Pulmonary embolism is a blockage in one of the pulmonary arteries in your lungs. In most cases, pulmonary embolism is caused by blood clots that travel to the lungs from the legs or, rarely, other parts of the body (deep vein thrombosis).
Because the clots block blood flow to the lungs, pulmonary embolism can be life-threatening. However, prompt treatment greatly reduces the risk of death. Taking measures to prevent blood clots in your legs will help protect you against pulmonary embolism.
Signs and Symptoms
Shortness of breath
Chest pain
Cough
Excessive sweating
Irregular heart beat
Lightheadedness
Causes
Pulmonary embolism occurs when a clump of material, most often a blood clot, gets wedged into an artery in your lungs. These blood clots most commonly come from the deep veins of your legs. This condition is known as deep vein thrombosis (DVT).
In most cases, multiple clots are involved but not necessarily all at once. The portions of lung served by each blocked artery are robbed of blood and may die. This is known as pulmonary infarction. This makes it more difficult for your lungs to provide oxygen to the rest of your body.
Occasionally, blockages in the blood vessels are caused by substances other than blood clots, such as:
Pulmonary hypertension is a type of high blood pressure that affects the arteries in your lungs and the right side of your heart.
In one form of pulmonary hypertension, tiny arteries in your lungs, called pulmonary arterioles, and capillaries become narrowed, blocked or destroyed. This makes it harder for blood to flow through your lungs, and raises pressure within your lungs' arteries. As the pressure builds, your heart's lower right chamber (right ventricle) must work harder to pump blood through your lungs; eventually causing your heart muscle to weaken and fail.
Some forms of pulmonary hypertension are serious conditions that become progressively worse and are sometimes fatal. Although some forms of pulmonary hypertension aren't curable, treatment can help lessen symptoms and improve your quality of life.
Signs and Symptoms
Shortness of breath (dyspnea), initially while exercising and eventually while at rest
Fatigue
Dizziness or fainting spells (syncope)
Chest pressure or pain
Swelling (edema) in your ankles, legs and eventually in your abdomen (ascites)
Bluish color to your lips and skin (cyanosis)
Racing pulse or heart palpitations
Causes
Your heart has two upper chambers (atria) and two lower chambers (ventricles). Each time blood passes through your heart; the lower right chamber (right ventricle) pumps blood to your lungs through a large blood vessel (pulmonary artery).
In your lungs, the blood releases carbon dioxide and picks up oxygen. The oxygen-rich blood then flows through blood vessels in your lungs (pulmonary arteries, capillaries and veins) to the left side of your heart. Ordinarily, the blood flows easily through the vessels in your lungs, so blood pressure is usually much lower in your lungs.
With pulmonary hypertension, the rise in blood pressure is caused by changes in the cells that line your pulmonary arteries. These changes can cause the walls of the arteries to become stiff and thick, and extra tissue may form. The blood vessels may also become inflamed and tight.
These changes in the pulmonary arteries can reduce or block blood flow through the blood vessels. This makes it harder for blood to flow, raising the blood pressure in the pulmonary arteries.
Risk Factors
Idiopathic pulmonary arterial hypertension is more common in younger adults
Overweight
Family history of the disease
Illegal drugs, such as cocaine
Appetite-suppressant medications
Complications
Cor Pulmonale
Blood Clots
Bleeding
Arrhythmias
Treatments
Pulmonary hypertension can't be cured, but doctors can help you manage your condition. Treatment may help improve your symptoms and slow the progress of pulmonary hypertension.
Respiratory failure is a condition in which your blood doesn't have enough oxygen or has too much carbon dioxide. Sometimes you can have both problems.
When you breathe, your lungs take in oxygen. The oxygen passes into your blood, which carries it to your organs. Your organs, such as your heart and brain, need this oxygen-rich blood to work well.
Another part of breathing is removing the carbon dioxide from the blood and breathing it out. Having too much carbon dioxide in your blood can harm your organs.
