Aortic Aneurys
An aortic aneurysm is a weak, bulging area in the wall of the aorta. The bulging develops from a weakness or defect in the aortic wall and tends to get bigger with time. The aorta is the body's largest artery. It carries blood from the heart for delivery to the rest of the body. The aorta travels through the chest (thoracic aorta) and the abdomen (abdominal aorta). Abdominal aortic aneurysms are more common than thoracic aortic aneurysms.
The greatest danger is that an aneurysm will rupture. This will cause heavy, uncontrollable bleeding (hemorrhage). Aortic aneurysms can also occur with aortic dissection. Dissection is defined as a small tear in the aortic wall. Blood from the aneurysm can leak through this tear and spread between the layers of the aortic wall, eventually leading to rupture of the vessel.
The greatest danger is that an aneurysm will rupture. This will cause heavy, uncontrollable bleeding (hemorrhage). Aortic aneurysms can also occur with aortic dissection. Dissection is defined as a small tear in the aortic wall. Blood from the aneurysm can leak through this tear and spread between the layers of the aortic wall, eventually leading to rupture of the vessel.
CAUSES
Any condition that causes the walls of the arteries to weaken can lead to an Aneurysm. The following increase the risk of an aneurysm or an aortic dissection:
* Atherosclerosis (a build-up of fatty plaque in the arteries).
* High blood pressure.
* Smoking.
* Deep wounds, injuries, or infections of the blood vessels.
* A congenital abnormality (a condition that you are born with).
* Inherited diseases. An inherited disease such as Marfan syndrome, which affects the body's connective tissue, causes people to have long bones and very flexible joints. People with this syndrome often have aneurysms.
Aneurysms can develop anywhere, but are most common in the aorta, iliac artery, and femoral artery.
RISK FACTORS
* High blood pressure
* Smoking
* Arteriosclerosis, atherosclerosis
* Inherited connective tissue defects ( Marfan syndrome , Ehlers-Danlos syndrome )
* Polyarteritis nodosa
* Bacterial endocarditis
* Syphilis
* Age: 60 or older
* History of heart attack
* Obesity
* Family members with aneurysms, particularly male children of an effected mother
* Infectious aortitis
* Great vessel arteritis (Takayasu’s disease)
* Injury to the aorta, from either a motor vehicle accident or a stab wound.
SYMPTOMS
Many aneurysms do not have symptoms and are detected during a routine physical exam or during x-ray evaluation for another disorder.
Symptoms may occur when the aneurysm grows or disrupts the wall of the aorta. Symptoms depend on the size and location of the aneurysm and may include:
* Pain in the abdomen or in the lower back
* Boring, gnawing, constant pain occurring over hours or days
* Sudden onset of severe stabbing pain
* Unusual sensation of pulsing in the abdomen
* Cough, shortness of breath (thoracic aortic aneurysm)
* Sudden blood pressure drop, fainting (upon rupture of aneurysm)
* Hoarseness
* Difficulty swallowing
* Coughing up blood
* Weight loss
* Bowel obstruction
* Chest pain
DIAGNOSIS
* Abdominal or chest x-ray
* Abdominal or chest ultrasound
* CT scan of the abdomen or chest–a type of x-ray that uses a computer to make images of the inside of the body
* MRI scan of the abdomen or chest–a test that uses magnetic waves to make images of the inside of the body
* Transesophageal echocardiography (ECHO)– the use of ultrasound to study the heart and its vessels; a transducer, which records the information, is swallowed by the patient
* Aortography – the use of x-rays and injection of a contrast dye to make images of the heart and the aorta
* Cardiac catheterization – a tube-like instrument is inserted into the heart through a vein or artery (usually in the arm or leg) to detect problems with the heart and its blood supply.
TREATMENT
Treatment includes surgery or stenting.
SURGERY
Surgery to repair an aortic aneurysm is called ANEURYSMECTOMY. It involves removing the portion of the aorta that contains the aneurysm and replacing it with a mesh graft.
With aneurysms of the thoracic aorta, the aortic valve may also be affected and need to be replaced or repaired. If the aneurysm involves important branches of the aorta, these vessels may either be repaired or bypassed.
When deciding whether to operate, the doctor will consider:
* Age
* General health
* Symptoms
* The size of the aneurysm
* Associated disease ( kidney failure , stroke , etc.)
