An aortic aneurysm is a bulging or dilation of the wall of the aorta, the largest artery in the human body. The aorta starts at the heart, passes through the chest, and ends in the abdomen, carrying oxygen-rich blood from the heart to all other parts of the body.

An aortic aneurysm can develop in the thoracic (chest) or abdominal region and often causes no symptoms or health problems. However, the greatest danger of an aortic aneurysm is rupture, which can lead to severe internal bleeding and become life-threatening within minutes.

If an aneurysm or a rupture is suspected, it’s important to go to the hospital immediately for testing and to begin treatment as advised by a cardiologist or vascular surgeon.

female physician listening to older man's heart

Main symptoms

In most cases, an aortic aneurysm does not cause specific symptoms and is often found incidentally during routine medical exams such as CT scans or when it ruptures.

However, if the aneurysm grows large, it may affect nearby structures like nerves, muscles, or organs, leading to more specific symptoms depending on the part of the aorta involved. These include:

1. Symptoms of thoracic aortic aneurysm

In a thoracic aortic aneurysm, some people may experience:

Severe or intense pain in the chest or upper back, which may radiate to the lower back or abdomen;
Shortness of breath;
Wheezing;
Difficulty breathing or swallowing;
Hoarseness;
Cough.

In rare cases, coughing up blood may occur due to bleeding into the lungs.

2. Symptoms of abdominal aortic aneurysm

Symptoms of an abdominal aortic aneurysm are less common than those of a thoracic aneurysm but can include:

Abdominal or flank pain;
A feeling of the abdomen “pulsating” or “trembling”;
Feeling full after eating only a small amount;
Severe pain in the back or sides;
Pain in the buttocks, groin, or legs.

Other possible symptoms include swelling in the legs, vomiting, or difficulty urinating if the aneurysm compresses the ureter, the tube that carries urine from the kidneys to the bladder.

3. Symptoms of ruptured aortic aneurysm

Symptoms of a ruptured aortic aneurysm include:

Sudden, severe back or abdominal pain;
Sudden, sharp chest pain;
Nausea and vomiting;
Cold, clammy sweating;
Pale and cool skin;
Rapid heartbeat;
Shortness of breath;
Dizziness or lightheadedness;
Confusion;
Fainting.

If signs of an aortic rupture appear, seek emergency medical care immediately. A rupture can cause internal bleeding and hypovolemic shock, both of which are life-threatening emergencies.

Confirming a diagnosis

An aortic aneurysm is diagnosed by a cardiologist or vascular surgeon through imaging tests such as computed tomography (CT), ultrasound, X-ray, or magnetic resonance imaging (MRI). These exams help confirm the diagnosis and identify the type of aneurysm.

If an aneurysm is detected, the doctor will also evaluate the person’s age, medical history, and the aneurysm’s size and development to determine the best treatment approach.

Different types

Aortic aneurysms are classified according to the part of the aorta affected:

Thoracic aortic aneurysm: Occurs in the thoracic section of the aorta (chest area);
Abdominal aortic aneurysm: The most common type, found below the chest area.

The type of aneurysm is determined through imaging exams, and they are often discovered during routine evaluations for other health conditions.

Possible causes

The exact cause of an aortic aneurysm is not fully understood, but it appears to result from a weakening of the aortic wall that leads to dilation. It can develop anywhere along the aorta, in the chest or abdomen.

Several factors may contribute to the development of an aortic aneurysm, including:

Atherosclerosis (plaque buildup in the arteries);
Smoking;
Family or personal history of aortic aneurysm or rupture;
High blood pressure or high cholesterol;
Chronic obstructive pulmonary disease (COPD);
Coronary artery disease;
Syphilis;
HIV infection.

Some genetic conditions, such as Ehlers-Danlos syndrome, Loeys-Dietz syndrome, and Marfan syndrome, also increase the risk.

Other inflammatory or autoimmune conditions, such as arteritis, systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis, or sarcoidosis, can increase the risk as well, especially when they affect the aorta.

The likelihood of developing an aortic aneurysm increases with age and is more common in men over 65.

Treatment options

Treatment for an aortic aneurysm should always be guided by a cardiologist or vascular surgeon. The approach depends on factors such as the aneurysm’s size, location, and severity, as well as the person’s overall health.

The main treatment options include:

1. Medical monitoring

Medical monitoring is recommended when the aneurysm is smaller than 5 cm and no symptoms are present. In these cases, imaging tests are performed every 6 to 12 months to monitor the aneurysm’s progression.

2. Use of medication

Blood pressure-lowering medications, such as beta-blockers or calcium channel blockers, may be prescribed to reduce blood pressure, slow aneurysm growth, and lower the risk of rupture.

Doctors may also recommend cholesterol medicine (such as statins) to treat atherosclerosis and further reduce rupture risk.

3. Surgery

Surgery is usually recommended when the aneurysm is larger than 5 cm, grows rapidly (more than 0.5 cm within six months), or causes symptoms.

The surgery involves removing the affected portion of the aorta and replacing it with a synthetic graft.

Recovery from aortic aneurysm surgery generally takes 2 to 3 months. Normal activities should be resumed gradually after 6 weeks, with medical clearance. During recovery, it’s also important to minimize stress to prevent blood pressure spikes and complications.

Lifestyle changes

Certain lifestyle changes are essential for maintaining cardiovascular health and preventing complications, including:

Taking prescribed medications at the correct times;
Attending regular medical appointments;
Quitting smoking;
Avoiding alcohol consumption;
Engaging in regular physical activity as recommended by a healthcare provider;
Reducing salt and processed food intake;
Eating a balanced diet rich in fruits and vegetables.

These habits help control risk factors and promote long-term heart and vascular health.

Aortic Aneurysm: Symptoms, Diagnosis & Treatment