addition, with a large aneurysm of the thoracic aorta, the borders of the heart or mediastinum may be slightly shifted. With an abdominal aortic aneurysm, percussion is less informative, since the vessel passes along the posterior wall of the abdominal cavity. Palpation in this case will be more informative.
• Palpation. Palpation of the thoracic cavity is almost impossible due to the rib frame, therefore palpation is almost never used in the diagnosis of thoracic aortic aneurysm. With an abdominal aneurysm, you can often find a formation pulsating in time with the heart. This speaks volumes about the presence of an aneurysm, since such formations do not occur in other diseases. In addition, palpation can include detection of the pulse. If the frequency or filling of the pulse is different in different arms or in the carotid arteries, this may indicate the presence of an aortic arch aneurysm. Weak or absent pulsations in the femoral arteries (or different rates in different legs) may indicate an infrarenal aneurysm.
• Auscultation. Listening with a stethoscope (listener) is a very common and valuable diagnostic method. With an abdominal aortic aneurysm, by applying a stethoscope to the site of the aneurysm projection, you can hear an increased noise of blood flow. With an aneurysm of the thoracic aorta, pathological changes can be different - a metallic accent of the second tone above the aorta, a systolic murmur at the Botkin point, etc.
• Pressure measurement. The most common finding in patients with an aneurysm is hypertension (high blood pressure). With large aortic arch aneurysms, the pressure on different arms may be different (the difference is more than 10 mm Hg).

X-ray for aortic aneurysm

X-rays can also be used to study with contrast (aortography). In this case, a special substance is injected into the aorta, which intensely stains the vessel in the image. Thus, the doctor receives clear boundaries of the vessel and its main branches. The shape and size of the aneurysm and its location are well determined. In practice, however, contrast studies are rarely used. Firstly, this is an invasive (traumatic) procedure, since it is necessary to insert a special catheter into the aorta through the femoral artery. Because of this, there is a risk of bleeding, infection, etc. Secondly, if there is an aneurysm (especially a dissecting one), there is a high risk of causing a rupture during the study. Therefore, this procedure is performed only for special indications.

Ultrasound for aortic aneurysm

Ultrasound for patients with aortic aneurysm has the following advantages:

• relatively low cost;
• painless and safe for the patient examination;
• immediate results;
• the duration of the study is only 10 – 15 minutes;
• the ability to determine the shape and size of the aneurysm;
• the ability to detect some complications of an aneurysm;
• the ability to assess blood flow in the aorta and its branches;
• the ability to detect forming blood clots.

MRI and CT for aortic aneurysm

MRI uses a special property of nuclear magnetic resonance. The image is obtained by placing the patient in a powerful electromagnetic field, in which a computer detects the movements of hydrogen nuclei. A high-precision image is formed, which shows not only the volumetric shape of the aneurysm, but even the thickness of its walls. All this is very important when making a prognosis for the patient and for deciding on surgical treatment. The examination lasts approximately 15–20 minutes, during which the patient cannot move.

MRI has the following contraindications:

• ear implants and built-in hearing aids;
• the presence of metal pins or plates after operations;
• presence of a pacemaker;
• some types of prosthetic heart valves.

With computed tomography, the method of obtaining the image is slightly different. As with radiography, we are talking about differences in the absorption of x-rays in different tissues of the body. In modern tomographs, the radiation source rotates around the patient, taking a series of images. The computer then simulates the result. The result is a series of high-precision cross-sectional images. Based on the results of computed tomography, an experienced doctor can not only detect changes in the structure of the aorta, but also determine their size, position and other features. The possibility of using contrast makes CT even more informative. The introduction of a contrast agent into the vessel allows you to obtain a computer model of the patient’s vessels in 3D format. The intensity of X-ray radiation during the procedure remains low, despite the series of images taken. An absolute contraindication for this procedure is pregnancy (there is a risk to the fetus).

ECG for aortic aneurysm

The main advantages of ECG are the speed of the study (the standard procedure lasts about 10 minutes), safety for the patient (the procedure has no absolute contraindications) and immediate results. The resulting record should be carefully studied by a cardiologist, who can use it to obtain a variety of information about the functioning of the heart.

