A Simple Guide to Thoracic Aortic Aneurysm, Diagnosis, Treatment and Related Conditions

By Kenneth Kee

This book describes Thoracic Aortic Aneurysm, Diagnosis and Treatment and Related Diseases

A thoracic aortic aneurysm is a thin weakened area in the wall of a major blood vessel (aorta) that supplies blood to the body.

When the aorta wall is weak, the pressure of the blood pushing against the vessel wall can induce it to bulge like a balloon (aneurysm).

The thoracic aorta comprises:
1. The aortic root,
2. Ascending aorta,
3. Aortic arch, and
4. The descending aorta.

An aneurysm happens when the normal diameter of the artery rises by 50%.

It happens due to the intrinsic weakness of the aortic wall.

Thoracic aortic aneurysms (TAA) seldom manifest with symptoms, and about 95% of the patients have no symptoms.

These aneurysms can produce catastrophic emergencies, such as aortic dissection or rupture, and are termed “silent killers.”

About 22% of persons die before reaching the hospital during an aneurysm complication.

Most aneurysms in the thoracic aorta happen in the root or ascending aorta, followed by descending aorta and rarely happen in the arch.

A thoracic aortic aneurysm is also called a thoracic aneurysm, and aortic dissection can happen due to an aneurysm.

A dissection is a tear in the wall of the aorta that induces life-threatening bleeding or sudden death.

Male gender, older age, hypertension, chronic obstructive pulmonary disease (COPD), coronary artery disease, smoking, and previous aortic dissection are some risk factors of TAA.

The distinctive demarcation in causes for aortic aneurysms is the ligamentum arteriosum.

Above this point, the degenerative functions in the elastic media cause the formation of aneurysms, and below the ligament, atherosclerosis is the main cause.

Thoracic aortic aneurysms normally often grow slowly without symptoms, making them hard to detect.

As a thoracic aortic aneurysm grows, some people may observe:
Tenderness or pain in the chest
Back pain
Hoarseness
Cough
Shortness of breath

If an aneurysm ruptures or one or more layers of the artery wall starts to tear, the patient may feel:
Sharp, sudden pain in the upper back that radiates downward
Pain in the chest, jaw, neck or arms
Difficulty breathing

A contrast-enhanced CT scan is the most often used imaging technique to diagnose thoracic aortic aneurysms.

Genetic testing can now be used to assess for thoracic aortic aneurysm.

The purpose of treatment is to prevent the aneurysm from growing and to treat it before it dissects or ruptures.

Depending on the size and growth rate of the thoracic aortic aneurysm, treatment may vary from watchful waiting (monitoring) to surgery.

Medical treatment aims at reducing stress in the aorta, which in turn prevents the growth of the aneurysm.

Anti-impulse treatment is necessary, and beta-blockers are the first-line medicines as they reduce stress by reducing blood pressure and contractility.

Angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors are advantageous for patients with Marfan syndrome as they decrease TGF-B signaling.

Lipid-lowering agents, mainly statins, are also given as they decrease oxidative stress, rate of rupture, and dissection.

Surgery is normally advised for the treatment of thoracic aortic aneurysms about 1.9 to 2.4 inches (about 5 to 6 centimeters) and larger.

The doctor may advise surgery for smaller aneurysms due to the risk of aortic dissection.

TABLE OF CONTENT
Introduction
Chapter 1 Thoracic Aortic Aneurysm
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis
Chapter 7 Abdominal Aortic Aneurysm
Chapter 8 Cerebral Aneurysm
Epilogue

• Language: English
• Publisher: Kenneth Kee
• Release date: Nov 14, 2021
• ISBN: 9780463345696

