Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Most aortic aneurysms cause no symptoms and are found when a person undergoes a medical test or procedure for some other reason. Others are found only when the individual has symptoms (described above).
The typical symptoms of an abdominal aortic aneurysm are not specific. This means that they could be caused by a number of different conditions.
The health care professional will probably not know at first what is causing symptoms. He or she will rapidly consider the possibilities and develop a plan for systematically ruling each one out.
This evaluation will start with the most serious conditions, and ruptured aneurysm is near the top of the list.
If the person is able, they can help by giving a focused, detailed description of how the symptoms started, how they were feeling before the symptoms started, and how the situation once the symptoms started. Because some patients cannot communicate or remember items, it is helpful to arrive in an emergency department with someone who knows or who has access to the patient's medical and surgical history. This is especially helpful if the patient has a documented history of an aortic aneurysm or conditions that might predispose them to aneurysms (connective tissue disease disorders).
A full exam, with special attention to the cardiovascular system and abdomen, will give clues to the diagnosis.
The health care professional may be able to feel a pulsating bulge in the abdomen or hear a loud pulse (termed a bruit) or other signs of aortic enlargement with the stethoscope.
The exam findings will guide the rest of the evaluation.
Probably the first test that will be performed is an electrocardiogram (ECG or EKG). This is done to rule out a heart attack and other serious heart conditions.
A series of electrical wires will be attached to the chest, arms, and legs. The ECG records the electrical impulses that control the beating of the heart.
The rate and rhythm of the heartbeat is measured.
Abnormalities in the ECG may point to heart damage.
Often the ECG result is normal in uncomplicated aortic aneurysm.
The test may be repeated after a short time to see if any changes have occurred in heart function.
Usually, an aneurysm shows up on plain radiographs only if it has become calcified as a result of atherosclerosis.
Ultrasound will show abnormalities in the shape of the aorta. Echocardiography is a special type of ultrasound that shows the heart in great detail. This may be done in certain situations in which heart damage is suspected and/or the thoracic aorta is thought to be involved. A transesophageal echocardiogram is more sensitive and specific; the procedure involves swallowing a long tube with a probe at its distal end. Prior to placement of the probe, local anesthesia is applied to the back of the throat. This probe is very sensitive and can easily identify heart or aortic problems within a few minutes.
Aortography is an X-ray procedure done after a contrast or X-ray dye is injected into the bloodstream to show the areas where blood is flowing. This study highlights blood vessel abnormalities, such as bulges, and confirms the diagnosis of an aneurysm. Aortography involves inserting a catheter inside the body and aorta, with its associated risks.
A CT scan is an X-ray that shows much more detail of the organs, blood vessels, and other structures inside the body. It requires the use of a dye, which can damage the kidney in rare cases.
MRI is also a highly specialized technique that gives a very detailed view of the soft tissues inside of the body.
CT scan and MRI have largely replaced aortography. The only hazard of CT scan and MRI is that the patient is transported and manipulated in a radiological suite for about 20 to 30 minutes, which may not be advisable for a patient with low blood pressure.
If an aortic aneurysm is strongly suspected, most emergency medical staff choose to notify a surgeon early in the diagnostic process.
Abdominal aortic aneurysms (AAAs) represent a degenerative process of the abdominal aorta that is often attributed to atherosclerosis; however, the exact cause is not known. A familiar clustering of AAAs has been noted in 15-25% of patients undergoing repair of the problem.