Lab tests

In patients with an aortic aneurysm, the following changes in laboratory tests may be detected:

• Changes in leukocyte levels. It can be observed with certain infections, which, in turn, cause the development of an aneurysm. The level of leukocytes usually increases during acute infectious processes and decreases during chronic ones. In chronic cases, the proportion of non-segmented neutrophils in the leukocyte formula also increases.
• Changes in blood clotting. The study of platelet levels, clotting factors and a number of other indicators often changes if blood clots form in the aneurysm cavity.
• Increased cholesterol levels. Hypercholesterolemia is an increase in blood cholesterol levels to 5 mmol/l or more. Most often this indicates atherosclerotic damage to the aorta. This is also indirectly indicated by elevated levels of triglycerides or low-density lipoproteins (even if total cholesterol is normal).
• In rare cases, urinalysis may detect blood impurities (microhematuria), which are detected during a specific analysis.

Treatment of aortic aneurysm

An important part of treatment is preventing aneurysm rupture. It includes changes in lifestyle, nutrition, and some of the patient’s habits. Compliance with preventive measures will allow the patient to better prepare for surgical treatment (it will not be urgent due to dissection or rupture, but planned).

Prevention of aneurysm formation and rupture includes the following recommendations:

• stopping smoking is perhaps the most important measure both to prevent the development of an aneurysm and to delay the increase in the diameter of an existing thoracic aortic aneurysm;
• normalization of blood pressure (including with the help of medications);
• normalization of body weight, if necessary with the help of a nutritionist;
• following a low-cholesterol diet to prevent atherosclerosis;
• refusal of serious physical activity;
• prevention of psycho-emotional stress (including taking sedatives).

Medicines for aortic aneurysm

But in the following cases, it is necessary to resort to medications in order to delay the growth of the aneurysm for as long as possible and alleviate the symptoms of the disease:

• With a small diameter of the pathological area in the aorta (up to 5 cm) during the period of dynamic observation of a patient with a thoracic aortic aneurysm.
• In case of severe concomitant diseases, when the risk from the operation exceeds the risk of rupture of the aneurysm itself. These conditions include acute coronary circulatory disorders, acute cerebral circulatory disorders, and heart failure of II – III degrees.
• During the period of preparation for surgery.

For aneurysms of the thoracic or abdominal aorta, medications with the following effect can be prescribed:

• drugs that reduce heart rate (heart rate);
• drugs to lower blood pressure;
• cholesterol-lowering drugs.

Drugs to lower heart rate in patients with aortic aneurysm

Drugs to lower blood pressure in patients with aortic aneurysm

Drugs to lower cholesterol in patients with aortic aneurysm

Surgical treatment of aortic aneurysm

Currently, the following contraindications to surgical treatment of aortic aneurysm are identified:

• acute circulatory disorders in the vessels of the heart;
• circulatory failure II or III degree;
• serious problems with blood circulation in the vessels of the brain (if there are corresponding neurological problems);
• impossibility of adequate revascularization of at least the deep arteries of the femur (after the operation there will be insufficient blood circulation).

In general, in each individual case the possibility of surgical treatment and its plan are considered separately. The duration of the operation and its complexity are influenced by the type of aneurysm, its location, and the presence of complications.

To detect contraindications and complete preoperative examination of the patient, the following procedures are prescribed:

• detailed examination of the state of the respiratory system (spirography);
• assessment of the condition of the kidneys, in order to exclude hidden renal failure;
• It is mandatory to assess the condition of the blood vessels of the lower extremities, as well as the coronary arteries and arteries of the pulmonary circulation;
• determination of sensitivity to antibiotics prescribed for staphylococci and Escherichia coli (these microorganisms most often cause postoperative complications).

Currently, there are several options for surgical treatment of aortic aneurysm:

• Classic surgery. Classic intervention is understood as a large-scale abdominal operation with general anesthesia and wide tissue dissection. The goal is to remove the section of the aorta with the aneurysm and replace it (usually with a graft). As a result, blood flow through the aorta is completely restored. The big disadvantage of this operation is its traumatic nature. There is a high risk of complications during and after surgery. Even in the absence of complications, the patient usually takes a long time to recover and loses his ability to work for a long time.
• Endovascular surgery. Endovascular surgery is understood as a set of methods in which large-scale tissue dissection does not occur. All necessary instruments are brought to the aneurysm through other vessels (often through the femoral artery). Depending on the type and size of the aneurysm, there are several intervention options. Sometimes a special reinforcing mesh is installed into the lumen of the vessel, which prevents the growth or separation of the formation. For small saccular aneurysms, sometimes they resort to “sealing” the mouth. Currently, there is a fairly wide range of manipulations through endovascular access. However, all of them are performed, as a rule, for small saccular aneurysms, when there is no serious threat of rupture.