Signs and Symptoms
An injury to your chest or ribs
A drug or alcohol overdose, which can harm your brain and breathing
Lung damage from breathing in fumes or smoke
Lung disease or infection, like chronic obstructive pulmonary disease (COPD), cystic fibrosis, or pneumonia
Muscle and nerve damage from conditions like amyotrophic lateral sclerosis (ALS), spinal cord injuries, and stroke
Scoliosis or other spine problems, which can affect bones and muscles involved in breathing
Blocked blood flow to your lung, like with a blood clot
Causes
Disorders of the spine, such as scoliosis
Inhalation injuries, such as inhaling smoke from fires or fumes
Lung-related conditions, such as acute respiratory distress syndrome (ARDS), cystic fibrosis, chronic obstructive pulmonary disease (COPD), pneumonia, or a pulmonary embolism
Nerve or muscle conditions that affect a person's ability to breathe, such as ALS, muscular dystrophy, spinal cord injuries, or stroke
Pericarditis is swelling and irritation of the pericardium, the thin sac-like membrane surrounding your heart. Pericarditis often causes chest pain and sometimes other symptoms. The sharp chest pain associated with pericarditis occurs when the irritated layers of the pericardium rub against each other. Pericarditis usually begins suddenly but doesn't last long (acute). When symptoms develop more gradually or persist, pericarditis is considered chronic. Most cases are mild and usually improve on their own. Treatment for more-severe cases may include medications and, rarely, surgery. Early diagnosis and treatment may help to reduce the risk of long-term complications from pericarditis.
Signs and Symptoms
Acute pericarditis usually lasts less than a few weeks. Chronic recurrent pericarditis has two types, including the incessant type which occurs within six weeks of weaning medical treatment for an acute episode, and the intermittent type which occurs after six weeks.
If you have acute pericarditis, the most common symptom is sharp, stabbing chest pain behind the breastbone or in the left side of your chest. However, some people with acute pericarditis describe their chest pain as dull, achy or pressure-like instead, and of varying intensity.
The pain of acute pericarditis may travel into your left shoulder and neck. It often intensifies when you cough, lie down or inhale deeply. Sitting up and leaning forward can often ease the pain. At times, it may be difficult to distinguish pericardial pain from the pain that occurs with a heart attack.
Chronic pericarditis is usually associated with chronic inflammation and may result in fluid around the heart (pericardial effusion). The most common symptom of chronic pericarditis is chest pain.
Depending on the type, signs and symptoms of pericarditis may include some or all of the following:
Sharp, piercing chest pain over the center or left side of the chest
Shortness of breath when reclining
Heart palpitations
Low-grade fever
An overall sense of weakness, fatigue or feeling sick
Cough
Abdominal or leg swelling
Causes
Under normal circumstances, the two-layered pericardial sac that surrounds your heart contains a small amount of lubricating fluid. In pericarditis, the sac becomes inflamed and the resulting friction from the inflamed sac leads to chest pain.
The cause of pericarditis is often hard to determine. In most cases, doctors either are unable to determine a cause (idiopathic) or suspect a viral infection.
Pericarditis can also develop shortly after a major heart attack, due to the irritation of the underlying damaged heart muscle. In addition, a delayed form of pericarditis may occur weeks after a heart attack or heart surgery. This delayed pericarditis is known as Dressler's syndrome. Many experts believe Dressler's syndrome is due to a mistaken inflammatory response by the body to its own tissues (autoimmune response) — in this case, the heart and pericardium.
Other causes of pericarditis include:
Systemic inflammatory disorders. These may include lupus and rheumatoid arthritis.
Trauma. Injury to your heart or chest may occur as a result of a motor vehicle or other accident.
Other health disorders. These may include kidney failure, AIDS, tuberculosis and cancer.
Certain medications. Some medications can cause pericarditis, although this is unusual.
Complications
Constrictive pericarditis. Although uncommon, some people with pericarditis, particularly those with long-term inflammation and chronic recurrences, can develop permanent thickening, scarring and contraction of the pericardium.
In these people, the pericardium loses much of its elasticity and resembles a rigid case that's tight around the heart, which keeps the heart from working properly. This condition is called constrictive pericarditis and often leads to severe swelling of the legs and abdomen, as well as shortness of breath.
