Preventing Premature Death From Aortic Aneurysms

Show co-host Kym McNicholas is dedicating this how to her Mom Marilyn Lou Baum McNicholas who transitioned earlier this year due to an undetected abdominal aortic aneurysm that ultimately ruptured. Marilyn’s cardiologist told Kym that there’s still so much doctors don’t know about aneurysms and because of that, there are gaps in care, which lead to premature death. Marilyn was diagnosed with having a 4cm thoracic aneurysm six months prior to her transition. Her cardiologist said it was small in size and nothing to worry about, just to keep watch every year since a surgeon typically does not treat an aneurysm until it’s at least 5cm. No one on her healthcare team talked about how to prevent it from growing or that she may also be at increased risk of having an abdominal aortic aneurysm because of it. So, not further testing was done despite textbook symptoms of increasing erratic blood pressure, tachycardia, a pulsating feeling around her belly button, an abdominal mass, and severe radiating pain in her back. Her cardiologist, a vascular surgeon, and an emergency room doctor told her there was nothing life-threatening with her symptoms. They told her to take muscle relaxers and prescribed physical therapy, along with traction. The autopsy revealed what doctors missed. ??

Should Marilyn’s 4cm thoracic aneurysm have been taken more seriously? Should she have been tested for an abdominal aortic aneurysm after being diagnosed with a thoracic aneurysm? Should her symptoms have been a red flag for doctors?

In this episode, co-host Dr. John Phillips leads the discussion with guest Cardiothoracic Surgeon Dr. George Arnaoutakis , about specifically thoracic and thoraco abdominal aortic aneurysms. For those who aren’t familiar with what an aneurysm is and how it forms, they will go through the basics. But the primary discussion will be around the current gaps in care, new innovative approaches to diagnosis and treatment, as well as critical questions to discuss with your healthcare team.

What is an aneurysm?

Imagine a balloon inflating and becoming more and more transparent as it grows, the tension on the rubber lining of the balloon increases to a point where it no longer has the strength to withstand that pressure and will tear or rupture. That’s an analogy Dr. Arnaoutakis used to kick off his discussion on aneurysms and their life-threatening potential. An aneurysm is a ballooning in the wall of an artery, which can rupture and cause internal bleeding, which is often fatal if it occurs in the aorta, which is the largest artery in the body that runs from the left ventricle of the heart and feeds the oxygenated blood to the circulatory system. An aneurysm can occur in arteries throughout the body. But this discussion is narrowly focused on a thoracic aortic aneurysm, which occurs in your chest and a thoracoabdominal aneurysm that extends from the chest to below the diaphragm. Dr. Arnaoutakis touches upon Abdominal Aortic Aneurysms (AAA) as well.

Aneurysm Symptoms

Much of the time an aneurysm is silent as it grows. Symptoms of a rupturing aortic aneurysm may include sharp and sudden pain in the upper back that radiates downward, or from back to front, difficulty in breathing, radiating tenderness or pain in chest, tachycardia, or a pulsating feeling at the belly button (for AAA).

Gaps in Aneurysm Care

One issue discussed on the program with aneurysms is who to test and when. Screening programs such as ultrasound, CT scan, or an MRI are usually reserved for those with high risk factors such as family history who show signs or symptoms. The problem is as stated above that many with aneurysms may not show obvious symptoms, and studies thus far have not identified benefit for widespread screening programs. Opportunities for research in the future are defining ways to better identify high risk patients who would benefit from screening. Those with risk factors such as genetic condition, high blood pressure, high cholesterol, blood clotting disorders, bicuspid aortic valve and atherosclerosis should talk to their doctor about mitigating their risk and testing. If test results do show a thoracic aortic aneurysm is present, there are some different opinions in the surgical community whether to operate at 5.5cm as the current guidelines suggest, versus at a small diameter for example 5cm. A surgeon typically will discuss treatment with a patient only when an aneurysm is approximately 5cm but Dr. Arnaoutakis says that a smaller framed individual may need treatment at a smaller sized diameter. The current treatment for ascending aneurysms requires open heart surgery, but aneurysms in other areas of the aorta may be repaired with a less invasive means called a stent graft, devlivered through the groin. In the future, stent grafts may be available for the ascending aorta.

Can Aneurysms be prevented?

Dr. Arnaoutakis talks about ways to mitigate your risk of an aneurysm and aneurysm rupture.?It’s important to stop smoking and using tobacco products, keep blood pressure under control, manage cholesterol levels, and reduce fats in your diet.

Talking to your doctor about aneurysms

Discuss your risk factors with your physician and a good start is to say, “Hey Doctor, Let’s C.H.A.T.” Take your stethoscope and check my Carotids, Heart, Abdomen (Aneurysm), Toes (leg pulses). It’s not a comprehensive test but it is a good jumping off point. If you do have high risk factors, the next step for evaluating for an abdominal aortic aneurysm might be an ultrasound. But Dr. Arnaoutakis says that the best way to diagnose an aneurysm is by CT scan.

A patient’s Story of Thriving with an aneurysm

Retired Veterinarian, triathlete, PhD, and author Dr. Kevin Morgan shares his personal story about how he diagnosed his own abdominal aortic aneurysm (AAA), found the right treatment, and continues to compete in running and cycling events. Dr. Morgan has a website where he blogs about his journey called Athlete With Stent - How to Train for Aging, The Ultimate Endurance Sport. He also just released a new book on Amazon, ”How To Fight The Crippling Pain of Peripheral Artery Disease,” that talks about his diagnosis with Peripheral Artery Disease, which is a narrowing of mainly the leg arteries due to plaque build-up, and how he is continuing to train to become the oldest participant, at age 80, in the 2023 Ironman World championship in Finland.

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