* If the aneurysm has ruptured or not
* If you've had a recent heart attack
STENTING
Depending on where the aneurysm is located and how complex it is, stenting may be done. A stent-graft is a polyester tube covered by a tubular metal web. The stent-graft is inserted through a small incision in the upper thigh into the aorta. Using x-ray, it is guided through the aorta to the site of the aneurysm. With the stent-graft in place, blood flows through the stent-graft instead of into the aneurysm, eliminating the chance of rupture.
PREVENTION
There are no guidelines for preventing an aneurysm because the cause is not known. However, one can reduce some of the risk factors by following these recommendations:
* Eat a healthful diet, one that is low in saturated fat and rich in whole grains, fruits, and vegetables.
* Don't smoke. If you smoke, quit.
* Maintain a healthful weight.
* Begin a safe exercise program as recommended by your doctor.
* Seek treatment for high blood pressure, syphilis, and other infections.
* If you have Marfan syndrome, see your doctor regularly for monitoring and CT scans.
TREATMENT
One type of Aortic Dissection requires immediate major surgery. Another type can often be managed without surgery (if no blood vessels are obstructed). It depends on where in the aorta the dissection occurs. Treatment options include the following:
SURGERY
The chest is opened, and the aorta is repaired. A length of Dacron (called a Stent) may be used to replace the damaged segment of aorta. This is as major as surgery gets.
MEDICAL TREATMENT
THe blood pressure will be reduced to minimize stress on the aorta. One may undergo repeat imaging studies every 6-12 months to detect further dissection.
PREVENTION
* Follow and control blood pressure
* Ask the doctor to check if you have any of the risk factors for aortic dissection
* Keep hyperlipidemia under control through diet and/or medications.
Deep Vein Thrombosis (DVT)
Deep Vein Thrombosis is a condition in which a blood clot (thrombus) forms in one or more of the deep veins in the body, usually in the legs.
Deep Vein Thrombosis is a serious condition because a blood clot that has formed in the vein can break loose and travel to the lungs. This is called Pulmonary (lung) Embolism.
CAUSES
Several factors contribute to clot formation, including:
* Slow blood flow, often due to lying or sitting still for an extended period of time
* Pooling of blood in a vein, often due to:
a)Immobility
b)Medical conditions
c)Damage to valves in a vein or pressure on the valves, such as during pregnancy
* Injury to a blood vessel
* Clotting problems (can occur due to aging or disease)
* Catheters placed in a vein
RISK FACTORS
* Not moving the body.Sitting for long periods of time, such as when driving or flying.
* Hospitalization
* Surgery, especially involving bones or joints
* Medical conditions such as:
a)Varicose veins
b)Cancer
c)Heart failure
d)Heart attack
e)Inflammatory bowel disease
f)Blood disorders
* Obesity
* History of deep vein thrombosis
* Taking birth control pills or estrogen therapy
* Pregnancy
SYMPTOMS
Symptoms occur when:
* The clot interferes with blood flow in the vein
* Local inflammation occurs
* A clot breaks free and travels to the lungs
Some patients may not experience any symptoms until the clot moves to the lungs, a condition called Pulmonary Embolism.
Symptoms of Deep Vein Thrombosis may include:
* Pain
* Swelling of a limb
* Tenderness along the vein
* Warmth
* Redness, paleness, or blueness of the skin of the affected limb.
DIAGNOSIS
Tests may include:
DUPLEX VENOUS ULTRASOUND – a test that uses sound waves to detect changes in blood flow.
VENOGRAPHY – X-rays taken after dye is injected into a small vein to show areas of normal and abnormal blood flow.
IMPEDANCE PLETHYSMOGRAPHY – measures changes in blood volume in the veins as a blood pressure cuff wrapped around the thigh is inflated and deflated.
TREATMENT OF DEEP VEIN THROMBOSIS
Treatment aims to:
* Prevent Pulmonary Embolism
* Stop the clot from growing
* Dissolve the clot (sometimes)
Treatments include:
SUPPORTIVE CARE
This may include:
* Resting in bed
* Elevating the affected limb above the heart
* Wearing compression stockings as recommended by the doctor.
MEDICATIONS
Anticoagulant drugs to prevent additional clot formation include:
* Heparin injection – fast-acting drug that prevents more clot formation (given for several days)
* Warfarin (taken by mouth) – slowly prevents more clot formation (usually given for several months)
* Fibrinolytic enzymes – helps to dissolve a major clot. These include:
a)Streptokinase
b)Urokinase
c)TPA
SURGERY
In certain situations, doctors may place a filter in the inferior vena cava, a major vein returning blood from the lower body to the heart. The filter may trap any clots that break loose and travel toward the lungs.
