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Dated Dec 17, 2022

THORACIC AORTIC ANEURYSM: CONDITION THAT KILLED GRANT WAHL

AMERICAN FOOTBALL writer Grant Wahl, 49 and seemingly healthy, suddenly died last week with some suspecting foul play. However, his autopsy found that Wahl had an "ascending thoracic aortic aneurysm", The New York Times reported.

The condition

An aneurysm is a localised weakening of the wall of a blood vessel, causing the vessel to bulge in that area. It increases in size over time, and the wall of the blood vessel affected gets progressively weaker. The vessel may ultimately burst or separate, triggering a bleeding rush that can be potentially lethal.

An aortic aneurysm is a weakening and bulging in a portion of the aorta, the main artery that ships blood out from the heart; "thoracic" refers to the chest region.

Causes and symptoms

Among the possible causes of thoracic aortic aneurysm, a Johns Hopkins note lists (i) degenerative disease breaking down the aortic wall tissue; (ii) genetic disorders; (iii) family history; (iv) inflammation of the arteries; and (v) plaque build-up on the artery walls.

The NYT report said doctors are exploring whether Wahl had Marfan syndrome, a genetic disorder that increases the risk of this type of aneurysm. According to the CDC, the syndrome presents in around 1 in 5,000 individuals, and limits the body's ability to make the proteins needed to build connective tissue.

Symptoms of thoracic aortic aneurysms may depend on the location, size and speed of growth of the bulging; often, there are no symptoms at all.

Symptoms, if they appear, may include (i) pain in the jaw, neck, chest, or upper back; (ii) wheezing, coughing, or shortness of breath (due to pressure on the trachea); (iii) hoarseness (due to pressure on the vocal cords); and (iv) trouble swallowing due to pressure on the oesophagus.

Since these symptoms are not unique to this condition, medical attention is often delayed. For instance, Wahl had complained of a "cold" in the days before he passed away.

Diagnosis and treatment

According to the Johns Hopkins note, a doctor looks at the patient's medical history and carries out a detailed physical examination, including a CT scan, an MRI, an echocardiogram, a chest X-ray, and an arteriogram (angiogram).

Treatment includes monitoring the size and rate of growth of the bulge, and managing risk factors such as quitting smoking controlling blood sugar, losing weight, and eating healthy. Medicines may be prescribed for high cholesterol or high blood pressure.

Surgical intervention is needed when an aneurysm is large and causing symptoms. This may include thoracic aortic aneurysm open repair or endovascular aneurysm repair (EVAR). Surgeries can remove the aneurysm, or insert a stent to support the blood vessel against possible rupture.