What is a Heart Aneurysm?

A heart aneurysm is a bulge in the wall of the aorta, the main artery that carries blood away from the heart. Healthy artery walls are thick and muscular, but when an area in the artery wall becomes weak, it allows pressure in the artery wall to bulge outward, appearing something like a balloon. This abnormality can be detected by an X-ray, magnetic resonance imaging (MRI), a computed tomography (CT) scan or an echocardiography. Aneurysms are a serious health concern because they can lead to the formation of plaque, which further weakens artery walls, and because of the possibility of blood clots forming, which can cause strokes. Most serious is the chance that an aneurysm might rupture, which can lead to shock, loss of consciousness, heart attack or even death.

Heart aneurysms, also called aortic aneurysms, actually can form either within the abdominal cavity or below the kidneys as well as in the chest area. These aneurysms are created by accumulated plaque inside an artery. Other causes of a heart aneurysm include hardening of the arteries from plaque buildup, high blood pressure, diabetes complications, injury, arterial abnormalities that exist at birth and syphilis. Older people are more likely to develop aneurysms than younger adults.

Abdominal aortic aneurysms (AAA) develop in the length of aorta passing through the abdomen. Symptoms might include back or abdominal pain, nausea and loss of appetite. In nine out of 10 cases of AAA, the aneurysm develops below the kidneys, which is known as infrarenal AAA and poses fewer risks to the patient than its counterpart, suprarenal AAA. Suprarenal AAA occurs above the kidneys and is more serious because it can decrease blood flow to them. It is possible to experience an aneurysm both above and below the kidneys at the same time.

Thoracic aneurysms, which occur in the chest area, are either ascending or descending. An ascending aneurysm forms in the section of the aorta that passes through the chest cavity. It can affect the aortic valve and main arteries to the head and arms. Symptoms vary according to the exact location of the aneurysm but can include shortness of breath, a hoarse voice, dry cough and pulsating pain in the head or chest.

A heart aneurysm in the ascending aorta requires immediate attention, in the form of surgery. Fifty percent of people suffering from this type of heart aneurysm die before reaching the hospital. Those who make it to the operating room face a 50- to 75-percent chance of survival.

Descending aneurysms are located in the chest section of the aorta that leads to the left arm and abdomen. As with ascending aneurysms, symptoms vary depending on the specific site of the weakness. Pain under the left shoulder, left chest or between shoulder blades indicates a descending heart aneurysm.

Doctors prefer to monitor the growth of this type of aneurysm before taking action. Medication might be prescribed to lower blood pressure and alleviate pain. CT or ultrasound checks will be required every six to 12 months. If the weakness becomes enlarged, surgery might be indicated to restore the artery.

A heart aneurysm requiring surgical intervention is repaired by removing the weakened area of the artery and replacing it with a Dacron® graft. This is a serious and lengthy operation. Hemorrhaging and damage to vital organs can occur, threatening a patient's life. Recovery consists of one night in an intensive care unit and five to seven days of routine hospital care.

A less invasive type of treatment for abdominal aortic aneurysms is endovascular repair. With this technique, a surgeon threads a stent graft through the patient's groin to the site of the aneurysm. After it is in place, the graft stops the bleeding and provides a new pathway for the blood to flow. Endovascular repair has proven to lower blood loss, length of recovery time in intensive care, and patient deaths.