Should You Be Concerned about an Aortic Aneurysm?

By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

It’s usually symptomless, often found incidentally, and life-threatening. It’s much more common in men than women, and the risk increases after age 60.

I’m speaking of the most common kind of aortic aneurysm (pronounced, “an-your-ism”).

What Is an Aneurysm?

An aneurysm is a dangerous bulge in the aorta, the biggest artery in the body. It’s a problem that I encountered many times in my cardiology practice.

Your heart pumps blood directly into the aorta, which then branches off at multiple sites to supply the whole body from top to bottom. The big danger zone – 80% of aneurysms occur there − is where the aorta passes through the lower abdomen. The walls of the aorta become damaged and weakened in one spot and bulge out like a balloon. If the balloon bursts, death can occur rapidly.

A ruptured abdominal aorta was the cause of death of Albert Einstein in 1955.

More than 15,000 people die from this a year. According to the U.S. Centers for Disease Control, aortic aneurysms caused almost 18,000 deaths in the United States in 2009 (they were the primary cause of death in about 11,000 cases).

Risk Factors

Abdominal aneurysms affect four to six times as many men as women, and occur in up to 8 percent of men ages 65 and older. Researchers estimate that 1% of men between the ages of 55 and 64 have “clinically relevant” aneurysms, and with each decade that follows comes a 2 to 4% increase in prevalence. On average, women tend to be affected 10 years later than men.

Abdominal aneurysms are commonly associated with smoking, arterial disease, high blood pressure, low HDL cholesterol levels, and a family history of aneurysms. An aneurysm higher up in the aorta, in the chest, tends to affect men and women equally, and usually involves high blood pressure or sudden injury.

Symptoms / Areas Affected

Aortic aneurysms usually develop slowly over many years. Many times, there are no symptoms, and the problem is identified by ultrasound, CT scans, or MRIs when doctors are looking for something else.

If an aneurysm expands rapidly, ruptures, or blood leaks along the wall of the vessel, symptoms may develop suddenly. They include a pulsating sensation in the abdomen, severe, sudden, persistent, or constant pain in the abdomen or groin that could radiate to the buttocks and legs, nausea, and the appearance of an abdominal mass. If in the thoracic (chest & upper back) region, symptoms could manifest as difficulty breathing or swallowing, and sharp, sudden pain.

Aneurysms can also occur in peripheral arteries. Though less likely to rupture, the slower blood flow in these arteries can cause blood clots to form.

Size of the aneurysm is considered a strong predictor of rupture risk. The larger the aneurysm the greater the risk. And the risk increases significantly when the diameter of the bulge exceeds 5.5 cm (more than 3 cm is considered an aortic aneurism, and 4 cm indicates “clinical significance”). Surgical repair is warranted at that size as well. Smaller aneurysms are generally subject to watchful waiting.

Screening / Testing

Screening is crucial. According to the U.S. Preventive Services Task Force, men between the ages of 65-75, and particularly individuals who have smoked in their lives, should obtain an ultrasound screening for an abdominal aortic aneurysm. There is no such recommendation for men of that age bracket who have never smoked, and a screening is not recommended for women. The Canadian Society for Vascular Surgery, however, recommends screening for women with multiple risk factors, such as smoking, cerebrovascular disease, and family history. The American College of Cardiology recommends a screening for men over 60 who have a sibling or parent with an aortic aneurysm. High risk individuals should also have an echocardiogram (an ultrasound diagnostic procedure for the heart) to determine any suspicious enlargement of the aorta artery close to the heart.

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Treatment / Surgery

For decades, surgeons repaired this condition primarily by placing a synthetic graft through a large surgical incision. Cutting into the abdomen is always risky business. Recovery can take months. Moreover, older and compromised patients run the risk of renal failure, cardiovascular complications, and adverse reactions to anesthesia. Many an older patient with an aneurysm told me they would rather wait it out than subject themselves to surgery. That’s one tough decision because an aneurysm is like sitting on a time bomb. In some of those cases, the aneurysm ruptured and patients died.

In recent years, a newer procedure − called endovascular aneurysm repair − has become widely adopted by surgeons. EVAR, as it is called for short, involves embedding a fabric covered stent at the damaged site via a catheter inserted through the femoral artery in the groin. The blood bypasses the aneurysm. The procedure involves only a tiny incision, much less anesthesia, and has a much quicker recovery time.

Studies have shown that the new procedure is considerably safer but requires more follow-up interventions of a minor nature.


