7 Warning Signs and Symptoms of Aortic Aneurysm You Should Never Ignore

An aortic aneurysm is a potentially life-threatening condition that occurs when a weakened area of the aorta, the body’s largest blood vessel, begins to bulge or balloon outward. The aorta carries oxygen-rich blood from the heart to the rest of the body, and when an aneurysm develops, it can rupture without warning, leading to severe internal bleeding and potentially fatal consequences.

Understanding the symptoms of an aortic aneurysm is crucial because many people have no symptoms until the aneurysm becomes large or ruptures. However, when symptoms do appear, they serve as critical warning signs that require immediate medical attention. Early detection can be lifesaving, as treatment options are available before a rupture occurs.

This article explores the most common and important symptoms associated with aortic aneurysms, helping you recognize when something might be wrong and when to seek emergency medical care.

1. Deep, Constant Pain in the Abdomen or Chest

One of the most significant symptoms of an aortic aneurysm is persistent, deep pain that doesn’t go away with rest or position changes. The location of this pain depends on where the aneurysm has formed along the aorta.

For abdominal aortic aneurysms (AAA), patients typically experience a steady, gnawing pain deep in the abdomen. This pain may be described as:

• A constant ache that feels like it’s coming from deep inside the belly
• A sensation of fullness or heaviness in the abdomen
• Discomfort that may radiate to the lower back or groin
• Pain that persists for hours or days without relief

For thoracic aortic aneurysms (TAA), the pain manifests in the chest area and may feel similar to other cardiac conditions. This chest pain is often described as sharp, tearing, or ripping in nature, and it can extend to the neck, jaw, or between the shoulder blades.

The intensity of the pain often correlates with the size of the aneurysm and whether it’s expanding or beginning to rupture. Any unexplained, persistent pain in these areas warrants immediate medical evaluation.

2. Pulsating Sensation Near the Navel

A distinctive symptom of abdominal aortic aneurysm is feeling a pulsating mass or throbbing sensation in the abdomen, typically near the navel or belly button. This symptom occurs because the enlarged, weakened portion of the aorta pulses with each heartbeat, and when it becomes large enough, this pulsation can be felt through the abdominal wall.

Patients or their doctors may notice:

• A rhythmic pulsing that matches the heartbeat
• A bulge or lump that can be felt when pressing gently on the abdomen
• A sensation of something “beating” or “throbbing” in the stomach area
• Increased awareness of pulsation when lying flat on the back

While it’s normal to occasionally feel your heartbeat in your abdomen, especially if you’re thin or lying in certain positions, a consistently strong, prominent pulsation or a noticeable bulge should be evaluated by a healthcare provider. This sign is particularly important because it can be detected before the aneurysm causes other serious symptoms.

3. Back Pain That Won’t Resolve

Persistent back pain, particularly in the lower back, is a common symptom of abdominal aortic aneurysm. This pain occurs because the enlarged aorta may press against nearby structures, including the spine and surrounding tissues.

The back pain associated with aortic aneurysm has several distinguishing characteristics:

• It’s typically deep and difficult to pinpoint to a specific spot
• The pain doesn’t improve with typical back pain remedies like rest, heat, or over-the-counter pain relievers
• It may worsen gradually over time as the aneurysm expands
• The pain is often constant rather than intermittent
• It may be accompanied by abdominal discomfort

Because back pain is so common and has many causes, it’s easy to dismiss this symptom. However, back pain that persists without a clear cause, especially in individuals with risk factors for cardiovascular disease, should be thoroughly evaluated. The combination of unexplained back pain with other symptoms like abdominal pulsation or chest discomfort is particularly concerning.

4. Sudden, Severe Tearing Chest or Back Pain

When an aortic aneurysm begins to tear (dissect) or rupture, it causes a distinctive type of pain that medical professionals recognize as a medical emergency. This symptom represents a critical, life-threatening situation requiring immediate emergency care.

