Aortic aneurysm: Deadlier than a heart attack

“You can better afford having a heart attack than a ruptured aneurysm, because if you suffer from a ruptured aneurysm you are unlikely to get a second chance,” said Dr. Timothy Dy.

There's a deadly vascular disease that can cause death within minutes. And an estimated 200,000 Filipinos are oblivious to the fact that they have the condition.

People are familiar with, and normally fear, heart attacks, but less is known of the silent killer called aortic aneurysm, the third leading cause of sudden death.

Because it's usually asymptomatic, aortic aneurysm develops slowly and quietly over many years. Once it strikes, only 50 per cent make it to the hospital alive, and only half of those who do survive their operation.

Early detection and intervention could have prevented these deaths. This was revealed during the awareness symposium hosted by the Aortic Endovascular Unit, Heart Institute of the Chinese General Hospital and Medical Center (CGHMC) in Manila.

Aortic aneurysm occurs when the aorta wall deteriorates and weakens, causing the artery to dilate (balloon) until it ruptures. The aorta is the largest artery in the body where most of the blood is contained. Aneurysms occur in the arteries, where the oxygenated blood from the heart is transported to supply the body's organs.

Very rarely do they occur in the veins, the blood vessel responsible for carrying the used, deoxygenated blood back to the heart.

"Ruptured aortic aneurysm has a higher mortality rate than heart attacks. Seventy-five to 80 per cent with ruptured aortic aneurysm die compared to 10 to 20 per cent of people coming in with heart attacks," said Dr. Timothy Dy, an interventional cardiologist at the CGHMC.

Pressure in the arteries is 120 millimeter of mercury (mm Hg), compared 5-10 mm Hg in the veins. The body contains about 5 liters of blood. When the aneurysm ruptures, the high pressure in the arteries is enough to cause massive internal hemorrhage that people die within minutes.

Think of aneurysm like the high-pressure pipes in your house, said interventional cardiologist Dr. Melissa Co-Sia. When all that suppressed high pressure suddenly bursts, the water supply for the entire household will be aborted.

"That is why this is so deadly. The rest of the body is no longer supplied with blood. Mortality is high, around 82 per cent do not survive it, because of the sudden loss of blood. Naubos ang dugo. Second chances are rare," Sia said.

Two kinds

There are two kinds of aortic aneurysm: Thoracic Aortic Aneurysm (TAA), which occurs in the aorta close to the heart; and Abdominal Aortic Aneurysm (AAA), or one that occurs in the abdominal area.

Conditions that cause TAA include aging, or the inevitable deterioration of the body along with the aorta; development of cholesterol deposits in the blood vessels; chronic hypertension, where high tension in the wall of the arteries destroys the

integrity of the arteries; chest injury from accidents that can tear or rupture the aorta; and genetic predisposition.

A simple change in lifestyle, such as adopting a diet and a set of activities that can control blood pressure, can help prevent the disease from developing or progressing.

"Aneurysm can develop in any part of the body. Any organ with an artery can develop an aneurysm," said Dr. Nelson Lee, thoracic and cardiovascular surgeon.

Symptoms

Although TAA is usually asymptomatic, if symptoms do manifest they include: hoarse voice, since it affects the nerves responsible for the voice; difficulty swallowing; pain in the chest, the hallmark of the disease; and severe chest or back pain.

People at risk for TAA are those 50 years and above. Actor/comedian John Ritter was only 54 when he died from a ruptured TAA.

Smokers are at high risk, as well as those with a family history of aneurysm. Men are also more predisposed to the disease compared to women, Lee said, since hypertension and heavy smoking are more common among men.

Screening, such as CT scan, chest X-ray, 2D echo or MRI, should ideally start at 50, he said. But since the disease today strikes people even in their 30s and 40s, Lee said it would be best to start a few years earlier.

AAA, on the other hand, is the dilation of the aorta in the abdomen area. This caused the death of physicist Albert Einstein.

As it turns out, smoking is deadlier than you think. People normally associate smoking with lung problems or cancer, but it also affects the blood vessels starting from the head all the way to the toes, Sia said.

"Smoking increases the chances of abdominal aneurysm," said Sia.

You can look okay on the outside, but inside you are falling apart," said Dr. Melissa Co-Sia Also at risk of developing AAA are those with heart diseases, high blood pressure, history of abdominal aneurysm, blood vessel disease, blockage in the arteries that can also cause weakening of the arteries.

The incidence of AAA is more common than TAA. The overall mortality rate of a ruptured AAA is 90 per cent. Screening, such as ultrasound and CT scan, is recommended for early detection.

Dy said repairing the aorta is like patching up a hole in the water hose. There is no guarantee the water hose will not develop new holes in the future. If an aneurysm has already occurred, there is a chance other parts of the aorta have also been compromised and weakened.

The American comedienne Lucille Ball, for instance, survived TAA but eventually succumbed to AAA years later.

Traditionally, an aortic aneurysm is repaired via open-heart surgery. A new technology, however, called Endovascular Aneurysm Repair (Evar) for AAA and Thoracic Endovascular Aneurysm Repair (Tevar), involves repairing the aorta from the inside by creating a 2-centimeter incision in the groin area, and inserting a catheter and guide wire to deploy a stent graft made of space-age material.

This creates a "bridge" or pathway in the damaged area where blood can travel once more. The cost of such procedure ranges from P800,000 (S$23,880) to over P1 million.

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