Understanding the symptoms of aortic aneurysm could save your life or the life of someone you love. An aortic aneurysm is a potentially life-threatening bulge in the wall of the aorta, the largest blood vessel in your body, and it often develops silently without any noticeable warning signs. The symptoms of aortic aneurysm typically become apparent only when the aneurysm grows large enough to press on surrounding structures or, in the most dangerous scenario, when it begins to rupture.
Because a ruptured aortic aneurysm is a medical emergency with a high mortality rate, knowing what to look for and when to seek immediate care is critical. This article will cover the different types of aortic aneurysms, their symptoms at various stages, risk factors, and the emergency warning signs that demand an immediate call to 911.
What Is an Aortic Aneurysm?
The aorta runs from your heart through your chest and abdomen, delivering oxygen-rich blood to the entire body. An aortic aneurysm develops when a section of the aortic wall weakens and balloons outward. According to the Centers for Disease Control and Prevention, aortic aneurysms were a contributing cause of over 9,900 deaths in the United States in 2019.
There are two main types based on location. An abdominal aortic aneurysm (AAA) occurs in the lower portion of the aorta and is the more common type. A thoracic aortic aneurysm (TAA) develops in the chest portion of the aorta. Some aneurysms extend through both regions and are called thoracoabdominal aneurysms. Related cardiovascular conditions can increase risk. Learn more in our article on symptoms of high blood pressure.
The danger of an aortic aneurysm lies in its potential to rupture or dissect. A rupture means the aneurysm wall breaks open, causing massive internal bleeding. A dissection occurs when a tear in the inner layer of the aortic wall allows blood to flow between the layers, potentially blocking blood flow to vital organs. Both are medical emergencies. For more on serious health conditions, see our medical conditions guide.
Symptoms of Abdominal Aortic Aneurysm (AAA)
Most abdominal aortic aneurysms develop slowly over years and produce no symptoms until they become large or rupture. When symptoms do occur, they may include the following.
Deep, constant abdominal pain: A dull, gnawing pain in the abdomen or on one side of the abdomen is one of the most commonly reported symptoms. This pain may be steady or come and go and is often described as a deep ache rather than a sharp pain. It can easily be mistaken for a stomach issue or muscle strain.
Pulsating sensation near the navel: Some people notice a throbbing or pulsating feeling in their abdomen, particularly when lying down. While you can normally feel your aortic pulse if you press on your abdomen, an abnormally strong or visible pulsation may indicate an enlarged aorta.
Back pain: Pain that radiates to the lower back is another common symptom, especially as the aneurysm grows larger. According to the Mayo Clinic, back pain from an AAA can be persistent and may not respond to typical back pain treatments.
Symptoms of Thoracic Aortic Aneurysm (TAA)
Thoracic aortic aneurysms are less common than abdominal aneurysms but can be equally dangerous. Because the thoracic aorta runs through the chest, symptoms tend to affect the chest and upper body.
Chest or upper back pain: A deep, aching pain in the chest or between the shoulder blades is the most frequent symptom. This pain may be described as a tearing or ripping sensation, particularly if the aneurysm is dissecting.
Shortness of breath and cough: A large thoracic aneurysm can press on the airways, causing difficulty breathing or a persistent cough. In some cases, this pressure can also affect the voice by pressing on the recurrent laryngeal nerve, leading to hoarseness.
Difficulty swallowing: When the aneurysm presses on the esophagus, swallowing can become uncomfortable or difficult. This symptom is less common but can occur with larger aneurysms in specific locations.
Emergency Symptoms of a Ruptured or Dissecting Aneurysm
A ruptured or dissecting aortic aneurysm produces sudden, severe symptoms that require immediate emergency care. The National Heart, Lung, and Blood Institute emphasizes that every minute counts when an aneurysm ruptures.
Sudden, severe pain: The most prominent symptom is sudden, intense pain in the chest, abdomen, or back. Patients often describe it as the worst pain they have ever experienced. The pain may feel like tearing, ripping, or stabbing and often comes on without warning.
Signs of internal bleeding and shock: Rapid heart rate, dizziness, lightheadedness, cold and clammy skin, nausea, vomiting, and sudden weakness are all signs that the body is losing blood internally. Blood pressure may drop rapidly, and loss of consciousness can occur.
Pain that radiates: The pain may radiate from the chest to the back, jaw, neck, or arms. In the case of a dissecting aneurysm, the pain may seem to move or migrate as the dissection progresses along the aorta.