Diagnosis
Electrocardiogram (ECG)
Chest X-ray
Computerized tomography (CT)
Cardiac magnetic resonance imaging (MRI)
Treatment
Severe cases may require one or more of the following:
pericardiocentesis to treat pericardial effusion/tamponade
antibiotics to treat tuberculosis or other bacterial causes.
steroids are used in acute pericarditis but are not favored because they increase the chance of recurrent pericarditis.
in rare cases, surgery
in cases of constrictive pericarditis, pericardiectomy
Myocardial infarction (MI) or acute myocardial infarction (AMI), commonly known as a heart attack, occurs when blood flow stops to a part of the heart causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw. Often it is in the center or left side of the chest and lasts for more than a few minutes. The discomfort may occasionally feel like heartburn. Other symptoms may include shortness of breath, nausea, feeling faint, a cold sweat, or feeling tired. About 30% of people have atypical symptoms, with women more likely than men to present atypically. Among those over 75 years old, about 5% have had an MI with little or no history of symptoms. An MI may cause heart failure, an irregular heartbeat, or cardiac arrest.
Signs and Symptoms
While the classic symptoms of a heart attack are chest pain and shortness of breath, the symptoms can be quite varied. The most common symptoms of a heart attack include:
pressure or tightness in the chest
pain in the chest, back, jaw, and other areas of the upper body that lasts more than a few minutes or that goes away and comes back
shortness of breath
sweating
nausea
vomiting
anxiety
a cough
dizziness
a fast heart rate
It’s important to note that not all people who have heart attacks experience the same symptoms or the same severity of symptoms. Chest pain is the most commonly reported symptom among both women and men. However, women are more likely than men to have:
shortness of breath
jaw pain
upper back pain
lightheadedness
nausea
vomiting
Causes
Atherosclerosis
Coronary occlusion secondary to vasculitis
Ventricular hypertrophy (eg, left ventricular hypertrophy, hypertrophic cardiomyopathy)
Coronary artery emboli, secondary to cholesterol, air, or the products of sepsis
Coronary trauma
Primary coronary vasospasm (variant angina)
Drug use (eg, cocaine, amphetamines, ephedrine)
Arteritis
Coronary anomalies, including aneurysms of coronary arteries
Factors that increase oxygen requirement, such as heavy exertion, fever, or hyperthyroidism
Factors that decrease oxygen delivery, such as hypoxemia of severe anemia
Aortic dissection, with retrograde involvement of the coronary arteries
Risk Factors
High Blood Pressure
You’re at greater risk for heart attack if you have high blood pressure. Normal blood pressure is below 120/80 mm Hg (millimeters of mercury) depending on your age. As the numbers increase, so does your risk of developing heart problems. Having high blood pressure damages your arteries and accelerates the buildup of plaque.
High Cholesterol Levels
Having high levels of cholesterol in your blood puts you at risk for acute myocardial infarction. You may be able to lower your cholesterol by making changes to your diet or by taking certain medications called statins.
High Triglyceride Levels
High triglyceride levels also increase your risk for having a heart attack. Triglycerides are a type of fat that clog up your arteries. Triglycerides from the food you eat travel through your blood until they’re stored in your body, typically in your fat cells. However, some triglycerides may remain in your arteries and contribute to the buildup of plaque.
Diabetes and High Blood Sugar Levels
Diabetes is a condition that causes blood sugar, or glucose, levels to rise. High blood sugar levels can damage blood vessels and eventually lead to coronary artery disease. This is a serious health condition that can trigger heart attacks in some people.
Obesity
Your chances of having a heart attack are higher if you’re very overweight. Obesity is associated with various conditions that increase the risk of heart attack, including:
diabetes
high blood pressure
high cholesterol levels
high triglyceride levels
Smoking
Smoking tobacco products increases your risk for heart attack. It may also lead to other cardiovascular conditions and diseases.
Age
The risk of having a heart attack increases with age. Men are at a higher risk of a heart attack after age 45, and women are at a higher risk of a heart attack after age 55.
Family History
You’re more likely to have a heart attack if you have a family history of early heart disease. Your risk is especially high if you have male family members who developed heart disease before age 55 or if you have female family members who developed heart disease before age 65.
Other factors that can increase your risk for heart attack include:
stress
a lack of exercise
the use of certain illegal drugs, including cocaine and amphetamines
a history of preeclampsia, or high blood pressure during pregnancy
Diagnosis
A combination of the following
Chest pain
ECG reveals ST segment elevation, ischemia
Elevated Troponins
Stress Test
Cardiac catheterization
Echocardiogram
Treatment
Blood thinners, such as aspirin, are often used to break up blood clots and improve blood flow through narrowed arteries.
Thrombolytics are often used to dissolve clots.
Antiplatelet drugs, such as clopidogrel, can be used to prevent new clots from forming and existing clots from growing.
