Aortic Disease Often Has No Warning Signs. Here's What Older Adults Need to Know

As we age, we often pay closer attention to blood pressure, cholesterol and heart health. What many people don't realize is that the body's largest blood vessel, the aorta, can also develop serious health problems over time. 

The aorta carries oxygen-rich blood from the heart to the rest of the body. As we age, its walls can weaken, stretch or tear, potentially leading to life-threatening aortic disease.

The good news is that aortic conditions can be identified early and safely monitored or treated before they become emergencies.

What Is Aortic Disease?

Aortic disease refers to several conditions that affect the aorta, including:

• Aortic Aneurysm: An aneurysm occurs when part of the aorta becomes enlarged or bulges outward because the vessel wall has weakened. Small aneurysms often cause no symptoms and may be discovered during imaging tests performed for another reason.
• Aortic Dissection: A dissection occurs when a tear develops in the inner layer of the aortic wall. Blood can enter the tear and separate the layers of the vessel. This is a medical emergency that requires immediate treatment.
• Other Aortic Conditions: The aorta may also be affected by genetic conditions, chronic inflammation, hardening of the arteries or other complications.

Because many aortic diseases develop slowly, people may feel completely healthy until the condition becomes serious. 

Who Is at Risk?

Several factors can increase the risk of developing aortic disease:

• Being over age 60
• Long-term high blood pressure 
• Smoking history
• High cholesterol
• Family history of aortic aneurysm or dissection
• Family history of early or unexpected/sudden deaths
• Bicuspid aortic valve or certain inherited connective tissue disorders

Risk increases with age, but age alone does not necessarily mean you need screening. If you're in your 60s or older, especially if you've smoked, have high blood pressure or have a family history of aortic disease, talk with your physician about your individual risk and whether screening or imaging may be appropriate.

Warning Signs That Should Never Be Ignored

One of the biggest challenges with aortic disease is that many patients experience few or no warning signs.

However, symptoms that require immediate medical attention include:

• Sudden, severe chest pain
• Sudden upper back pain
• Tearing or ripping pain in the chest or back
• Shortness of breath
• Fainting
• Sudden weakness, numbness or difficulty speaking

These symptoms may indicate an aortic dissection or rupture and should be treated as a medical emergency. Call 911 immediately.

When Monitoring Is the Right Approach

Not every aortic condition requires surgery. For older adults, finding an aneurysm does not necessarily mean a heart procedure or surgery is in your immediate future.

Small or stable aneurysms can often be managed with regular imaging, blood pressure control, medication and healthy lifestyle habits. Periodic imaging can track changes in size and determine if treatment is needed.

For many patients, this approach provides years of safe management while reducing the risk of complications.

Treatment Options Continue to Advance

When treatment is needed, options have expanded significantly.

Depending on the type and location of the disease, treatment may include:

• Medication: Controlling blood pressure is one of the most important ways to reduce stress on the aorta and slow the disease’s progression.
• Minimally Invasive Endovascular Procedures: Some aneurysms can be treated using catheter-based techniques that place a stent graft inside the blood vessel through small incisions.
• Open Surgical Repair: More complex aneurysms and dissections may require surgical treatment to repair or replace damaged sections of the aorta.

Advances in imaging, surgical techniques and minimally invasive technology have helped improve outcomes for patients with aortic disease.

What Can Older Adults Do to Protect Their Aortic Health?

As you get older, knowing your risk of aortic disease becomes increasingly important.

If you’re in your 60s or older, consider these steps to protect your aortic health:

• Know your blood pressure: High blood pressure stresses the walls of the aorta. Have it checked regularly and work with your physician to keep it controlled.
• Talk about your smoking history: Smoking can increase the risk of aortic aneurysm. If you’re 60 or older and have smoked, ask whether screening may be appropriate.
• Know your family history: Tell your physician if a family member has had an aortic aneurysm or dissection. Family history may help determine whether imaging is appropriate.
• Keep up with routine medical care: Aortic disease can develop without noticeable symptoms. Regular health screenings are an opportunity to discuss your cardiovascular risk factors with your physician.
• Know when symptoms can’t wait: Sudden, severe chest or back pain, fainting, shortness of breath or sudden weakness or difficulty speaking should never be dismissed as part of aging. Call 911 immediately.

Aortic disease can be serious, but many conditions can be safely monitored or treated when identified early. Understanding your risk, staying on top of your cardiovascular health and recognizing symptoms that require immediate attention can help protect your health as you age.

Medically Reviewed By:

Asad Shah, M.D., medical director, Cardiac Surgery, MemorialCare Heart & Vascular Institute, Saddleback Medical Center

About the Author:

Dr. Asad Shah is medical director of Cardiac Surgery at MemorialCare Heart & Vascular Institute at Saddleback Medical Center. A board-certified cardiothoracic surgeon, he specializes in thoracic aortic disease, robotic cardiac surgery, minimally invasive valve surgery, coronary artery bypass grafting and transcatheter therapies, including TAVR and TEVAR. Dr. Shah is one of the few surgeons in Southern California who routinely performs robotic heart surgery and has extensive research experience in thoracic aortic aneurysms and bicuspid aortic valve disease. He has authored more than 40 peer-reviewed publications and serves as a principal investigator for multiple cardiac surgery clinical trials.