Understanding Risks of an Aortic Aneurysm

Q&A with cardiothoracic surgeon James Wu, MD

When sports journalist Grant Wahl collapsed and died while covering the World Cup in Qatar, people wondered what caused the death of the 49-year-old. An autopsy performed by the New York City Medical Examiner’s Office determined he died from “the rupture of a slowly growing, undetected ascending aortic aneurysm with hemopericardium.”

James K. Wu, MD

Cardiothoracic Surgery

So, what is an aortic aneurysm? How common are they? How can they be treated? We asked cardiothoracic surgeon James Wu, MD, Chief, Division of Cardiothoracic Surgery for Lehigh Valley Heart and Vascular Institute, these very questions. Here’s what he had to say:

What is an aortic aneurysm?

An aortic aneurysm is a condition when the largest blood vessel in our body, the aorta, develops a balloon-like appearance or a bulging of the blood-vessel wall. This can lead to rupture or dissection. Aortic aneurysms are usually separated by where they are located: in the chest (thoracic) or in the stomach area (abdominal).

How common is an aortic aneurysm?

Aortic aneurysms occur in five to 10 cases per 100,000 patients a year. About 10,000 people die each year from aortic aneurysms.

Some conditions that put you at risk for aortic aneurysm include high blood pressure, smoking, atherosclerosis, Marfan syndrome and Ehlers-Danlos syndrome. - James Wu, MD

Could a person have any signs or symptoms of an aortic aneurysm and how is it diagnosed?

Usually, the symptoms are vague or nonspecific. If the aortic aneurysm is in the chest, it can cause chest pain or chest tightness. If it is in the abdomen, usually there is abdominal pain or one can have a pulsating mass. Pain occurs in the later stages. It is usually diagnosed with a computed tomography (CT) scan, or an ultrasound.

How is an aortic aneurysm treated, if found?

There are certain criteria for treatment. The criteria usually are based on aneurysm size, family history or genetic history. Depending on the size and location, an aneurysm is treated with surgery or endovascular stents. If the aneurysm is small or does not meet criteria, it is usually treated with antihypertensive medications or serial follow-up with CT scans.

From what we have heard, Grant Wahl didn’t feel well before he collapsed – is that common?

Mr. Wahl’s presentation is uncommon. He had a thoracic aortic aneurysm that ruptured. Prior to his collapse, he had complaints of chest pain and tightness. He was also under a great deal of stress covering the World Cup event. People with thoracic aneurysms usually do not have a lot of symptoms; this is one of the reasons why they are frequently undiagnosed.

Is this the same as aortic dissection?

No. Grant Wahl’s wife said that Wahl died from the “rupture of a slowly growing, undetected ascending aortic aneurysm with hemopericardium.” The chest pressure he experienced shortly before his death may have represented the initial symptoms. When the ascending aortic aneurysm ruptures, it ruptures into the pericardium, or the heart sac. Blood accumulates rapidly inside the sac and basically compresses or squeezes the heart so that it can no longer function. This is called pericardial tamponade. This leads to cardiac arrest.

Are there conditions or family history that may put you at risk for aortic aneurysm?

Some conditions that put you at risk for aortic aneurysm include high blood pressure, smoking, atherosclerosis, Marfan syndrome and Ehlers-Danlos syndrome.