The pain associated with aortic dissection or rupture is characterized by:

• Sudden onset – the pain strikes abruptly and reaches maximum intensity within seconds
• Severe intensity – often described as the worst pain the person has ever experienced
• Tearing or ripping quality – patients commonly use these specific words to describe the sensation
• Radiating pattern – the pain typically starts in the chest or upper back and may move downward as the dissection progresses
• Unrelenting nature – the pain doesn’t come and go but remains constant and severe

This type of pain is distinctly different from the gradual, chronic discomfort that may occur with a stable aneurysm. The sudden, tearing chest or back pain signals that the aneurysm is no longer stable and requires emergency intervention. Anyone experiencing this symptom should call emergency services immediately, as every minute counts in preventing death from internal bleeding.

5. Difficulty Breathing or Swallowing

When a thoracic aortic aneurysm develops in the chest cavity, it can grow large enough to compress nearby structures, including the trachea (windpipe) and esophagus (the tube that carries food to the stomach). This compression leads to respiratory and swallowing difficulties that may develop gradually as the aneurysm expands.

Symptoms related to compression include:

• Shortness of breath: Difficulty breathing that worsens with activity or when lying flat
• Wheezing or stridor: High-pitched breathing sounds caused by airway narrowing
• Chronic cough: A persistent cough without other signs of illness or infection
• Dysphagia: Difficulty or discomfort when swallowing food or liquids
• Feeling of food “sticking”: Sensation that food gets caught in the chest
• Hoarseness: Changes in voice quality if the aneurysm affects the recurrent laryngeal nerve

These symptoms can be subtle at first and may be attributed to other conditions like asthma, acid reflux, or respiratory infections. However, when they occur in combination or persist despite treatment for other conditions, an aortic aneurysm should be considered, especially in individuals with cardiovascular risk factors. The progressive nature of these symptoms – getting worse over time rather than improving – is a key indicator that something more serious may be occurring.

6. Rapid Heart Rate and Low Blood Pressure

Changes in heart rate and blood pressure can be important indicators of an aortic aneurysm, particularly if the aneurysm is leaking or has ruptured. These vital sign changes reflect the body’s response to blood loss and cardiovascular stress.

Key cardiovascular symptoms include:

• Tachycardia: A rapid heartbeat (over 100 beats per minute) as the heart tries to compensate for reduced blood volume
• Hypotension: Low blood pressure resulting from blood loss or reduced cardiac output
• Weak pulse: A pulse that feels thready or difficult to detect
• Dizziness or lightheadedness: Resulting from inadequate blood flow to the brain
• Near-fainting or syncope: Brief loss of consciousness due to severely reduced blood pressure

In cases of rupture, these symptoms typically appear suddenly and are accompanied by other severe symptoms like intense pain. The combination of rapid heart rate, falling blood pressure, and severe pain constitutes a medical emergency requiring immediate treatment.

Even in non-emergency situations, unexplained changes in heart rate or blood pressure, particularly when accompanied by other symptoms like chest or abdominal pain, should prompt medical evaluation. Regular monitoring of vital signs is especially important for individuals known to have an aortic aneurysm or those at high risk for developing one.

7. Symptoms of Poor Blood Flow to Extremities

An aortic aneurysm can affect blood circulation to the legs and feet, causing symptoms related to inadequate blood supply to the lower extremities. This occurs because the aneurysm may contain blood clots, or the altered blood flow through the widened vessel may lead to decreased perfusion of downstream tissues.

Symptoms of compromised blood flow include:

• Claudication: Pain, cramping, or fatigue in the legs during walking that improves with rest
• Cold feet or legs: Noticeably cooler temperature in one or both legs compared to the rest of the body
• Color changes: Pale, bluish, or mottled skin on the legs and feet
• Weak or absent pulses: Diminished or undetectable pulses in the feet or legs
• Numbness or tingling: Sensory changes in the lower extremities
• Slow-healing wounds: Sores or injuries on the feet or legs that heal poorly or not at all
• Hair loss: Reduced hair growth on the legs and feet

These symptoms occur because pieces of blood clot from the aneurysm can break off and travel downstream, blocking smaller arteries (embolization), or because the aneurysm itself disrupts normal blood flow patterns. While these symptoms may develop gradually and seem less dramatic than severe pain or breathing difficulties, they indicate significant vascular compromise and require medical attention.