You’ve likely read my mantra, “prevention is easier than cure” elsewhere on this site, but I cannot reiterate it enough. Keep your arteries strong and healthy. Here are some tips:

  • Exercise. Regular physical activity helps to keep your blood vessels healthier and protects their sensitive inner lining from age-related changes. Even a minimum can make a difference.
  • Reduce the sugar and refined carbohydrates in your diet. They spike blood sugar (glucose) and cause damaging changes in the lining of your blood vessels. Make sure you eat plenty of fruit. A study among 80,000 middle-aged and older Swedes found that those who ate two or more servings of fruit daily had a much lower risk of aneurysms.
  • For individuals with aneurysms I recommend nutritional supplements such as omega-3 fatty acids (fish or squid oil, 1-2 grams daily), CoQ10 (200-300 milligrams), and magnesium (250-500 milligrams). They are all helpful against high blood pressure and contribute to healthy blood vessels. I would also suggest vitamin K-2 (the MK-7 form, 150-300 micrograms) to help remove calcium out of hardened arteries.


© 2015 HeartMD Institute. All rights reserved.

Leave a Reply


  1. Miss Vanessa pattenden

    on September 24, 2017 at 8:39 am

    My mum died in 1998 January the 14th at Truro hospital .no one knew what it was as she died in her sleep of aortic aneurysm ,main aortic (heart) .2nights,I didn’t make it to see her before.she did change a year before. She had high pressure ,but also she was taking HRT which she shouldn’t of because of your high cholesterol ,anyone would know that.she did smoke but wasn’t a heavy smoker. My mum was only 55 yrs old. I am now 48 & want to found out if I have aneurysm .my doctors haven’t even offered any testing/ screening/scanning .cholestrol ,they did say that having a mri scan can drigger cancer? I don’t think that’s the reason.!!
    Kind regards


  2. Jennine Armistead

    on January 20, 2018 at 7:13 am

    Change your doctors. Find one that actually cares about your health there are plenty out there

  3. Ron E.

    on May 28, 2018 at 12:45 am

    I have been told I have an ascending aortic aneurysm 4.5cm dia. The cardiologist has chosen to try medication to relieve the hypertension ( caused by Conn’s Syndrome) that has produced the aneurysm. So far it has had marginal effect, coming down from 180/120 to 160/110. This last figure has been my average for nearly 20 years, occasionally higher. As this aneurysm was not picked up by previous echo cardiograms (2 in the last 5 years), and even as recently as 2 months ago I had a heart X-Ray which did not pick it up, should I be concerned that it might to be growing very fast? I always experience chest and back pains , even on light exertion, as well as breathlessness. At what stage should I insist on surgical intervention? The hypertension caused by Conn’s is very difficult to control as it involves various endocrine hormones, mainly aldosterone, and in the past I have had poor or no response to the usual Cardiac drugs used. I am left wondering if the specialists fully realize what additional stress this “ticking time bomb” inside me is causing.
    Where do I go from here?

  4. Lisa

    on August 1, 2018 at 3:43 pm

    I would suggest Ron that you run don’t walk to the hospital for immediate diagnostic treatment as you could die in your sleep from aortic aneurysm. VERY SERIOUS!!! I lost my 56 year old friend this way and it is oh so sad.

  5. Thomas

    on September 16, 2018 at 5:35 pm

    I have occasional throbbing in my abdominal region. I am going to see a doctor as soon as possible. Is the throbbing alone enough to indicate a possible aortic aneurysm? I’d like to thank the doctor for the “prevention-is-easier-than-cure” mantra. I will remember that.

  6. Aronald

    on October 5, 2018 at 8:23 pm

    I almost had a stent placed 4 months after a mild heart attack 2 yrs ago. I say almost because the doctor placing the stent cut my aorta instead and I ended up with a triple bypass. I’ve felt weak and out of breath since – never felt this way before the bypass – and the doctors kept saying it was in my head and I just needed to exercise more vigorously. Went to a new doctor last week. He gave me a stress echo and found an aneurysm at the juncture of what’s left of my aorta and the vein they took out of my thigh to repair the tear my other doctor made when he screwed up trying to place the stent. Based on the size and location they say open heart is my only option. All I can think is screw me once shame on you, screw me twice I’m an idiot, screw me a third time I die on the operating table. I get that I now have a severly limit life expectancy, but other than that am I missing anything here?

  7. Aronald

    on October 5, 2018 at 8:28 pm

    Forgot to add that it’s an emergent aneurysmal dilitation of the thoracic aorta at the level of coronary bypass.

  8. Bill D.

    on November 9, 2018 at 11:15 am

    I am a 76 year old male with no previous cardiac issues. I have been diagnosed recently with an aortic aneurism close to the base of my heart. I have no symptoms and was surprised when the Cardiologist, after an ultra sound of my heart, informed me of the condition.
    It is 4.3cm. I have never smoked but do have genetically related hypertension and have been on BP medication many, many ye-.ars. My normal BP, when at rest is in the range of 127/73 =/. Normal heart rate 70-88.