Traditional treatment of aortic aneurysm

As an alternative to drug treatment, the following folk remedies are sometimes used:

• Dill infusion. Infuse one tablespoon of finely chopped dill in 400 ml of boiling water. Divide this portion into 3 parts and drink throughout the day.
• Hawthorn infusion. Dry and chop the red hawthorn fruits well. To prepare the infusion, you need two spoons of the resulting powder. Pour the powder into 300 ml of boiling water and leave for half an hour. Divide into three parts and consume 30 minutes before meals.
• Infusion of gillyflower. This infusion is prepared from two tablespoons of jaundice. Pour in 150 ml of boiling water. Drink 15 ml 5 times a day. You can add sugar to the prepared infusion to improve the taste.
• Elderberry decoction. To prepare this decoction you need Siberian elderberry root. Boil 200 ml of water, add chopped elderberry root, let simmer over low heat for 15 minutes. Remove from heat and leave for another 30 minutes. Strain the resulting broth and pour into a glass container. Drink one tablespoon 3 times a day.

Prognosis for aortic aneurysm

The prognosis for aortic aneurysm is influenced by the following factors and indicators:

• Aneurysm shape. As a rule, dissecting aneurysms are the most dangerous. The best prognosis is often for fusiform true aneurysms, the walls of which are stronger.
• Reason for formation. Aneurysms that appear against the background of atherosclerosis grow more slowly. With syphilis, the prognosis is worse, since the disease that has reached the aortic wall is already at a late stage, and other organs may be affected. Congenital connective tissue diseases generally have a poor prognosis because there is no effective treatment.
• Aneurysm size. Larger aneurysms often cause more symptoms and are more likely to rupture. The prognosis for them will be worse.
• Patient's age. Atherosclerotic aneurysms usually form in people over 40 years of age. At the same time, they may have various concomitant diseases - coronary heart disease, kidney or liver problems, etc. All this can become a relative or even absolute contraindication to surgical treatment. The prognosis, of course, is getting worse.
• Stage of the disease. Fresh aneurysms that form within the last few weeks have a worse prognosis because it is more difficult for doctors to assess the risk of rupture. Subacute aneurysms have a better prognosis.
• Location of the aneurysm. It is difficult to say which aneurysms are more dangerous - the thoracic or abdominal aorta. In both cases, rupture most often leads to the death of the patient. An important factor is which branches of the aorta are affected by the aneurysm. This largely determines the volume and complexity of surgical intervention (especially when it comes to prosthetics). The worst prognosis will be for multiple aortic aneurysms located in both the thoracic and abdominal cavities.

Is there any disability for an aortic aneurysm?

With an aneurysm of the thoracic or abdominal aorta, at first there is no talk of disability. First, you need to undergo a full course of treatment, which includes surgical correction of this pathology. In other words, while doctors have treatment options, the patient is not referred for a medical and social examination.

After surgical treatment, a certain time must pass - usually from six months to 1 - 2 years. During this period, the patient visits rehabilitation centers, which do everything possible to restore health. In the absence of complications or serious consequences of the disease (or surgery), the patient is considered healthy. Of course, the question of obtaining a disability group does not arise again.

If the patient, after a course of rehabilitation, does not get rid of the serious consequences of the operation or illness, he is referred for a medical and social examination. With an aneurysm of the abdominal or thoracic aorta, such consequences can be, for example, disruption of the heart, deterioration of the blood supply to individual organs. Sometimes the diseases that led to the formation of an aneurysm (Marfan syndrome and a number of other congenital diseases) progress, and the patient receives a group not so much because of the aneurysm, but because of the underlying pathology. With Marfan syndrome, for example, there is joint weakness, severe visual impairment, and heart defects. The medical and social examination will consider these manifestations together.