Nitroglycerin can be used to widen your blood vessels.
Beta-blockers lower your blood pressure and relax your heart muscle. This can help limit the severity of damage to your heart.
ACE inhibitors can also be used to lower blood pressure and decrease stress on the heart.
Pain relievers may be used to reduce any discomfort you may feel.
Acute renal failure occurs when your kidneys suddenly lose the ability to eliminate excess salts, fluids, and waste materials from the blood. This elimination is the core of your kidney's main function. Body fluids can rise to dangerous levels when the kidneys lose their filtering ability. The condition will also cause electrolyte and waste material to accumulate in your body, which can also be life-threatening.
Acute renal failure is also known as acute kidney injury or acute kidney failure. It's most common for people who are already in the hospital. It may develop rapidly over a few hours. It can also develop over a few days to weeks. People who are critically ill and need intensive care have the highest risk of developing acute kidney failure.
Signs and Symptoms
Bloody stools, breath odor
Slow, sluggish movements
Generalized swelling or fluid retention
Fatigue, hand tremor
Pain between ribs or hips
Bruising easily, Nausea, Vomiting
Mental status change
Seizures, HTN
A metallic taste in your mouth
Causes
Acute renal failure can occur for many reasons. Among the most common reasons are:
Acute tubular necrosis
Severe or sudden dehydration
Toxic kidney injury from poisons or certain medications
Autoimmune kidney diseases, such as acute nephritic syndrome and interstitial nephritis
Urinary tract obstruction
Reduced blood flow can damage your kidneys. The following conditions can lead to decreased blood flow to your kidneys:
Low blood pressure
Burns
Dehydration
Hemorrhage
Injury
Septic shock
Serious illness
Surgery
Certain disorders can cause clotting within your kidney's blood vessels, and this can lead to acute kidney failure. These conditions include:
Hemolytic uremic syndrome
Idiopathic thrombocytopenia purpura
Malignant hypertension
Transfusion reaction
Scleroderma
Risk Factors
The chances of acquiring acute renal failure are greater if you're an older person or if you have any of the following long-term health problems:
Kidney disease
Liver disease
Diabetes
Hypertension
Heart failure
Morbid obesity
Complications
Potential complications of acute kidney failure include:
Fluid buildup
Chest pain
Muscle weakness
Permanent kidney damage
Death
Treatment
IV fluids
Treat the electrolyte imbalances such as hyperkalemia, hypocalcemia
Acute respiratory distress syndrome (ARDS), previously known as respiratory distress syndrome (RDS), adult respiratory distress syndrome, or shock lung, is a medical condition occurring in critically ill patients characterized by widespread inflammation in the lungs. ARDS is not a particular disease, rather it is a clinical phenotype which may be triggered by various pathologies such as trauma, pneumonia and sepsis.
The hallmark of ARDS is diffuse injury to cells which form the alveolar barrier, surfactant dysfunction, activation of the innate immune response, and abnormal coagulation. In effect, ARDS results in impaired gas exchange within the lungs at the level of the microscopic alveoli.
The syndrome is associated with a high mortality rate between 20 and 50%.The mortality rate with ARDS varies widely based on severity, the patient's age, and the presence of other underlying medical conditions.
Although the terminology of "adult respiratory distress syndrome" has at times been used to differentiate ARDS from "infant respiratory distress syndrome" in neonates, international consensus is that "acute respiratory distress syndrome" is the best moniker because ARDS can affect those of all ages.
Signs and Symptoms
The signs and symptoms of ARDS often begin within two hours of an inciting event, but can occur after 1–3 days. Signs and symptoms may include:
Severe shortness of breath
Labored and unusually rapid breathing
Low blood pressure
Confusion and extreme tiredness
Causes
The mechanical cause of ARDS is fluid leaked from the smallest blood vessels in the lungs into the tiny air sacs where blood is oxygenated. Normally, a protective membrane keeps this fluid in the vessels. Severe illness or injury, however, can cause inflammation that undermines the membrane's integrity, leading to the fluid leakage of ARDS.
The most common underlying causes of ARDS include
Sepsis
Inhalation of harmful substances
Severe pneumonia
Head, chest or other major injury
Trauma, lung contusion
Multiple blood transfusions
Risk Factors
Most people who develop ARDS are already hospitalized for another condition, and many are critically ill. You're especially at risk if you have a widespread infection in your bloodstream (sepsis).
