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Living with a thoracic aneurism

By Keith Roach, M.D. on

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.

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Dr. Roach

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