Kenneth Kee

Medical doctor since 1972.Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009.Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993.Dr Kenneth Kee is still working as a family doctor at the age of 74However he has reduced his consultation hours to 3 hours in the morning and 2 hours inthe afternoon.He first started writing free blogs on medical disorders seen in the clinic in 2007 on http://kennethkee.blogspot.com.His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiography account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.comThis autobiography account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.From which many free articles from the blog was taken and put together into 1000 eBooks.He apologized for typos and spelling mistakes in his earlier books.He will endeavor to improve the writing in futures.Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical disorders.He has published 1000 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.The purpose of these simple guides is to educate patient on health disorders and not meant as textbooks.He does not do any night duty since 2000 ever since Dr Tan had his second stroke.His clinic is now relocated to the Buona Vista Community Centre.The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.He is now doing some blogging and internet surfing (bulletin boards since the 1980's) startingwith the Apple computer and going to PC.The entire PC is upgraded by himself from XT to the present Pentium duo core.The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.He is also into DIY changing his own toilet cistern and other electric appliance.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"

Book preview

A

Simple

Guide

To

Thoracic Aortic Aneurysm,

Diagnosis,

Treatment

And

Related Conditions

By

Dr Kenneth Kee

M.B.,B.S. (Singapore)

Ph.D (Healthcare Administration)

Copyright Kenneth Kee 2021 Smashwords Edition

Published by Kenneth Kee at Smashwords.com

Dedication

This book is dedicated

To my wife Dorothy

And my children

Carolyn, Grace

And Kelvin

This book describes Thoracic Aortic Aneurysm, Diagnosis and Treatment and Related Diseases which is seen in some of my patients in my Family Clinic.

(What You Need to Treat Thoracic Aortic Aneurysm)

This e-Book is licensed for your personal enjoyment only. This eBook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each reader.

If you’re reading this e-book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy.

Thank you for respecting the hard work of this author.

Introduction

I have been writing medical articles for my blog: http://kennethkee.blogspot.com (A Simple Guide to Medical Disorder) for the benefit of my patients since 2007.

My purpose in writing these simple guides was for the health education of my patients.

Health Education was also my dissertation for my Ph.D (Healthcare Administration).

I then wrote an autobiography account of my journey as a medical student to family doctor on my other blog: http://afamilydoctorstale.blogspot.com.

This autobiography account A Family Doctor’s Tale was combined with my early A Simple Guide to Medical Disorders into a new Wordpress Blog A Family Doctor’s Tale on http://kenkee481.wordpress.com.

From which many free articles from the blog was taken and put together into 800 eBooks.

Some people have complained that the simple guides are too simple.

For their information they are made simple in order to educate the patients.

The later books go into more details of medical disorders.

The first chapter is always from my earlier blogs which unfortunately tends to have typos and spelling mistakes.

Since 2013, I have tried to improve my spelling and writing.

As I tried to bring the patient the latest information about a disorder or illness by reading the latest journals both online and offline, I find that I am learning more and improving on my own medical knowledge in diagnosis and treatment for my patients.

My diagnosis and treatment capability has improved tremendously from my continued education.

Just by writing all these simple guides I find that I have learned a lot from your reviews (good or bad), criticism and advice.

I am sorry for the repetitions in these simple guides as the second chapters onwards have new information as compared to my first chapter taken from my blog.

I also find repetition definitely help me and maybe some readers to remember the facts in the books more easily.

I apologize if these repetitions are irritating to some readers.

Chapter 1

Thoracic aortic aneurysm

(Chapter from A Simple Guide to Thoracic aortic aneurysm 2021 by Kenneth Kee)

What is Thoracic aortic aneurysm?

A thoracic aortic aneurysm is a thin weakened area in the wall of a major blood vessel (aorta) that supplies blood to the body.

When the aorta wall is weak, the pressure of the blood pushing against the vessel wall can induce it to bulge like a balloon (aneurysm).

The thoracic aorta comprises:

1. The aortic root,

2. Ascending aorta,

3. Aortic arch, and

4. The descending aorta.

An aneurysm happens when the normal diameter of the artery rises by 50%.

It happens due to the intrinsic weakness of the aortic wall.

Thoracic aortic aneurysms (TAA) seldom manifest with symptoms, and about 95% of the patients have no symptoms.