People who have a history of chronic alcoholism are at higher risk of developing ARDS. They're also more likely to die of ARDS.
Complications
ARDS is extremely serious, but thanks to improved treatments, more people are surviving it. However, many survivors end up with potentially serious — and sometimes lasting — complications, including:
Scarring in the lungs (pulmonary fibrosis). Scarring and thickening of the tissue between the air sacs can occur within a few weeks of the onset of ARDS. This stiffens your lungs, making it even more difficult for oxygen to flow from the air sacs into your bloodstream.
Collapsed lung (pneumothorax). In most ARDS cases, a breathing machine called a ventilator is used to increase oxygen in the body and force fluid out of the lungs. However, the pressure and air volume of the ventilator can force gas to go through a small hole in the very outside of a lung and cause that lung to collapse.
Blood clots. Lying still in the hospital while you're on a ventilator can increase your risk of developing blood clots, particularly in the deep veins in your legs. If a clot forms in your leg, a portion of it can break off and travel to one or both of your lungs (pulmonary embolism) — where it blocks blood flow.
Infections. Because the ventilator is attached directly to a tube inserted in your windpipe, this makes it much easier for germs to infect and further injure your lungs.
Abnormal lung function. Many people with ARDS recover most of their lung function within several months to two years, but others may have breathing problems for the rest of their lives. Even people who do will usually have shortness of breath and fatigue and may need supplemental oxygen at home for a few months.
Memory, cognitive and emotional problems. Sedatives and low levels of oxygen in the blood can lead to memory loss and cognitive problems after ARDS. In some cases, the effects may lessen over time, but in others, the damage may be permanent. Most ARDS survivors also report going through a period of depression, which is treatable.
Diagnosis
There's no specific test to identify ARDS. The diagnosis is based on the physical exam, chest X-ray and oxygen levels and by ruling out other diseases and conditions — for example, certain heart problems — that can produce similar symptoms.
A pneumothorax is an abnormal collection of air or gas in the pleural space that causes an uncoupling of the lung from the chest wall. Like pleural effusion (liquid buildup in that space), pneumothorax may interfere with normal breathing. It is often called collapsed lung, although that term may also refer to atelectasis. One or both lungs may be affected.
A primary pneumothorax is one that occurs spontaneously without an apparent cause and in the absence of significant lung disease, while a secondary pneumothorax occurs in the presence of existing lung pathology. Pneumothoraces can be caused by physical trauma to the chest (including blast injury), or as a complication of medical or surgical intervention; in this case it is referred to as a traumatic pneumothorax. In a minority of cases of both spontaneous or traumatic pneumothorax, the amount of air in the chest increases markedly when a one-way valve is formed by an area of damaged tissue, leading to a tension pneumothorax. This condition is a medical emergency that can cause steadily worsening oxygen shortage and low blood pressure. Unless reversed by effective treatment, these sequelae can progress and cause death.
Signs and Symptoms
Chest pain
Shortness of breath
Decreased or absent breast sounds on the affected side
Agitation
Tachycardia
Causes
A pneumothorax can be caused by:
Chest injury. Any blunt or penetrating injury to your chest can cause lung collapse. Some injuries may happen during physical assaults or car crashes, while others may inadvertently occur during medical procedures that involve the insertion of a needle into the chest.
Lung disease. Damaged lung tissue is more likely to collapse. Lung damage can be caused by many types of underlying diseases, including chronic obstructive pulmonary disease (COPD), cystic fibrosis and pneumonia.
Ruptured air blisters. Small air blisters (blebs) can develop on the top of your lung. These blebs sometimes burst — allowing air to leak into the space that surrounds the lungs.
Mechanical ventilation. A severe type of pneumothorax can occur in people who need mechanical assistance to breathe. The ventilator can create an imbalance of air pressure within the chest. The lung may collapse completely.
Risk Factors
Risk factors for a pneumothorax include:
Sex. In general, men are far more likely to have a pneumothorax than are women.
Smoking. The risk increases with the length of time and the number of cigarettes smoked, even without emphysema.
Age. The type of pneumothorax caused by ruptured air blisters is most likely to occur in people between 20 and 40 years old, especially if the person is a very tall and underweight.
Genetics. Certain types of pneumothorax appear to run in families.
