The aorta is the largest artery in the human body and is connected to the left ventricle of the heart. It sends the blood pumped by the heart through many branches that carry blood to all of the organs of the body. Aortic diseases can affect people at any age. They are complex illnesses that must be continually monitored.
Patients with aortic disease usually have no symptoms and are unaware of the changes in their aorta. Often, the diagnosis is made incidentally through imaging tests such as chest X-rays, CT scans, or echocardiograms performed for other reasons.
The wall of the aorta can become weakened for a variety of reasons, and the weakened section may become enlarged. This enlargement or dilatation, known as a thoracic aortic aneurysm, can develop slowly over many years. Like an inflated balloon, the wall of the aorta becomes thin and can tear (dissect) or rupture when it is stretched by an aneurysm.
In the event of an aortic dissection, the wall of the aorta tears causing blood to flow through the tear into the inner layers of the aortic wall, pushing them apart and reducing blood flow to the rest of the body. An aortic dissection or rupture requires immediate surgical repair.
The causes of aortic diseases include:
- Hardening of the arteries (atherosclerosis), which is more common in people with high cholesterol, high blood pressure and those who smoke
- Connective tissue disorders (e.g., Marfan’s syndrome)
- Inflammation of the aorta
- Birth defects (e.g., bicuspid aortic valve)
- Genetic predisposition
Most aortic aneurysms do not cause symptoms, but symptoms may include:
- Chest Pain
- Back Pain
- Hoarseness of the voice
- Swallowing problems
- High-pitched breathing (stridor)
Symptoms of a ruptured aortic aneurysm include:
- Severe chest or back pain
- Loss of consciousness
- Low blood pressure
- Rapid heart rate
Aortic aneurysms can be diagnosed and monitored using imaging techniques including computed tomography (CT) scans, echocardiograms, or magnetic resonance imaging (MRI). Once it is confirmed that the aorta is enlarged or an aneurysm exists, routine imaging tests (i.e., CT scans or echocardiograms) are used to monitor the progress of the disease. If the size of the aorta continues to grow, your physician will discuss the options to repair the aorta.
It is important for patients with aortic aneurysms to control the risk factors that can make the condition worse. Smoking and high blood pressure are the greatest concerns:
- Smokers must quit smoking. Patients may be referred to the Heart Institute Quit Smoking Program. A variety of aids and support are available to help with the quitting process.
- Blood pressure must be kept within normal limits (<130/80). Adjustment of medications, a low sodium diet and exercise can achieve this. Patients should avoid heavy lifting and highly physical activities.
- Exercise is vital to maintaining good health. Patients with aortic aneurysms are advised to avoid strenuous lifting, pushing or pulling when there is straining involved. They can perform aerobic/cardio-type exercises eg. Walking, cycling, swimming, light jog, treadmill.
- Heart healthy diet with low fat and salt will prevent the build-up of plaque in the aorta and other arteries. Low salt (sodium) will help to lower blood pressure.
- Stress contributes to high blood pressure. Management of stress through exercise, yoga, mindfulness activities (meditation) and counselling are recommended. The Heart Institute offers stress management courses.
Patients referred to the Aortic Clinic are seen in consultation with a cardiac surgeon or a cardiologist and a registered nurse. A thorough individualized assessment of the risk of complications is performed and a plan of care is determined, including imaging studies and follow-up appointments. Depending on their situation, the patient may be managed medically or surgically.
Medical treatment involves regular imaging of the aorta and careful management of blood pressure to achieve a measurement < 130/80 mmHg. Advice on appropriate exercise, diet, smoking cessation, and stress management are also provided.
For patients needing a repair of the aorta, discussions will cover the type of surgical procedure required, preparation for surgery, and the hospital stay. The aorta repair may be done by open heart surgery or a less-invasive stent procedure. The surgeon will discuss which option best suits the patient. Prior to the aortic repair, diagnostic tests will be completed and a visit to the Pre-admission unit will complete the preparation. The hospital stay is approximately 5-7 days for open heart surgery and 3 days following a stent procedure. A follow-up appointment will be 4-6 weeks after discharge. Following recovery, the patient will be monitored either with the cardiologist, family doctor or the Aortic Clinic.
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