These aneurysms can produce catastrophic emergencies, such as aortic dissection or rupture, and are termed silent killers.

About 22% of persons die before reaching the hospital during an aneurysm complication.

Most aneurysms in the thoracic aorta happen in the root or ascending aorta, followed by descending aorta and rarely happen in the arch.

A thoracic aortic aneurysm is also called a thoracic aneurysm, and aortic dissection can happen due to an aneurysm.

A dissection is a tear in the wall of the aorta that induces life-threatening bleeding or sudden death.

Aortic emergencies

In aortic dissection, a tear happens in the wall of the aorta.

This causes bleeding into and along the aortic wall and, in some cases, completely outside the aorta (rupture).

An aortic dissection is a life-threatening emergency, depending on the location in the aorta that it happens.

It is important to treat an aortic aneurysm to try to prevent dissection.

If dissection happens, the patient can still be treated with surgery, but he or she will have a higher risk of complications.

Large, fast-growing aneurysms may rupture but small slow-growing aneurysms may never rupture.

Depending on the cause, size and growth rate of the thoracic aortic aneurysm, treatment may differ from watchful waiting to emergency surgery.

Ideally, surgery can be elective if necessary.

What are the causes of Thoracic aortic aneurysm?

Causes

Male gender, older age, hypertension, chronic obstructive pulmonary disease (COPD), coronary artery disease, smoking, and previous aortic dissection are some risk factors of TAA.

The distinctive demarcation in causes for aortic aneurysms is the ligamentum arteriosum.

Above this point, the degenerative functions in the elastic media cause the formation of aneurysms, and below the ligament, atherosclerosis is the main cause.

This is possibly caused by the dissimilar embryonic derivation of the smooth muscle cells in these two areas.

A family history of thoracic aortic aneurysm is a strong risk factor, since 20% of cases of TAA are a result of genetic disorders.

About 5% of the patients have Marfan syndrome, Loeys-Deitz syndrome, and Ehlers-Danlos syndrome.

About 21% of the patients with a family history are non-syndromic, and these aneurysms are referred to as non-syndromic familial aortic aneurysms and have no extra-aortic manifestations.

Left-sided valvular endocarditis can rarely cause aortic root dilation.

Syphilis was the leading cause of aortic aneurysms before the advent of antibiotics the killed the syphilis bacteria.

Arteritis, (such as Takayasu, Behcet, giant cell, systemic lupus erythematosus, sarcoidosis, rheumatoid arthritis, and ankylosing spondylitis), can affect the aorta in rare cases and lead to an aneurysm.

A bicuspid aortic valve and an isolated sinus of Valsalva aneurysm are also infrequent causes of TAA.

There is a TAA link with an abdominal aortic aneurysm, cerebral aneurysm, renal cysts, and bovine aortic arch.

Incidence

In the USA, about 13000 patients die due to aortic disease each year, and TAA is the 18 most frequent causes of death among all persons.

Thoracic aortic aneurysm has an incidence of 10 patients per 100000 patient years and a prevalence of 0.16 to 0.34%.

The incidence of TAA is rising due to better diagnostic imaging and improved life expectancy in the general population.

Patients with familial TAA have an average age of manifestation at 56.8 years, while patients with TAA due to other causes manifest around 64.3 years.

More men have TAA than women.

More women develop worse medical outcomes and have a higher risk of dissection.

Aortic ulcers, which are abnormal atherosclerotic plaques and intramural hematoma (collection of blood within the aortic wall), are also present in the descending aorta.

These ulcers can result in dissection or rupture.

A mycotic aneurysm can happen due to an infection damaging an area in the aortic wall.

Factors that can add to an aneurysm's development are:

Hardening of the arteries (atherosclerosis)

As plaque accumulates on the artery walls, they become less flexible, and the additional pressure can cause them to weaken and bulge.

Increased blood pressure and high cholesterol are risk factors for hardening of the arteries.

This is more frequent in older people.

Genetic disorders

Aortic aneurysms in younger people often are due to genetic