Lung disease. Having an underlying lung disease — especially chronic obstructive pulmonary disease (COPD) — makes a collapsed lung more likely.
Mechanical ventilation. People who need mechanical ventilation to assist their breathing are at higher risk of pneumothorax.
Previous pneumothorax. Anyone who has had one pneumothorax is at increased risk of another, usually within one to two years of the first.
Diagnosis
A pneumothorax is diagnosed by a combination of signs and symptoms, chest X-ray, and CT scan of the chest
Cardiac tamponade, also known as pericardial tamponade, is a type of pericardial effusion in which fluid, pus, blood, clots, or gas accumulates in the pericardium (the sac in which the heart is enclosed), resulting in slow or rapid compression of the heart.
Cardiac tamponade is pressure on the heart muscle which occurs when the pericardial space fills up with fluid faster than the pericardial sac can stretch. If the amount of fluid increases slowly (such as in hypothyroidism) the pericardial sac can expand to contain a liter or more of fluid prior to tamponade occurring. If the fluid effusion occurs rapidly (as may occur after trauma or myocardial rupture) as little as 100 mL can cause tamponade.
Myocardial rupture is a somewhat uncommon cause of pericardial tamponade. It typically happens in the subacute setting after a heart attack, in which the infarcted muscle of the heart thins out and tears. Myocardial rupture is more likely to happen in elderly individuals without any previous cardiac history who suffer from their first heart attack and are not revascularized either with thrombolytic therapy or with percutaneous coronary intervention or with coronary artery bypass graft surgery.
One of the most common settings for cardiac tamponade is in the first 24 to 48 hours after heart surgery. After heart surgery, chest tubes are placed to drain blood. These chest tubes, however, are prone to clot formation. When a chest tube becomes occluded or clogged, the blood that should be drained can accumulate around the heart, leading to tamponade. Nurses will frequently clear clots from the tubes, but even with these efforts chest tubes can become clogged.
Signs and Symptoms
anxiety and restlessness
low blood pressure
weakness
chest pain radiating to your neck, shoulders, or back
trouble breathing or taking deep breaths
rapid breathing
discomfort that’s relieved by sitting or leaning forward
fainting, dizziness, and loss of consciousness
Causes
gunshot or stab wounds
blunt trauma to the chest from a car or industrial accident
accidental perforation after cardiac catheterization, angiography, or insertion of a pacemaker
punctures made during placement of a central line, which is a type of catheter that administers fluids or medications
cancer that has spread to the pericardial sac, such as breast or lung cancer
a ruptured aortic aneurysm
pericarditis, an inflammation of the pericardium
lupus, an inflammatory disease in which the immune system mistakenly attacks healthy tissues
high levels of radiation to the chest
hypothyroidism, which increases the risk for heart disease
A thoracic aortic aneurysm is an aortic aneurysm that presents primarily in the thorax. A thoracic aortic aneurysm is the "ballooning" of the upper aspect of the aorta, above the diaphragm. Untreated or unrecognized they can be fatal due to dissection or "popping" of the aneurysm leading to nearly instant death. Thoracic aneurysms are less common than an abdominal aortic aneurysm. However, a syphilitic aneurysm is more likely to be a thoracic aortic aneurysm than an abdominal aortic aneurysm.
A thoracic aortic aneurysm may also be called thoracic aneurysm and aortic dissection (TAAD) because an aneurysm can lead to a tear in the artery wall (dissection) that can cause life-threatening bleeding. Small and slow-growing thoracic aortic aneurysms may not ever rupture, but large, fast-growing aneurysms may rupture. Depending on the size and growth rate of your thoracic aortic aneurysm, treatment may vary from watchful waiting to emergency surgery. Ideally, surgery for a thoracic aortic aneurysm can be planned if necessary.
Signs and Symptoms
Thoracic aortic aneurysms often grow slowly and usually without symptoms, making them difficult to detect. Some aneurysms will never rupture. Many start small and stay small, although many expand over time. How quickly an aortic aneurysm may grow is difficult to predict.
As a thoracic aortic aneurysm grows, some people may notice:
Tenderness or pain in the chest
Back pain
Hoarseness
Cough
Shortness of breath
Aneurysms can develop anywhere along the aorta, which runs from your heart through your abdomen. When they occur in the upper part of the aorta, they are called thoracic aortic aneurysms. Aneurysms can occur anywhere in the thoracic aorta, including the ascending aorta near the heart, the aortic arch in the curve of the thoracic aorta and the descending aorta in the lower part of the thoracic aorta.