    These are my concerns: I have always been a physical person without weight issues. My weight ranges 190-201 but mostly an avg of about 195. I am 6’1″. I still would like to continue to play tennis. I walk a couple of miles a day and ride my bicycle several times a week. Is this safe? Am I at risk of dropping dead on a tennis court or taking a walk.

    This is very concerning to me. Would a surgical repair be suggested with a 4.3cm aneurism?

    This is the best site I have seen on this subject. Simple and to the point. Thank you.

  9. Sam

    on December 10, 2018 at 3:18 pm

    Hi Bill and Ron. Its typically thought that aortic aneurisms under 5cm diameter can be monitored over time but greater than 5cm may require surgery. This is because surgery has its own risks and studies have shown that aortic aneurisms under 5cm are not an immediate concern. That said I am not a doctor and every patient is different. Some patients may have other health concerns that may warrant a earlier surgery. Its always important to weight out the risks of surgery vs not having surgery but a discussion with your doctor who knows all of your health information, your values, your goals and should be able to give you the information you need and help you make a decision. I can imagine its a tough situation to be in but I always say that a person shouldn’t base their healthcare another persons experiences since every individual has unique health concerns but rather with a healthcare provider that you can trust.

  10. John R

    on August 26, 2019 at 7:26 am

    DR Sinatra I have a aorta aneurism for 8 years it was work related when found it was 3.7 . I called Dr Becker he said to take omega 3 and you took as much as 10 G a day . I started with 10 and reduced it to 4 G a doy the aneurism stabilize at 4.2 for 4 years . Then a tecnicktion ad used me and it when to 5.4 . I started taking 6 G of victim c and it reduced to 3.2 . I’m now 79 years old and a cardiologist gave me a complete hart examination no blockage but I have sick sinus rhythm . Pluse rate 108 to 76 it use to br in the low 50. I am now taking 5G of omega 3 high quality.Dhe 2G Epa 5G to avoid blood clots.

  11. Marie

    on August 26, 2019 at 5:42 pm

    As a middle aged relatively healthy caucasian woman who watched both her parents die of heart complications in the last 7 years, I decided to become very proactive about my own health. I’ve had the same primary care Dr. for the past 20 years, an Internist with endocrinology as her focus. who is almost the same age as myself. However, even she could not figure out the cause(s) of some very life intrusive, debilitating conditions that were severely interfering with my day to day life, including my job. Therefore, I took it upon myself to learn as much as I could what the possible causes of my conditions might be. What I learned has taken over 7 years of voracious reading, and I am still learning. As Dr. Sinatra stresses over and over again in his blogs, NUTRITION (what we put in our bodies) is the number one factor we can control to create and maintain good to great health. 7 years ago, I strictly disciplined myself by changing my diet to 80% fresh vegetarian and 5-10% fresh fruits (only ORGANIC for obvious reasons – Dr. Sinatra recently posted a blog why this is important), and healthy 10% fats and protein (organic extra virgin olive oil, organic flax oil, coconut oil, occasional organic unsalted butter (it’s more expensive so I use less), some cheeses such as Swiss, Feta, goat, organic Cheddar, and deep water fish , or Alaska wild salmon (to minimize heavy metals such as mercury and cadmium) in season when its cheaper, organic pasture raised chicken, eggs, etc). I’m not a red meat eater anymore, but if I did want to eat it, I would limit it to very small portions of grass fed and pay attention to where it is raised).

    After doing all of this, I was still not where I wanted to be energy or health wise. And my Dr. kept telling me that except for elevated blood pressure (140 – 150/86 or so), she thought I was in good health. Well, I may have been in comparison to some of her other patients, but not for me. I still work a demanding job full time, and plan to until at least 70, so I need more than “good”, I really need optimal health, and I was still taking too many sick days from work..

    I read about Dr. Sinatra in Suzanne Somers books – I’ve bought and have read almost everything she has published – and believe me, if I had known about him before I lost my mother, I might have been able to send her to him and she may still be here. My father also. Anyway, I decided I needed a more integrative, comprehensive evaluation, so I opened a Health Spending Account (HSA), and in 1/2019, paying out of pocket, I went to an “anti-aging” clinic locally. They ran a very very comprehensive blood test, provided me with a 26 page assay, and for the first time I had some answers. I found out, for example, I carried a gene from 1 of my parents that put me at risk for the same heart disease that my mother had. I found out ALL my cholesterol levels, not only the basic HDL and LDL. I found out that although I have very good HDL, there is one LDL level that is very high and needs to be lowered. I learned that there are natural ways to support the body to lower this, such as more moderate exercise, drinking plenty of pure water daily, eating smaller portion sizes at meals, and adding a high quality Norwegian Fish Oil every day (EPA 800, DHA 500-600). (I was already taking CoQ10 for many years). I also REALLY SERIOUSLY stopped eating sugar and simple white carbs. Yes, this is not easy, in fact it is HARD, but I want a quality of life into my senior years so I had to make that choice. Also, I will be quite aged when (if) I retire, so its important for me to have as many years as possible to enjoy retirement, and do other things I’d like to do, with my heart and brain in good to great condition.