In some cases, sudden, severe leg pain with coldness and pale or blue coloration represents an acute arterial occlusion – a medical emergency that can result in limb loss if not treated promptly. This acute presentation requires immediate emergency care.

Main Causes of Aortic Aneurysm

Understanding the causes and risk factors for aortic aneurysm helps explain why this condition develops and identifies who is at greatest risk. While the exact cause isn’t always clear, several factors contribute to the weakening of the aortic wall:

Atherosclerosis

The buildup of plaque (cholesterol, fat, and other substances) inside the arteries is the most common cause of aortic aneurysms. Atherosclerosis damages the inner lining of the aortic wall, making it more susceptible to weakening and bulging over time.

High Blood Pressure

Chronic hypertension places excessive stress on the arterial walls. Over time, this constant pressure can weaken the aorta, particularly in areas where the wall is already compromised, leading to aneurysm formation and growth.

Genetic and Hereditary Factors

Certain genetic conditions affect the connective tissue that provides structural support to blood vessels. Conditions such as Marfan syndrome, Ehlers-Danlos syndrome, and Loeys-Dietz syndrome significantly increase the risk of aortic aneurysm. Additionally, having a family history of aortic aneurysms increases individual risk even without identified genetic syndromes.

Aging and Gender

Aortic aneurysms are more common in people over 65 years old, as the arterial walls naturally weaken with age. Men are more likely to develop abdominal aortic aneurysms than women, though women face a higher risk of rupture when aneurysms do occur.

Tobacco Use

Smoking is one of the strongest modifiable risk factors for aortic aneurysm. Tobacco use damages blood vessel walls, accelerates atherosclerosis, and increases inflammation throughout the cardiovascular system. Smokers are several times more likely to develop aortic aneurysms than non-smokers.

Infection and Inflammation

Though less common, infections can weaken the aortic wall, leading to what’s called a mycotic aneurysm. Inflammatory conditions such as vasculitis (inflammation of blood vessels) can also damage the aorta and contribute to aneurysm formation.

Trauma

Blunt force trauma to the chest or abdomen from accidents can damage the aorta and potentially lead to aneurysm development. This type of aneurysm may occur immediately following injury or develop over time.

Prevention Strategies

While some risk factors for aortic aneurysm, such as age and genetics, cannot be changed, many preventive measures can significantly reduce your risk or slow the growth of existing aneurysms.

Quit Smoking

Stopping tobacco use is the single most important step you can take to prevent aortic aneurysm. If you currently smoke, talk to your healthcare provider about smoking cessation programs, support groups, and strategies to help you quit successfully. The risk begins to decrease soon after quitting and continues to improve over time.

Control Blood Pressure

Maintaining healthy blood pressure levels reduces stress on arterial walls. This involves:

• Regular blood pressure monitoring at home and during medical appointments
• Following your healthcare provider’s recommendations for blood pressure management
• Reducing sodium intake in your diet
• Engaging in regular physical activity
• Managing stress through relaxation techniques

Manage Cholesterol Levels

Keeping cholesterol within healthy ranges helps prevent atherosclerosis, which contributes to aneurysm formation. This includes eating a heart-healthy diet low in saturated and trans fats, maintaining a healthy weight, and exercising regularly. Your doctor may recommend lipid testing to monitor your cholesterol levels.

Maintain a Healthy Diet

A diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats supports cardiovascular health. The Mediterranean diet and DASH (Dietary Approaches to Stop Hypertension) diet are both associated with reduced cardiovascular risk. Limit processed foods, excessive salt, and foods high in saturated fats.

Exercise Regularly

Regular physical activity strengthens the cardiovascular system and helps control weight, blood pressure, and cholesterol. Aim for at least 150 minutes of moderate-intensity aerobic activity per week. However, if you already have an aortic aneurysm, consult your doctor before starting an exercise program, as certain activities may need to be modified or avoided.

Screening for High-Risk Individuals

Ultrasound screening can detect abdominal aortic aneurysms before they cause symptoms. Screening is particularly recommended for:

• Men aged 65-75 who have ever smoked
• People with a family history of aortic aneurysm
• Individuals with genetic conditions that affect connective tissue
• Those with atherosclerosis or cardiovascular disease

Early detection through screening allows for monitoring and intervention before the aneurysm becomes dangerous. If you’re in a high-risk group, discuss screening options with your healthcare provider.

