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Aneurism of the Aorta.
Symptoms,-The symptoms caused by aneurism of the aorta vary considerably, according to the part of the vessel which is affected. The aorta extends upward from the base of the heart, behind the upper part of the breast bone, and then curves back ward and to the left, so as to reach the spinal column, along which it proceeds into the abdomen. The artery may be dilated at any point in its course, but is especially apt to undergo this change in the immediate vicinity of the heart. If the dilatation occur at that part of the vessel which lies behind the breast bone, there is often a swelling or tumor in the upper part of the chest, sometimes press ing one or two ribs a little forward, at other times merely filling out the spaces between the ribs. This tumor is apt to be tender upon pressure and painful. It usually gives a feeling of throbbing, corre sponding in time to the beats of the heart. When situated in this loca tion the tumor sometimes causes some numbness and loss of power in one or both arms. The circulation of the arms may be very feeble, causing one limb to be cooler than the other. This feeble ness of the circulation may be also indicated by the absence of pulse at the wrist of the same arm. Sometimes, too, there is decided interference with the return of blood from the head, causing the face to be somewhat puffed, and to exhibit a dusky or livid color.
If the dilatation take place a little further toward the left, the dilated vessel may press upon the windpipe or one of its branches, causing an obstruction to breathing; if this be considerable, the effect is indicated by a loud, hoarse noise, which may .be heard at some distance during the act of breathing. If the obstruction be considerable, the patient may show signs of a lack of breath by blueness of the skin. There may also occur a spasm of the larynx in consequence of this pressure upon one of its nerves ; in this case the patient suffers extremely in his efforts to breathe, and may seem to be suffocating. These symptoms may be so prominent as to mislead the physician into the belief that there is an obstruction in the larynx itself, and instances are known in which an operation has been performed for opening the windpipe, under the impression that the breathing would be thereby relieved.
The tumor may press also upon the oesophagus, whereby the passage of food into the stomach is impeded. Sometimes the most prominent symptoms are associated with the digestive organs, the patient being afflicted with obstinate vomiting. At other times pressure on certain nerves may cause partial or complete paralysis of a considerable part of the body. As has been already remarked, the pressure of the tumor frequently causes extreme pain in the chest and arm, these neuralgic attacks being desig nated angina pectoris.
It is evident, from what has been already said, that the detec tion of an aneurism of the aorta is a by no means easy matter ; indeed, the physician himself, though suspecting the existence of this difficulty, may long remain in doubt before he can satisfy him self as to the nature of the difficulty. The symptoms are so vari able in different cases that a non-professional person cannot be trusted to ascertain the presence or absence of aneurism.
Aneurism of the aorta almost invariably results in death. The chief question after the diagnosis has been settled, is, how long can the patient survive? There are, it is true, instances in which recov ery has occurred, either spontaneously or under treatment; in these cases the dilated part of the vessel becomes filled up with coagulated blood. But in the great majority of cases death results either from bursting of the aorta, so that the patient bleeds to death in a few minutes, or from the long continued pressure of the dilated vessel upon different organs, causing fatal disease. A patient suffering from aneurism of the aorta is not sure of life from one hour to another, since death may result even before the symptoms from pressure have occasioned serious inconvenience. Indeed, instances are known in which sudden death has occurred in previously healthy individuals, who had never exhibited marked symptoms of any disease, in which postmortem examination has shown the cause of death to be the bursting of an unsuspected aneurism.
No treatment is known whereby an aneurism of the aorta can be cured, or the dilatation of the vessel even arrested. The treat ment must, therefore, be directed simply to the relief of suffering and the prolongation of life. Everything which increases the force of the circulation, or stimulates the heart to unusually strong action, must be avoided; since, by increasing the strain upon the dilated vessel such influences increase the danger of rupture. Hence, all active physical exertion and all extreme excitement should be avoided. The general condition of the patient should be as good as possible, though it is not desirable that he should become exces sively stout. The pain must be relieved by opiates or other nar cotics, the quantity of which depends upon the intensity of the pain.
Aneurisms sometimes occur in other parts of the body. That is, it is in other arteries than the aorta. Among the most frequent locations is the back of the knee; the large artery which passes from the thigh to the leg runs across the back of the knee-joint, and in this situation is sometimes enlarged. This affection can be readily recognized by the size and shape of the tumor, as well as by its pulsations.
The treatment of an aneurism at the back of the knee is a surgical procedure which should not be attempted by inexperienced hands.
Aneurisms are also liable to occur in the arteries of internal organs, especially of the brain. In these cases it becomes im possible to recognize the nature of the condition, since the symp toms are merely those of interference with the functions of the various organs. The bursting of an anuerism of the brain is a frequent cause of apoplexy.
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