Aortic Aneurysm: The Causes And Signs To Look For

American sports journalist Grant Wahl died of a ruptured aortic aneurysm while covering the World Cup in Qatar. Wahl, who was 48, collapsed early Saturday during the soccer match between Argentina and the Netherlands and was taken to Doha’s Hamad General Hospital where he was pronounced dead.

In the week leading up to his death, Wahl had been experiencing respiratory issues and was being treated for a possible case of bronchitis. Suspicions grew that Wahl’s health had declined due to unhealthy conditions in Qatar, and some worried there was “foul play.”

However, an autopsy, which was performed by the New York City Medical Examiner’s Office, found that the soccer journalist died from an ascending aortic aneurysm with hemopericardium — a condition in which the heart’s main blood vessel swells and bursts.

“The chest pressure he experienced shortly before his death may have represented the initial symptoms. No amount of CPR or shocks would have saved him. His death was unrelated to COVID. His death was unrelated to vaccination status. There was nothing nefarious about his death,” Wahl’s wife, Dr. Céline Gounder, said in a statement.

What is an aortic aneurysm?

The aorta is the largest blood vessel in the body — it’s an inch wide and a foot long, traveling from your chest to your pelvis, where it splits off into the legs. Its main job is to carry oxygen-rich blood from your heart to the rest of your body. It also transports nutrients and hormones to various organs and tissues.

“It’s the highway for the blood to go,” Dr. Suyog Mokashi, director of the aortic surgery program at Temple University Hospital and assistant professor of surgery at the Lewis Katz School of Medicine at Temple University, told HuffPost.

Ascending aortic aneurysms, which are located in the chest region, occur when a bulge starts to form in the aorta. According to Mokashi, essentially a whole segment of the aorta enlarges, which puts a ton of stress on the wall of the aorta. The larger the aneurysm gets, the more likely it is that the weakened wall of the artery will rupture or tear.

Aortic aneurysms typically develop and grow without causing symptoms, which is why they can be so hard to detect. As the aneurysm grows, it can cause a range of symptoms, including back pain, cough, a weak, scratchy voice, shortness of breath and chest pain — though many people will remain asymptomatic.

In fact, Mokashi says about 95% of aortic aneurysms are totally asymptomatic until there is a rupture, tear or dissection in the aortic wall — which is what Wahl had. “If they were symptomatic, we would be able to detect more of these, but again 95% are asymptomatic until something bad happens,” Mokashi said.

Signs and symptoms that the aortic aneurysm has ruptured include sharp, sudden upper back pain, chest, jaw, or neck pain, difficulty breathing, low blood pressure, loss of consciousness and trouble swallowing. A dissection or rupture can lead to sudden death — about half of people who have an aortic dissection die before they’re able to get to a hospital, Mokashi said.

What causes aortic aneurysms.

Data shows that men and people 65 and older have a greater risk for aortic aneurysms. There also appears to be a genetic factor — the odds of developing an aortic aneurysms is 1 in 5 for people who have an immediate family member with the condition.

There are several genetic conditions that have been linked to a higher risk of aortic aneurysms; they include Ehlers–Danlos syndrome, Loeys–Dietz syndrome, Marfan syndrome, Turner syndrome, familial thoracic aortic aneurysms and bicuspid aortic valve. Other conditions associated with aortic aneurysms include high blood pressure, unhealthy cholesterol, obesity, cardiovascular diseases and kidney disorders.

Lifestyle habits, including cigarettes and stimulants like cocaine, can raise your blood pressure and increase your risk of developing an aortic aneurysm, too. Certain antibiotics — known as fluoroquinolones — can potentially increase your risk of a rupture if you have an aortic aneurysm or one of the above health conditions that can increase your risk.

How aortic aneurysms are detected and treated.

The only way to identify an aortic aneurysm is to be screened via an advanced imaging test. For the general population, there’s no routine screening recommendation. However, those with a first-degree relative who has (or had) an aortic aneurysm should get screened by a cardiologist or aortic specialist. People who have a first-degree relative who died suddenly under the age of 50 should also be screened, Mokashi said.

Early diagnosis and treatment can help slow the development of the aneurysm to prevent it from bursting, as can lifestyle modifications — like healthy eating, physical activity and smoking cessation.

“We do see a higher prevalence of smokers in this group, so obviously smoking cessation is critically important,” Mokashi said. Management of hypertension and unhealthy cholesterol, two risk factors for aortic aneurysms, is also crucial.

In general, people diagnosed with an aortic aneurysm should take it easy and avoid activities and substances that will put stress on the heart (think: competitive sports, amusements parks and smoking). If you’ve been diagnosed with an aortic aneurysm, it’s important to follow up with your physician and undergo routine screening.

If screening shows that the aneurysm is expanding, an elective surgery can be performed. If the aneurism grows and bursts before elective surgery is done, emergency surgery will be necessary. The goal is always to prevent a dissection or rupture from occurring so emergency surgery isn’t necessary, Mokashi explained.

“If you think about cardiovascular catastrophes, aortic dissection is definitely one of the deadliest,” Mokashi said.

It’s not common, but it’s not unheard of. The take-home message: Anyone with a first-degree family member who’s had one should get screened. “Those are the patients who need to be carefully screened for and follow up closely with their cardiologist,” Mokashi said.