Manage Underlying Health Conditions

Controlling chronic conditions such as diabetes, high cholesterol, and cardiovascular disease reduces your overall vascular risk. Follow your healthcare provider’s treatment recommendations, attend regular check-ups, and take prescribed medications as directed.

Frequently Asked Questions

Can an aortic aneurysm be present without any symptoms?

Yes, most aortic aneurysms, especially in their early stages, cause no symptoms at all. Many are discovered incidentally during imaging tests performed for other reasons. This is why screening is so important for high-risk individuals, as early detection before symptoms appear allows for monitoring and treatment before rupture occurs.

How quickly do aortic aneurysms grow?

Growth rates vary significantly between individuals. On average, abdominal aortic aneurysms grow about 0.3 to 0.4 centimeters per year, but some grow faster while others remain stable. Factors like smoking, high blood pressure, and aneurysm size influence growth rate. Larger aneurysms tend to grow faster and have a higher risk of rupture.

What is the difference between an aortic aneurysm and aortic dissection?

An aortic aneurysm is a bulging or widening of the aortic wall, while an aortic dissection occurs when the inner layer of the aorta tears, allowing blood to flow between the layers of the vessel wall. A dissection can occur in an aneurysm or in a normal-sized aorta. Both are serious conditions, but dissection is typically more immediately life-threatening and presents with sudden, severe, tearing chest or back pain.

At what size does an aortic aneurysm become dangerous?

Risk of rupture increases with aneurysm size. For abdominal aortic aneurysms, the risk becomes significantly higher when the diameter reaches 5.5 centimeters or greater in men, or 5.0 centimeters in women. For thoracic aneurysms, intervention is often considered at 5.5 to 6.0 centimeters, though this depends on location and individual factors. However, smaller aneurysms can also rupture, especially in people with uncontrolled hypertension or continued smoking.

Should I go to the emergency room if I suspect an aortic aneurysm?

If you experience sudden, severe chest or abdominal pain, especially if it has a tearing or ripping quality, call emergency services immediately. Other symptoms requiring emergency care include severe back pain with dizziness, rapid heartbeat with low blood pressure, loss of consciousness, or signs of shock. For less acute symptoms like persistent abdominal pulsation or chronic back pain, schedule an urgent appointment with your healthcare provider for evaluation.

Can exercise cause an aortic aneurysm to rupture?

Heavy lifting, straining, and intense exercise can temporarily increase blood pressure, which theoretically could stress an aneurysm. However, the relationship between exercise and rupture isn’t straightforward. If you have a known aortic aneurysm, discuss safe activity levels with your doctor. Generally, moderate aerobic exercise is beneficial for cardiovascular health, but activities involving heavy lifting, straining, or sudden intense exertion may need to be modified or avoided depending on your aneurysm’s size and location.

Are there different types of aortic aneurysms?

Yes, aortic aneurysms are classified primarily by location. Abdominal aortic aneurysms (AAA) occur in the portion of the aorta that passes through the abdomen and are the most common type. Thoracic aortic aneurysms (TAA) develop in the chest portion of the aorta and may affect the ascending aorta, aortic arch, or descending aorta. Thoracoabdominal aneurysms span both the chest and abdomen. Each type may present with somewhat different symptoms and requires specific management approaches.

Is there a cure for aortic aneurysm?

An aortic aneurysm cannot be reversed or cured with medication alone. Once the aorta has weakened and enlarged, it doesn’t return to normal size. However, treatment can prevent rupture and manage the condition. Small, stable aneurysms are monitored with regular imaging while managing risk factors. Larger or rapidly growing aneurysms may require surgical repair or endovascular procedures. Following preventive measures like quitting smoking and controlling blood pressure can slow aneurysm growth and reduce rupture risk.

References:

• Mayo Clinic – Abdominal Aortic Aneurysm
• American Heart Association – Aortic Aneurysm
• National Heart, Lung, and Blood Institute – Aneurysm
• Johns Hopkins Medicine – Aortic Aneurysm
• Centers for Disease Control and Prevention – Aortic Aneurysm