Football journalist Grant Wahl collapsed and died suddenly while covering the World Cup in Qatar. He was only 49 years old and would be in good health. His family announced on Wednesday that Mr Wahl had a burst blood vessel leading from his heart and that his death was the result of a ruptured aneurysm.
Aortic aneurysms are rare, doctors say, but more common than you might think. Between 1 and 2 percent of the US population is likely to develop them, said Dr. Eric Roselli, a cardiovascular surgeon at the Cleveland Clinic. “A lot of people don’t know about it,” Dr. Roselli added. “The aorta has been underestimated.”
Here’s what to know about the disease, risk factors and treatment options.
What is an aortic aneurysm?
Aneurysms, which are enlarged and weakened areas of blood vessels, can occur anywhere in the body. An aortic aneurysm is a bulge in the aorta, the main blood vessel that carries blood from the heart to the chest and the rest of the body.
There are two main types of aortic aneurysms: thoracic aortic aneurysms, which occur in the chest, and abdominal aortic aneurysms, which occur in the belly. Doctors tend to think of abdominal aortic aneurysms as a disease that occurs in older people, said Dr. Douglas Johnston, chief of cardiac surgery for Northwestern Medicine, but thoracic aortic aneurysms can also affect younger patients. Mr. Wahl had an ascending thoracic aortic aneurysm, according to the autopsy report.
What happens after an aortic aneurysm forms?
Two main problems can arise from an aortic aneurysm: a hole can form in the enlarged aorta, allowing blood to burst into the body, or blood pumping vigorously through the artery can tear the inner layers of the aorta . The tearing of the layers of the aorta is known as dissection, and when blood pools and continues to tear the arterial wall, it can lead to death.
Aortic aneurysms are a leading cause of unexpected death in otherwise healthy people, said Dr. James Pirruccello, assistant professor of medicine and cardiovascular researcher at the University of California, San Francisco.
Many people with an enlarged aorta will not experience these complications, Dr. Pirruccello said. The risk of a dissection or rupture increases as the aorta enlarges, he added. In some cases, depending on the size of the aneurysm, even patients without symptoms may have surgery to replace the segment of aorta that is too large.
Who is at risk of having an aortic aneurysm?
People with high blood pressure or high cholesterol, which are usually tested during regular physical exams, are more likely to develop the disease, according to the Centers for Disease Control and Prevention. Hardened arteries are also a risk factor.
Having a bicuspid aortic valve, which means your aortic valve has two flaps, instead of three, puts you at a higher risk of developing an aortic aneurysm. About 2% of the population has a bicuspid aortic valve, Dr. Johnston said.
Smoking is a huge risk factor for abdominal aortic aneurysms. According to the CDC, a history of smoking accounts for about 75% of all abdominal aortic aneurysms.
Men may also be at higher risk for abdominal aortic aneurysms, said Dr. Eric Isselbacher, associate professor of medicine at Harvard Medical School. The US Task Force on Preventive Services has recommended that men between the ages of 65 and 75 who have ever smoked undergo ultrasound screening.
Genetics also play a role, making it essential to know your family’s medical history. If you have a direct family member (sibling or parent) who has or has had an enlarged aorta, you should talk to your GP about getting tested, as the condition can be hereditary. Certain inherited disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, can increase the risk of developing an aortic aneurysm. It is crucial to know if a family member died suddenly and unexpectedly, as an aortic aneurysm could be a potential cause.
What are the symptoms and how to detect aortic aneurysms?
Abdominal aortic aneurysms can be detected during a physical exam, Dr. Isselbacher said — doctors can feel enlarged aortas by pressing on the abdomen.
But the average patient walking around with an aortic aneurysm in their chest will have no symptoms. Dr. Johnston noted that some people may experience chest tightness or have a cough. Others may have a slight heart murmur, he added.
CT scans and MRIs can detect thoracic aortic aneurysms, but doctors usually don’t recommend them unless you have a family history or another genetic risk for aortic enlargement. An echocardiogram, or ultrasound of the heart, can also help detect aortic aneurysms.
People with aortic ruptures or dissections may have difficulty breathing or swallowing and may experience severe chest pain radiating to the back, said Dr. Elizabeth Ratchford, director of the Johns Hopkins Center for Vascular Medicine.
“Anyone who develops sudden chest pain should be hospitalized as soon as possible,” Dr. Johnston said.
If a patient has access to emergency care and is correctly diagnosed, their chances of survival are high. Doctors can perform surgery to remove the enlarged part of the aorta and help the patient recover.
How can you reduce the risk of complications from an aortic aneurysm?
Once doctors detect an aneurysm, they monitor patients closely, typically taking imaging every six months, Dr. Pirruccello said. “It’s not like we find it once and hope it doesn’t grow up,” he said. “We are aggressive in following him,” he added. “If the aneurysm reaches a critical size, a doctor may perform surgery to replace the segment of the aorta that is too large.”
But for some patients, it doesn’t go that far. “A lot of people are just watched and never have anything to do about it,” Dr Ratchford said.
To help prevent the development of an aortic aneurysm, people should be aware of managing their blood pressure. The basics of cardiovascular health – diet, exercise, sleep – are essential tools for reducing the risk of developing or dying from an aortic aneurysm.
“An aneurysm is not a death sentence,” said Dr. Johnston. If managed well, “people have a normal way of life and a normal life expectancy,” he explained.