An unoperated aortic aneurysm can also become a reason for receiving a disability group. For example, if the patient has an aneurysm, but there are serious contraindications to surgery (disorders of the heart, lungs, kidneys, liver and other concomitant pathologies). All this confuses doctors, since it becomes impossible to solve the problem surgically. The risk of surgery becomes too high. Because the patient has to constantly reckon with the risk of aneurysm rupture and other complications, he is forced to frequently visit doctors and regularly take various medications. This may be a reason to refer him for a medical and social examination.

A dissecting aortic aneurysm is a damage to the inner lining of the enlarged aorta, which is accompanied by the appearance of hematomas and a false opening. This disease is characterized by longitudinal separation of the aortic walls of varying lengths. In medicine, this pathology is often called a more abbreviated version - “aortic dissection.”

Often, the aorta can dissect in the most hemodynamically weak areas, which include the area of ​​the ascending aorta, the aortic arch and the descending zone. In cardiology, an aneurysm is one of the group of severe pathologies that can cause significant inconvenience and threaten a person’s life. If you do not consult a doctor in a timely manner, the patient may experience bleeding from aortic rupture or acute ischemia.

As a rule, the disease develops in older people over 60 years of age. Doctors diagnose pathology more often in men than in women. The larger a person's aneurysm, the more progressively it enlarges and the chances of it rupturing increase. Accordingly, the risk of rupture increases with the size of the aneurysm, which can be several times larger than the normal diameter of the aortic lumen.

Etiology

Aneurysm dissection can occur for a variety of reasons. The main factor leading to the development of the disease is damage to the walls. With this pathology, specific plaques begin to form in the human aorta, which can serve as a provoking factor. These tumors are composed of cholesterol, calcium and fibrous tissue. With the progression of atherosclerosis, the number of plaques increases, which leads to a decrease in the lumen in the vessel. As a result, the walls lose their elasticity and become weaker. Clinicians also identify other factors leading to dissecting aortic aneurysm:

• excess weight;
• heredity;
• elevated blood pressure;
• nicotine consumption.

Pathology can develop under the influence of various other diseases. People with the following diseases may have a high chance of developing an aneurysm:

Quite rarely, the disease is diagnosed due to mechanical damage.

Classification

Classification of the disease consists in determining the types of the disease according to the characteristics of the course and the localization of the disease. According to the first criterion, doctors identified a rather conventional systematization, which is divided into the following forms:

• chronic – can last for months;
• subacute – the process lasts about 4 weeks;
• acute - death occurs a couple of hours after the exacerbation.

According to the location of the disease, the classification of the disease consists of 3 types:

• Type 1 – dissection occurs in the area of ​​the ascending aorta, and smoothly passes to the thoracic and abdominal region;
• Type 2 – damage is localized exclusively in the ascending section;
• Type 3 – from the descending zone the lesion moves to the area of ​​the abdominal aorta.

Symptoms

In the development of the clinical picture of pathology, doctors distinguish two stages of formation. With dissecting aortic aneurysm at the initial stage, the disease manifests itself in the three above-mentioned forms of the disease - acute, subacute, chronic.

During an acute attack of wall dissection, the patient is overcome by the following symptoms:

Dissecting aortic aneurysm is a disease that quickly subsides, but can provoke a reflex decrease in blood pressure and fainting. After a while, the patient begins to experience severe burning pain in the sternum, arms, neck, and shoulder blades. During moments of exacerbation, the patient also exhibits other symptoms: dry cough, feeling of lack of air, decreased blood pressure, collapse.

Diagnostics

The development of aortic disease with wall dissection can only be determined by instrumental examination. To accurately determine the cause of the development of pathology, the patient is prescribed to undergo research using such methods;

• radiography;
• tomography;
• angiography.

Thanks to an examination using an ECG, the doctor can rule out myocardial ischemia, which also provokes pain in the chest. X-ray helps to identify sudden changes in the structure of the vessel - an increase in the lumen and upper mediastinum, changes in contours, the presence of pleural effusion, a decrease in the pulse in the dilated part.

The patient is prescribed constant monitoring of blood pressure, diuresis and monitoring of ECG changes. To determine the dynamics of aneurysm progression and the presence of fluid in the pericardium and pleural cavities, the patient undergoes radiography.