PREVENTION
General prevention measures include:
* Not sitting for long periods, such as in a car or airplane or at a computer (Get up frequently and move around.)
* Not smoking
If you are admitted to the hospital, talk to your doctor about how to prevent blood clots, such as:
* Getting out of bed and walking as soon as possible during your recovery
* If you are restricted to bed:
- Doing range of motion exercises in bed
- Changing your position at least every two hours
* Wearing compression stockings, which promotes venous blood flow.
* Taking anticoagulant medication if advised by your doctor.
* Using a pneumatic compression device (a device that uses air to compress your legs and help improve venous blood flow).
Source:www.h4heart.com
Deep Vein Thrombosis is a condition in which a blood clot (thrombus) forms in one or more of the deep veins in the body, usually in the legs.
Deep Vein Thrombosis is a serious condition because a blood clot that has formed in the vein can break loose and travel to the lungs. This is called Pulmonary (lung) Embolism.
CAUSES
Several factors contribute to clot formation, including:
* Slow blood flow, often due to lying or sitting still for an extended period of time
* Pooling of blood in a vein, often due to:
a)Immobility
b)Medical conditions
c)Damage to valves in a vein or pressure on the valves, such as during pregnancy
* Injury to a blood vessel
* Clotting problems (can occur due to aging or disease)
* Catheters placed in a vein
RISK FACTORS
* Not moving the body.Sitting for long periods of time, such as when driving or flying.
* Hospitalization
* Surgery, especially involving bones or joints
* Medical conditions such as:
a)Varicose veins
b)Cancer
c)Heart failure
d)Heart attack
e)Inflammatory bowel disease
f)Blood disorders
* Obesity
* History of deep vein thrombosis
* Taking birth control pills or estrogen therapy
* Pregnancy
SYMPTOMS
Symptoms occur when:
* The clot interferes with blood flow in the vein
* Local inflammation occurs
* A clot breaks free and travels to the lungs
Some patients may not experience any symptoms until the clot moves to the lungs, a condition called Pulmonary Embolism.
Symptoms of Deep Vein Thrombosis may include:
* Pain
* Swelling of a limb
* Tenderness along the vein
* Warmth
* Redness, paleness, or blueness of the skin of the affected limb.
DIAGNOSIS
Tests may include:
DUPLEX VENOUS ULTRASOUND – a test that uses sound waves to detect changes in blood flow.
VENOGRAPHY – X-rays taken after dye is injected into a small vein to show areas of normal and abnormal blood flow.
IMPEDANCE PLETHYSMOGRAPHY – measures changes in blood volume in the veins as a blood pressure cuff wrapped around the thigh is inflated and deflated.
TREATMENT OF DEEP VEIN THROMBOSIS
Treatment aims to:
* Prevent Pulmonary Embolism
* Stop the clot from growing
* Dissolve the clot (sometimes)
Treatments include:
SUPPORTIVE CARE
This may include:
* Resting in bed
* Elevating the affected limb above the heart
* Wearing compression stockings as recommended by the doctor.
MEDICATIONS
Anticoagulant drugs to prevent additional clot formation include:
* Heparin injection – fast-acting drug that prevents more clot formation (given for several days)
* Warfarin (taken by mouth) – slowly prevents more clot formation (usually given for several months)
* Fibrinolytic enzymes – helps to dissolve a major clot. These include:
a)Streptokinase
b)Urokinase
c)TPA
SURGERY
In certain situations, doctors may place a filter in the inferior vena cava, a major vein returning blood from the lower body to the heart. The filter may trap any clots that break loose and travel toward the lungs.
PREVENTION
General prevention measures include:
* Not sitting for long periods, such as in a car or airplane or at a computer (Get up frequently and move around.)
* Not smoking
If you are admitted to the hospital, talk to your doctor about how to prevent blood clots, such as:
* Getting out of bed and walking as soon as possible during your recovery
* If you are restricted to bed:
- Doing range of motion exercises in bed
- Changing your position at least every two hours
* Wearing compression stockings, which promotes venous blood flow.
* Taking anticoagulant medication if advised by your doctor.
* Using a pneumatic compression device (a device that uses air to compress your legs and help improve venous blood flow).
Source:www.h4heart.com
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