Aneurysms that form in the lower part of your aorta — called abdominal aortic aneurysms — are more common than thoracic aortic aneurysms. An aneurysm can also occur in between the upper and lower parts of your aorta. This type of aneurysm is called a thoracoabdominal aneurysm.
Causes
Factors that can contribute to an aneurysm's development include:
Hardening of the arteries (atherosclerosis). As plaque builds up on your artery walls, they become less flexible, and the additional pressure can cause them to weaken and bulge. High blood pressure and high cholesterol are risk factors for hardening of the arteries. This is more common in older people.
Genetic conditions. Younger people with an ascending aortic aneurysm often have a genetic cause. People who are born with Marfan syndrome, a genetic condition that affects the connective tissue in the body, are particularly at risk of a thoracic aortic aneurysm. Those with Marfan syndrome may have a weakness in the aortic wall that makes them more susceptible to aneurysm. People with Marfan syndrome often have distinct physical traits, including tall stature, very long arms, a deformed breastbone and eye problems.Besides Marfan syndrome, other related disorders, such as Ehlers-Danlos and Loeys-Dietz syndromes, can contribute to a thoracic aortic aneurysm. Ehlers-Danlos syndrome causes your skin, joints and connective tissue to be fragile and makes your skin stretch easily.
Other medical conditions. Inflammatory conditions, such as giant cell arteritis and Takayasu arteritis, may cause thoracic aortic aneurysms.
Problems with your heart's aortic valve. Sometimes people who have problems with the valve that blood flows through as it leaves your heart (aortic valve) have an increased risk of thoracic aortic aneurysm. This is mainly true for people who were born with a bicuspid aortic valve, meaning the aortic valve has only two leaflets instead of three.
Untreated infection. Though it is a rare cause of thoracic aortic aneurysm, it's possible to develop this condition if you've had an untreated infection, such as syphilis or salmonella.
Traumatic injury. Rarely, some people who are injured in falls or motor vehicle crashes develop thoracic aortic aneurysms.
Risk Factors
Thoracic aortic aneurysm risk factors include:
Age. Thoracic aortic aneurysms occur most often in people age 65 and older.
Tobacco use. Tobacco use is a strong risk factor for the development of an aortic aneurysm.
High blood pressure. Increased blood pressure damages the blood vessels in the body, raising your chances of developing an aneurysm.
Buildup of plaques in your arteries (atherosclerosis). The buildup of fat and other substances that can damage the lining of a blood vessel (atherosclerosis) increases your risk of an aneurysm. This is a more common risk in older people.
Family history. People who have a family history of aortic aneurysm are at increased risk of having one. People who have a family history of aneurysms tend to develop aneurysms at a younger age and are at higher risk of rupture. This is a primary risk factor in younger people.
Marfan syndrome and related disorders. If you have Marfan syndrome or related disorders such as Loeys-Dietz syndrome or Ehlers-Danlos syndrome, you have a significantly higher risk of a thoracic aortic aneurysm.
Diagnosis
Chest X-ray
Echocardiogram
CT scan of chest
Magnetic Resonance Angiography (MRA)
Treatments
The size of the aneurysm, presence and severity of symptoms, and the risk of surgery help determine the treatment approach.
REGULAR MONITORING is standard treatment for smaller aneurysms that do not require surgery. Plan on visiting your vascular surgeon regularly—usually once a year or every 6 months, depending on the size of the aneurysm—for a computed tomography (CT) scan or MRI to check the status and growth of the aneurysm.
CONVENTIONAL SURGERY, a procedure called open thoracic aortic aneurysm repair or TAA, is done under a general anesthetic.
Through an incision along the side of the chest, a vascular surgeon uses special surgical tools to stop blood flow in the aorta above and below the aneurysm.
The section of the aorta with the aneurysm is replaced with an artificial graft.
The graft is sewn in place with fine stitches, and the incision is closed.
Most patients spend some time in the intensive care unit after surgery, and stay in the hospital 7-10 days.
ENDOVASCULAR TREATMENT is sometimes used and represents a less invasive approach. Thoracic aortic endograft repair (TEVAR) treats the aneurysm with a small device placed inside the aorta through a small incision or through puncture in the groin.