It is important to perform tomography to identify intramural hematoma and penetration of atherosclerotic ulcers of the thoracic aorta.

In diagnosing the disease, it is also important to conduct a differential examination and distinguish a dissecting aneurysm from the following ailments:

• occlusion of mesenteric vessels;
• spicy ;
• aorta;
• without delamination of walls;
• mediastinal tumor.

Treatment

If a patient has been diagnosed with an abdominal or thoracic aortic aneurysm, he is prescribed therapy depending on the type of dissection and the presence of consequences.

Drug therapy is used in the treatment of various forms of aneurysms. Medicines are the initial stage of eliminating the symptoms and causes of the disease. The patient is then scheduled for aortography and surgery.

Treatment with medications is based on the following goals:

• prevention of the development of further aortic dissection;
• normalization of hemodynamics and homeostasis;
• decrease in blood pressure indicators.

Doctors prescribe treatment of pathology with drugs from the following groups - beta-blockers, calcium antagonists, ACE inhibitors, nitroglycerin.

If conservative treatment turns out to be ineffective, then the patient is prescribed surgical intervention. It is based on resection of the affected area of ​​the aorta, eliminating the false lumen and restoring the damaged parts of the aorta. To achieve these goals, doctors use prosthetics or remove the defective area and stitch the ends of the healthy aorta.

Emergency surgical care is needed only for those patients who are at risk of aortic rupture - with severe vascular insufficiency, progressive dissection, with a saccular aneurysm, with ineffective therapy with conservative methods. Urgent surgical care is also provided if the patient has a hemorrhage in the pericardium or pleural cavity.

Often such operations are performed using artificial circulation. After surgical treatment, the patient begins the stage of rehabilitation in the hospital.

Complications

Complications can develop if a dissecting aortic aneurysm develops too quickly or the patient seeks medical attention too late. The most common consequences of the disease include such pathologies as myocardial infarction, stroke, and often aneurysm rupture and death.

Forecast

For people with this diagnosis, the outcome may be poor. A significant proportion of patients die during surgery or during the recovery period. Doctors have found that with emergency treatment of an acute aneurysm on the operating table, death occurs in 25% of cases, and with treatment of a chronic form of the disease in 17%.

Prevention

Dissecting aortic aneurysm is a severe form of the disease that is important to recognize early in its development. To reduce the chances of developing the disease, doctors advise periodically checking your blood pressure. If a patient has a high level of lipids in the blood, then for preventive purposes he is prescribed diet therapy and lipid-lowering drugs.

Doctors also advise all people to exercise, watch their diet and adhere to a healthy lifestyle.

Is everything in the article correct from a medical point of view?

Answer only if you have proven medical knowledge

An aneurysm is a protrusion of the wall of a blood vessel caused by its stretching or thinning due to any acquired or hereditary pathologies. The danger of such a problem largely depends on the location of the vascular defect and the caliber of the artery or vein.

Aortic aneurysm is rightfully included in the list of the most dangerous conditions that can lead to almost instant death. The insidiousness of this disease lies in the fact that the patient may not even be aware of its presence for a long time, and the aorta is the largest vessel of the human body, and if a large aneurysm formed on it ruptures, the patient may die or become seriously ill in a matter of minutes, caused by massive bleeding.

Brief information about the aorta

The aorta is the largest and longest artery of the human body, which is the main vessel. It is divided into three parts: ascending, aortic arch and descending. The descending aorta, in turn, is divided into the thoracic and abdominal sections. The length of this large vessel extends from the sternum to the lumbar spine. Such dimensions of the artery indicate that when blood is pumped, the highest pressure is created in it, and that is why areas of protrusion (aneurysm) can often form on it.

Mechanisms and causes of aneurysm development

Also, due to its anatomical features, the aorta is most susceptible to infections, atherosclerotic changes, injuries and death of the medial tunic of the vessel. All of these predisposing factors contribute to the development of aneurysms, dissection, or inflammation of the aorta (aortitis). Stretching or thinning of the walls of this largest artery is caused either by age-related changes or by various injuries or diseases (syphilis, atherosclerosis, diabetes mellitus, etc.).