    I have realized that the human body is quite an amazing organism, and if we give it what it needs, it can do its job pretty well such as filtering toxins from our bodies, etc. I am so grateful to Dr. Sinatra for his passion to help people to understand that our Drs. are here to help us, but ultimately, each of us is unique, so we need to pay attention to what our body tells us, so we can address problems when they are small, and have the ability to heal from them. I wish you all the very very best of health!!

  12. Jane C

    on August 31, 2019 at 3:28 pm

    Hi Dr Santra

    I h ave just had this echo result back but as you can see they discharged me with only a repeat echo in 5 yrs and

    I hope you dont mind me writing about the letter below that you sent to my doctor. I am a bank medical secretary here at the RD & E and would welcome some clarification about some of the comments in your letter. I have put brackets around the bits I am concerned about but I am disappointed that I have been discharged without having a discussion in the outpatient clinic, as I do have some very real concerns about the content of this letter, even though they say the findings are reassuring.

    I wonder if you could help me decipher the echocardiogram result below. I am rather concerned that they have discharged me, especially as you say I may need further interval measurements later? How will another interval measurement be picked up if I am discharged?

    The echocardiogram shows normal biventricular structure and function. (There is a mild degree of diastolic dysfunction). The atria is of normal size. (The RCC and LCC of the aortic valve appear partly fused but there is no significant aortic stenosis or regurgitation). The aortic root is mildly dilated when indexed with the BSA.The absolute values are 3.5cm at the sinus of valsalva and 3.4cm at the ascending aorta. There are no other significant abnormalities.These findings are reassuring. I am happy to discharge her back to your care but I will arrange a repeat echocardiogram in 5 years time just to reassess the aortic root dimensions. (She may require further interval measurements in due course).

    How will you do further measurements/echocardiogram if you have already discharged me?

    Previous history
    I have previous history of PAF which I believe was caused by years of under-treatment of the thyroid. I have Hashimotos Thyroiditis and am now on T3/NDT (natural dessicated thyroid) as Levothyroxine does not work for me. I previously lost daughter from heart at 18 mths in BRI years ago Tetratology of Fallots. My mum also had an enlarged heart caused by Rheumatic Fever. Husband also had AF ablation twice!

    I feel that it may have helped if they could have discussed the results with me personally in outpatients as well as asking about my previous history.

    I am concerned about the fact that I cannot have an earlier echocardiogram than 5 years bearing in mind my age (64) , although I appreciate
    there are probably Guidelines surrounding this.

    Thank you so much for your help.


  13. ROSA T

    on November 25, 2019 at 5:01 pm

    My mother in law had an aortic heart aneurysm 9 years a go. Recently it was discovered that her heart aneurysm is growing and she needs surgery right away which she has refused. Does anyone know an estimated time of life expectancy with this diagnosis?
    Thank you

  14. Debbie

    on June 24, 2020 at 10:31 am

    what is other procedures to correct an aortic aneuysms that is 4.5 cm

  15. Sandi

    on July 1, 2020 at 2:19 pm

    Hello Debbie,
    Thanks for reaching out, this is what Dr. Sinatra had to say:
    “The trouble size range for an aortic aneurysm is when it gets to 4.5 to 6 cm. You are at the lower end of that range,
    so the aneurysm is getting large and requires diligent monitoring. I am sure your MD’s follow you closely and track
    your aneurysm with echocardiograms, CT imaging, and the like. Be sure to keep regular follow up appointments with them.
    They most likely have given you a list of warning symptoms to watch for. Solutions for aneurysms involve surgery, and your
    own doctors can recommend what is the best approach for you. Be aware that it is better to act sooner with elective surgery,
    rather than later in an emergent situation.

    I take aortic aneurysms seriously. If we had any idea my dad had one, then we could have saved his life. At least you have that knowledge,
    so you can make informed decisions. Take care, Debbie.”

  16. Susan O.

    on January 17, 2021 at 4:42 pm

    I was diagnosed about six years ago with a 4.1 size upper thoracic aneurysm, I have NOT scans every two years now to monitor this, size has not changed in this time. I also have meds for an interactive thyroid, and regular B12 injections for pernicious anaemia, and recently diagnosed with Fibromyalgia, can these other health problems affect the aneurysm? I am 66yrs old, have never smoked, and am a moderate drinker.

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