Risk Factors for Aortic Aneurysm
Several factors increase the likelihood of developing an aortic aneurysm. Knowing your risk profile is especially important because most aneurysms are asymptomatic until they become dangerous.
Age and sex: Aortic aneurysms are most common in men over 65. Men are significantly more likely than women to develop abdominal aortic aneurysms. The U.S. Preventive Services Task Force recommends a one-time screening ultrasound for men aged 65 to 75 who have ever smoked.
Smoking: Cigarette smoking is the strongest modifiable risk factor. Smoking damages the aortic wall and accelerates the growth of aneurysms. Even former smokers carry an elevated risk compared to people who have never smoked.
High blood pressure and atherosclerosis: Chronic high blood pressure puts constant stress on the aortic wall, and atherosclerosis (buildup of plaque in the arteries) weakens the vessel wall over time. A family history of aortic aneurysm, connective tissue disorders like Marfan syndrome, and certain genetic conditions also increase risk.
Screening and Diagnosis
Because aortic aneurysms often produce no symptoms, screening is an important tool for early detection. An abdominal ultrasound is a simple, painless, and highly effective screening test for AAA. For thoracic aneurysms, echocardiography, CT angiography, or MRI may be used.
If you have risk factors, particularly if you are a male over 65 with a smoking history, talk to your doctor about screening. Early detection allows for monitoring and, when necessary, elective surgical repair before the aneurysm reaches a dangerous size. According to the Cleveland Clinic, aneurysms smaller than 5.5 centimeters in the abdomen are usually monitored with regular imaging, while larger aneurysms or those growing rapidly may require surgical intervention.
Treatment options include open surgical repair and endovascular aneurysm repair (EVAR), a less invasive procedure that involves placing a stent graft inside the aneurysm through small incisions in the groin.
When to See a Doctor
If you have known risk factors for aortic aneurysm, schedule a conversation with your healthcare provider about screening, even if you have no symptoms. Seek prompt medical attention if you develop unexplained abdominal, chest, or back pain, especially if it is persistent, deep, and not relieved by position changes or over-the-counter medications.
As emphasized throughout this article, call 911 immediately if you experience sudden, severe chest or abdominal pain, symptoms of shock (rapid pulse, dizziness, cold skin), or pain described as tearing or ripping. A ruptured aortic aneurysm can be fatal within minutes without emergency surgical treatment, and survival rates improve dramatically with fast medical intervention.
Frequently Asked Questions
Can you live with an aortic aneurysm without knowing it?
Yes, many people live with small aortic aneurysms for years without any symptoms. This is why screening is so important for people at higher risk. Small aneurysms that are monitored regularly and managed with blood pressure control and lifestyle changes may never require surgery. However, all aneurysms carry some risk of growth and rupture.
What size aortic aneurysm is considered dangerous?
For abdominal aortic aneurysms, the general threshold for considering surgical repair is 5.5 centimeters in diameter for men and 5.0 centimeters for women. For thoracic aneurysms, the threshold is typically around 5.5 to 6.0 centimeters. However, rapidly growing aneurysms (more than 0.5 cm per year) or symptomatic aneurysms may be treated at smaller sizes.
Is an aortic aneurysm the same as a heart attack?
No, although both are cardiovascular emergencies, they are different conditions. A heart attack occurs when blood flow to the heart muscle is blocked, usually by a blood clot in a coronary artery. An aortic aneurysm involves the bulging and potential rupture of the aorta itself. However, they share some risk factors, including high blood pressure, smoking, and atherosclerosis.
Can aortic aneurysms be prevented?
While some risk factors like age, sex, and genetics cannot be changed, several lifestyle modifications can reduce your risk. Quitting smoking is the single most important step. Controlling blood pressure, maintaining a healthy weight, exercising regularly, and managing cholesterol levels all help protect the health of your aorta and cardiovascular system overall.
Key Takeaways
The symptoms of aortic aneurysm are often silent until the aneurysm becomes large or life-threatening. When symptoms do appear, they typically include deep abdominal or chest pain, back pain, a pulsating abdominal sensation, and in emergency situations, sudden severe pain with signs of shock. Because a ruptured or dissecting aneurysm is a medical emergency with a high mortality rate, knowing the warning signs and acting immediately is essential. If you have risk factors, especially a smoking history and are over 65, talk to your doctor about screening. For a broader look at serious health conditions, explore our medical conditions guide.