According to statistics, it is atherosclerotic plaques that in most cases are the root cause of this disease. Also, not so long ago, scientists suggested that the development of aortic aneurysm may be facilitated by the herpes virus. At the moment, these data have not yet been conclusively confirmed, and scientific research is under development.

In the initial stages of the disease, aortic aneurysms do not manifest themselves in any way and can be discovered completely accidentally during a patient’s examination for other diseases (for example, when performing an ultrasound of blood vessels, abdominal organs or the heart). Subsequently, atrophy of elastic fibers occurs in the middle wall of this artery. They are replaced by fibrous tissue, and this leads to an increase in the diameter of the aorta and increased tension in its wall. With persistent progression of such pathological processes, the risk of rupture increases significantly.

Types of aneurysms

Aortic aneurysms can vary in structure and shape.

According to its pathological characteristics, an aneurysm can be:

• true - is a protrusion of the vessel wall, which is formed from all vascular layers of the aorta;
• false (or pseudoaneurysm) - is a protrusion of the vessel wall, which is formed from pulsating hematomas; the vessel walls consist of para-aortic connective tissue and sublayer deposits of blood clots.

According to its form, an aortic aneurysm can be:

• saccular - the cavity of the pathological protrusion of the aorta communicates with its lumen through the neck-shaped canal;
• fusiform - most common, its cavity is similar to the shape of a spindle and communicates with the aortic lumen through a wide opening;
• dissecting - a cavity is formed due to dissection of the walls of the aorta and is filled with blood; such an aneurysm communicates with the aortic lumen through the dissecting wall.

Based on clinical manifestations, cardiologists distinguish the following types of aneurysms:

• thoracic aorta;

Symptoms

The severity and nature of the signs of an aortic aneurysm are determined by its location and stage of development. They are nonspecific, varied and, especially when they are insufficiently expressed or rapidly progressing, are attributed by patients to other diseases. The sequence of their appearance is always determined by the following pathological processes:

• during a tear in the intima of the aorta, the patient experiences pain and a sharp decrease in blood pressure;
• in the process of dissection of the aortic wall, the patient experiences sharp pain of a migrating nature, repeated episodes of decreased blood pressure and organ symptoms (they are determined by the location of the aneurysm, intimal tear and hemorrhage);
• during a complete rupture of the aortic wall, the patient develops signs of internal bleeding (severe pallor, cold sweat, decreased blood pressure, etc.) and develops hemorrhagic shock.

Depending on the combination of all of the above factors, the patient may experience:

• pain of a burning, pressing or tearing nature, localized or radiating to the arm, chest, shoulder blades, neck, lower back or legs;
• cyanosis of the upper part of the body with the development of hemopericardium;
• fainting that develops when the vessels leading to the brain are damaged and irritated or when the patient becomes suddenly anemic due to massive bleeding;
• pronounced bradycardia at the beginning of intimal tear, which is subsequently replaced by tachycardia.

In most patients, aortic aneurysm, especially in the first stages of its development, is asymptomatic. This course of the disease is especially relevant when the pathological protrusion of the vessel wall is located in the thoracic aorta. In such cases, signs of pathology are either detected by chance during an instrumental examination for other diseases, or make themselves felt more clearly if the aneurysm is localized in the area of ​​the bend of the aorta into the arch. In some cases, with vascular irritation, aortic dissection in the area of ​​the coronary vessels and compression of the coronary arteries, the clinical picture of an aortic aneurysm is combined with symptoms of myocardial infarction or angina. When the pathological protrusion is located in the abdominal aorta, the symptoms of the disease are clearly expressed.

During an ECG examination of a patient with an aortic aneurysm, a variable picture may be observed. In 1/3 of cases, no abnormalities are detected, while in others there are signs of focal myocardial lesions and coronary insufficiency. In aortic dissection, these signs are persistent and are detected on several repeated ECGs.

A general blood test reveals leukocytosis and signs of anemia in the patient. With dissection of the aortic aneurysm, the decrease in the level of hemoglobin and red blood cells constantly progresses and is combined with leukocytosis.

Also, patients with this disease may experience some neurological symptoms:

• convulsions;
• disturbances during urination and defecation;
• hemiplegia;
• fainting conditions;
• paraplegia.

