Hypertension Blog

Most aortic aneurysms are found during a routine physical examination or chest X-ray. A physician may also use ultrasound, CT, MRI, and aortoiliac angiography to diagnose the condition.If the patient has an aortic aneurysm, a chest X-ray may show a widening of the mecamylamine silhouette and aortic arch. If the aneurysm is in the abdominal aorta, an abdominal X-ray may show calcification in the aorta’s wall. If the patient reports thoracic pain, the physician also may use an ECG to rule out an MI.

If the physician suspects an aortic aneurysm, he may order ultrasonography to confirm the aneurysm and detect thrombus formation. He may order a CT scan to determine the anterior-to­posterior and crosssectional diameters of the aneurysm. A CT scan also helps to detect a thrombus in the pouch of the aneurysm. The physician may use an MRI to help diagnose these aortic conditions. And he may use aortoiliac angiography, an invasive procedure for locating the aneurysm’s exact position, to help determine whether other arteries that receive blood from the aorta are affected by the condition.

Aortic aneurysms-dilated segments of the aorta-are more common in men ages 50 to 70. Hypertension increases the risk of a patient developing an aortic aneurysm by accelerating atherosclerosis in peripheral blood vessels. If an aortic aneurysm is larger than 6 mm in diameter, it has a 50% chance of rupturing within a year.

Pathophysiology

An aortic aneurysm results from atherosclerotic plaque formation on the aorta’s walls. These plaques, consisting of lipids, cholesterol, fibrin, and other debris, cause degenerative changes in the aorta’s medial layer. The aorta loses elasticity and becomes weak. The pulsatile flow of the blood places additional stress on the weakened aorta, causing it to dilate, thus forming an aneurysm.

The growth rate of an aortic aneurysm can’t be determined, but the larger the aneurysm, the greater the risk of rupture. An aneurysm can form anywhere along the aorta. But the most common location is the abdominal aorta below the renal arteries. Typically, an abdominal aortic aneurysm involves the iliac arteries at the point of bifurcation.

Aneurysms are divided into two classifications: true aneurysms and false aneurysms. In a true aneurysm, at least one layer of the aorta remains intact. One-fourth of true aneurysms occur in the thoracic region and three-fourths occur in the abdominal region. A true aneurysm may be a fusiform or saccular dilation .

A false aneurysm is a disruption of all three layers of the aorta. This condition results in blood leakage into a contained area.

The rupture of an aortic aneurysm is a life­threatening complication. If the rupture causes bleeding into the retroperitoneal space, it may be stopped by compression from the nearby organs. Bleeding into the abdominal cavity is fatal.

Each year, more than 35,000 Americans die as a direct result of hypertension. And thousands more die as a result of chronic complications that affect the coronary arteries, aorta, heart, brain, kidneys, and eyes.When atherosclerotic plaques form in the aorta and in the large and mediumsized arteries, the resulting hypertension can cause coronary artery disease (CAD) and peripheral vascular disease. When atherosclerosis of the carotid arteries causes hypertension, cerebral ischemia can result. And if hypertension causes the rupture of an aneurysm in a tiny cerebral artery, it can result in cerebral hemorrhage.

When hypertension affects the vessels of the eyes and kidneys, retinopathy and renal insufficiency may develop. When hypertension results in damage to the aorta’s intimal lining, it can cause an aortic dissection.

If your patient has been diagnosed with hypertension, you’ll need to teach him that he’s at risk for developing these chronic complications. You’ll also need to teach him how to prevent them and how to slow their progress.