What happens in the wall of the aorta
The aorta emerges from the left ventricle and passes through the chest and abdomen, giving off branches to all organs. With atherosclerosis, lipids accumulate in the inner lining, chronic inflammation develops, and a plaque forms, which over time becomes covered with a dense capsule and is saturated with calcium. The wall loses its elasticity, smoothes out the pulse wave worse, and the load on the heart increases. Large loose plaques are dangerous in a different way: their fragments can break off and clog small arteries of the kidneys, intestines, and skin of the feet. In the weakened area, the wall gradually stretches - this is how an aneurysm is formed.
- Lipid deposits and inflammation in the vessel wall
- Induration and calcification, loss of elasticity
- Increased load on the heart and increased pulse pressure
- Plaque fragment rupture and embolism
- Gradual expansion of the aorta and formation of an aneurysm
Causes and risk factors
Atherosclerosis of the aorta is not a separate disease, but a manifestation of a general process that is influenced by modifiable and unmodifiable factors. Age and heredity cannot be changed, but everything else can be controlled. Smoking damages the lining of blood vessels and accelerates the growth of plaques more than is commonly thought. Increased pressure mechanically injures the wall, high levels of LDL cholesterol supply material for plaque, diabetes and obesity increase inflammation. Separately take into account familial hypercholesterolemia, in which changes appear early and require active treatment.
- Age over 50–60 years, male
- Smoking
- Arterial hypertension
- Elevated LDL cholesterol
- Diabetes mellitus
- Obesity and inactivity
- Familial hypercholesterolemia
Symptoms and complications
Uncomplicated atherosclerosis of the aorta usually occurs without complaints, and this is the main difficulty. Symptoms appear when complications arise or when the branches extending from the aorta narrow: chest pain during exercise indicates damage to the coronary arteries, pain in the calves when walking indicates narrowing of the leg arteries, and difficult to treat pressure indicates narrowing of the renal arteries. The dilated aorta is silent for a long time, but when it dissects or ruptures it gives sudden severe pain and requires emergency help by calling 103. Some of the findings are simply age-related changes that do not affect well-being.
- Most often there are no complaints
- Angina pectoris due to damage to the coronary arteries
- Intermittent claudication due to damage to the arteries of the legs
- Treatment-resistant hypertension due to narrowing of the renal arteries
- Aneurysm of the thoracic or abdominal aorta
- Aortic dissection is a life-threatening condition
What examinations are needed
First of all, the general cardiovascular risk is assessed: blood pressure is measured, lipid profile, glucose or glycated hemoglobin are determined, smoking and family history are taken into account. Echocardiography shows the condition of the ascending aorta, valves and heart function. Duplex examination of the vessels of the neck and ultrasound of the abdominal aorta detect plaques and dilatation, are available and safe. The most accurate method for suspected aneurysm is computed tomography of the aorta with contrast. For men over 65 years of age, especially those who smoke, it is reasonable to check the diameter of the abdominal aorta at least once with an ultrasound.
- Blood pressure measurement and risk calculation
- Lipid spectrum, glucose, glycated hemoglobin
- EchoCG
- Duplex of brachiocephalic arteries
- Ultrasound or MSCT of the abdominal and thoracic aorta
- Renal function assessment
Treatment and prevention
Calcified plaques cannot be dissolved, so the goal of treatment is to stop progression and prevent complications. The basis is statins, which not only reduce LDL cholesterol, but also stabilize the plaque; The target level depends on the overall risk and is determined by the doctor. Strict control of blood pressure and complete cessation of smoking is important - this is the most effective measure. The diet is based on vegetables, whole grains, fish, olive oil, with limited trans fats and excess salt; Regular walking is beneficial. For an aneurysm, the diameter is monitored, and when threshold values are reached, the vascular surgeon suggests surgery.
- Statins and LDL cholesterol control
- Target blood pressure determined by your doctor
- Complete smoking cessation
- Mediterranean diet, salt restriction
- Regular aerobic exercise, walking
- Sugar and body weight control
- Monitoring the diameter of the aorta at the time prescribed by the doctor