When the femoral and iliac arteries are involved in the pathological process, signs of impaired blood supply to the lower extremities are observed. The patient may experience: pain in the legs, paleness or cyanosis of the skin, etc.

In the case of dissection of an aneurysm of the abdominal aorta, a pulsating and increasing tumor in size is formed in the abdominal area, and when blood leaks into the pleural cavity, pericardium or mediastinum, when the boundaries of the heart are tapped, their displacement, expansion and disturbances in the heart rhythm up to cardiac arrest are observed.

Symptoms of a ruptured aortic aneurysm

In most cases, a ruptured aortic aneurysm is not accompanied by any specific symptoms. Initially, the patient may experience discomfort and mild pain, and when bleeding begins, signs of hemorrhagic shock join the clinical picture.

In the case of massive and rapid hemorrhage, fainting and intense pain in different parts of the body may occur (if dissection or rupture of the aorta occurs in close contact with the nerve bundle). The further prognosis of such significant blood losses depends on the total volume of blood lost.

Treatment

To treat an aortic aneurysm, the patient must consult a vascular surgeon or cardiac surgeon. Determining its tactics depends on the growth rate, location and size of the aneurysm, which are determined during dynamic observation and constant x-ray monitoring. If necessary, to reduce the risk of developing possible complications or to prepare the patient for surgical treatment, anticholesterolemic drug therapy is also carried out.

The decision to perform planned surgical treatment is made in the following clinical cases:

• aneurysm of the abdominal aorta with a diameter of more than 4 cm;
• thoracic aortic aneurysm with a diameter of more than 5.5-6 cm;
• a constant increase in the size of a small aneurysm by 0.5 cm or more over six months.

Emergency surgery is performed as quickly as possible, because with massive or prolonged bleeding, the patient dies in a short time. Indications for it may include the following terminal situations:

• embolization of peripheral arteries;
• aortic dissection or rupture.

To eliminate an aneurysm, operations are performed, the purpose of which is to excision and suturing or replacing the damaged area of ​​the aorta with a prosthesis. In the presence of aortic insufficiency, the aortic valve is replaced during resection of the thoracic part of the vessel.

One of the minimally invasive surgical treatment options may be endovascular prosthetics with subsequent installation of a vascular prosthesis. If it is impossible to perform such operations, traditional interventions are performed with open access to the site of localization by resection:

• abdominal aneurysms;
• thoracic aneurysms during left ventricular bypass;
• thoracic aneurysms during artificial circulation;
• aneurysms of the aortic arch during artificial circulation;
• abdominal aortic aneurysm;
• abdominal aortic aneurysm with artificial circulation;
• aneurysms of the subrenal aorta.

After completion of surgical treatment, the patient is transferred to the cardiac intensive care unit, and when all vital functions are restored, to the vascular department or cardiac center. In the postoperative period, the patient is prescribed analgesic therapy and symptomatic treatment.

The prognosis for an aortic aneurysm will be determined by its size, rate of progression and concomitant pathologies of the cardiovascular and other body systems. In the absence of treatment, the outcome of the disease is extremely unfavorable, because due to the rupture of an aneurysm or its development, the patient will die. According to statistics, about 95% of patients die within the first three years. This is explained by the frequent latent course of the disease and the high risk of rupture of aneurysms, the diameter of which reaches 6 cm. According to statistics, about 50% of patients die per year with such aortic pathologies.

With early detection and planned surgical treatment of aortic aneurysms, the postoperative prognosis becomes more favorable, and the death rate is no more than 5%. That is why, for the prevention and timely detection of this disease, it is recommended to constantly monitor blood pressure levels, lead a healthy lifestyle, undergo regular scheduled preventive examinations and all doctor’s prescriptions for drug therapy for concomitant diseases.

Medical animation on the topic “Aortic aneurysm”:

TV show “Be Healthy” on the topic “Aortic Aneurysm”:

Note: Clinical suspicion of dissecting aortic aneurysm arises based on history, physical examination, chest x-ray, and ECG. A dissecting aneurysm less than 2 weeks old is classified as acute, while aneurysm that has existed for a longer period of time is classified as chronic. Complications of this condition include progression of the lesion to involve vital organs or extremities, rupture or threatened rupture (eg, formation of a saccular aneurysm), regurgitation in the aortic valve (very rare), retrograde extension of the dissection into the ascending aorta, and inability to control pain and blood pressure with medications. , Marfan syndrome. The proximal aneurysm includes a dissecting aneurysm involving the ascending section and aortic arch, and the distal aneurysm is localized below the origin of the left subclavian artery.

Symptoms of the disease:

Largely depend on the location of the lesion;
. characterized by a sudden onset with the appearance of severe “tearing” pain;
. pain is most often localized behind the sternum, in the interscapular region, in the lower back (its localization changes as the dissection progresses);
. possible loss of consciousness;
. both hypertension and hypotension are detected (you should first make sure that blood pressure is not determined in the vessel involved in the dissection process);
. with supravalvular localization of the lesion, regurgitation in the aortic valve (in severe cases leading to heart failure) and cardiac tamponade may occur;
. pulse deficiency, decreased pulsation amplitude in the vessels involved in the rupture;
. Symptoms of ischemia of the myocardium, brain and spinal cord, limbs, and abdominal organs may appear.

Chest X-ray:

Findings are nonspecific and often do not help diagnosis;
. possible expansion of the shadow of the aorta (sometimes with the presence of a characteristic protrusion at the site of dissection), less often the mediastinum, the appearance of fluid in the pleural cavity (usually on the left);
. A normal radiograph does not exclude the diagnosis.

ECG in 12 leads:

In the absence of characteristic changes, myocardial ischemia can be excluded as the cause of chest pain;
. the presence of changes characteristic of myocardial infarction (usually lower localization) does not exclude dissecting aortic aneurysm.

Aortic imaging methods:

The choice of method largely depends on capabilities and experience;
. transesophageal echocardiography is especially indicated in unstable patient conditions (can be quickly performed at the patient’s bedside, as well as in the operating room immediately before surgery, does not require cessation of monitoring and ongoing therapeutic measures);
. computed tomography with contrast agent injection can be used if transesophageal echocardiography is not available;
. Magnetic resonance is more often used in patients whose condition is stable, in the chronic form of the disease;
. aortography is used in cases where a specific diagnosis has not been established using the above studies.

Methods of drug treatment:

The main goals of treatment include reducing blood pressure and myocardial contractility;
. the desired level of systolic blood pressure is 100 - 120 mm Hg. Art. or the lowest level that does not cause ischemia of the heart, brain and kidneys in patients with hypertension;
. to quickly reduce high blood pressure, they resort to intravenous infusion of sodium nitroprusside or nitroglycerin with the obligatory simultaneous use of a b-blocker;
. to quickly reduce myocardial contractility, intravenous administration of b-blockers is carried out in an increasing dose until the heart rate reaches 50 - 60 per minute (propranolol - 1 mg every 3 - 5 minutes until the effect is achieved or up to a total dose of 0.15 mg / kg, repeated after 4 - 6 hours 2-6 mg; esmolol - bolus 30 mg, then infusion 3-12 mg/min);
. both goals can be achieved with labetolol (10 mg intravenously over 2 minutes, then 20 - 80 mg every 10 - 15 minutes to a maximum dose of 300 mg, as a maintenance measure - infusion of 2 - 20 mg / min);
. with contraindications to b - blockers can use calcium antagonists that slow down the heart rate (verapamil, diltiazem);
. taking short-acting nifedipine drugs orally or sublingually can lead to a rapid decrease in blood pressure even in refractory cases, but is associated with the risk of reflex tachycardia; apparently, these drugs should not be prescribed without prior administration of a b-blocker;
. when the renal arteries are involved in the dissection, intravenous administration of an angiotensin-converting enzyme inhibitor (enalapril 0.625 - 5 mg every 4 - 6 hours) may be most effective to reduce blood pressure;
. with clinically significant hypotension, rapid intravenous fluid administration is necessary; in refractory cases, an infusion of pressor agents is performed (preferably norepinephrine; dopamine is used only in low doses to stimulate urination).

Surgery:

If an aortic rupture or cardiac tamponade is suspected, it is necessary to take the patient to the operating room as quickly as possible;
. the urgency and expediency of surgical intervention depend on the location of the lesion, how long ago the dissection occurred and the presence of complications