- 6 days ago
An aortic aneurysm can be a life-threatening condition if not detected early. In this month’s Stay Well Health Chat, Andrew Salciunas speaks with Eden Payabyab, MD, a Virtua Health vascular surgeon, about what an aortic aneurysm is, how it develops, and why timely diagnosis is so important.
Dr. Payabyab explains that the aorta is the largest vessel carrying blood from the heart to the rest of the body. Over time, factors such as high blood pressure, high cholesterol, family history, or genetic conditions can weaken the aortic wall. This can cause the wall to bulge like an overinflated balloon, increasing the risk of rupture or tear—a medical emergency.
Dr. Payabyab explains that the aorta is the largest vessel carrying blood from the heart to the rest of the body. Over time, factors such as high blood pressure, high cholesterol, family history, or genetic conditions can weaken the aortic wall. This can cause the wall to bulge like an overinflated balloon, increasing the risk of rupture or tear—a medical emergency.
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LearningTranscript
00:00Hello, everyone. I'm Andrew Salchunas from 97.5 The Fanatic, and welcome in to another month of the Virtua Stay Well Health Chat.
00:09I always love doing these. I tell you guys every time I do one, I have a lot of family members in the medical field.
00:15So these are really special to me because I think I know what I'm talking about, and then I quickly find out that I have no idea what I'm talking about.
00:23And that's why I turn to the experts from the Virtua team. And today, I'm so lucky to be joined by Dr. Edin Pialbel, MD, board-certified, highly experienced cardiothoracic surgeon caring for adults with complex heart conditions.
00:38What I always say is the longer the bio, the better the doctor is. You can confirm that with me at some point, Doc, but you are a graduate of the University of Buffalo Jacobs School of Medicine.
00:48You have been just doing so much stuff. I know all about the effort that it takes to get to the point where you are at in your career, and I know that all that work pays off, and it's great, and you help people, and that's wonderful.
01:02And today, we're going to talk about something that I know family members of mine have dealt with in the past, so I'm excited to get the information from you, and I hope everybody that watches this, first and foremost, thank you so much for coming on today. I appreciate it.
01:15Thanks so much for having me. I'm excited to talk about one of my favorite things to talk about.
01:20And we're talking about aortic aneurysms. So what is an aortic aneurysm, and how is it formed?
01:28So an aortic aneurysm is a bulging or ballooning of the aortic wall. The aorta is the largest vessel that brings the blood from the heart to the rest of the body.
01:37Throughout time, the aortic wall weakens due to factors like high blood pressure, high cholesterol, and in some instances, family history, a genetic condition.
01:48So imagine it's like a balloon. You have this pipe that then starts to get larger. The walls weaken, and when the pressure pushes up against it, it starts to bulge or balloon, putting it at risk of rupturing or tearing, which is an emergency.
02:02And so how common are aortic aneurysms? I mentioned I know somebody in my family that unfortunately suffered from one. So is this common? Are certain groups more at risk than others?
02:15So there are two types of aneurysms. One is more common than the other, but they do happen more often than people think.
02:22So abdominal aortic aneurysms, which are in the belly, happen in about 1 in 25 people, and thoracic aneurysms happen in about 1 in 10,000, but they are more common than people think.
02:35And patients above 65, especially men who are smokers, are more at risk of aortic aneurysms.
02:42And again, family history plays a big role into it. So if you have a family history, you're more at risk, and that happens more in those populations.
02:48So before we continue learning more about aortic aneurysms, I want to know, how did you get into this field?
02:55I mean, you've done a lot. I mentioned the bio. I'll go through it now.
02:58You completed your fellowship at Emory University, New York Presbyterian, Weill Cornell Medical Center, Memorial Sloan Kettering Cancer Center.
03:07Like, you have done so much in your career to get to the point where you're at now. What led you to this decision?
03:13So the biggest decision was going into heart surgery. And, you know, I was in the operating room.
03:20I saw what the surgeons were doing to save patients' lives and the differences they were making, and really loved the pathophysiology of heart disease.
03:29My love for aortic surgery came mostly because I get to see patients continuously.
03:34We'll talk about it a little bit later, but one of the big things that I do is aortic surveillance.
03:38So when patients, we find a patient has an aneurysm, I get to see them do surveillance, make sure it's not growing, or if it is growing, we have to start talking about surgery.
03:48But I get to see these patients over and over again.
03:51So I'm not just operating on people and not getting to see how they are after surgery.
03:56I get to follow them and see how they're doing year to year.
03:59So we'll get to the post-op. Let's get to the pre-op.
04:05I'm not somebody that just knows, hmm, let me go to the doctor to see if my aorta's in trouble.
04:11Let me go see if I'm going to have an aortic aneurysm anytime soon.
04:15So what are some of the early signs that somebody that's watching this video can say, all right, let me keep an eye on that so I can maybe detect that there's something coming my way?
04:24So a lot of times there are no early signs. Some actually say it's a silent threat because patients don't know they have these aneurysms.
04:32If patients do have symptoms, they could be a continuous chest pain or back pain.
04:38And if we're in the situation where it's an emergency, a lot of patients in those situations will present with the worst pain they've ever had in their chest,
04:47a tearing chest pain that they feel that just doesn't get any better.
04:50A lot of times that's an indication that we are in an emergency where it's ruptured or it's torn and we have to act on it sooner than we can.
04:59So you mentioned smoking and how that could obviously be a factor.
05:03And I feel like smoking is tied to a lot of health issues that we see across the United States and across the world.
05:09What are some other lifestyle factors that may raise the risk of an aortic aneurysm?
05:15So some other key factors are high blood pressure.
05:18So we talked about how it's a balloon that expands.
05:21When you have that high pressure that's hitting against the walls, it does cause it to bulge faster.
05:27Think about, you know, a water balloon you're filling up with a hose.
05:30When you turn that screw higher and the water's coming out more, that balloon gets larger faster.
05:35So high blood pressure, managing that with medications if you have to is important for risk modification.
05:41Your cholesterol, so if you have high cholesterol, you can have calcium that builds and that also weakens the wall.
05:47And we talked about family history.
05:49One of, you know, a genetic component has been found in these aneurysms.
05:52So knowing your family history is also important.
05:55At what age do you think maybe somebody should get screened for that?
05:58As I mentioned, I have somebody in my family that did suffer from an aortic aneurysm.
06:02Is this something where, like, a child should go get screened?
06:05Or is this something where maybe it's teenage, early adult years?
06:08What sort of process would you consider for somebody at whatever age?
06:12So there are certain genetic diseases such as Marfan syndrome or Lois-Dietz.
06:18And if you have that in your family history, you would start doing a screening sooner in the patients in their 20s.
06:24If you have a family history of a sibling or a family member who had an aortic aneurysm, starting to screen 10 years before theirs was found or at the age of 30 is what I would recommend.
06:35What goes into the screening?
06:37Like, we hear screening.
06:38What exactly is the screening for somebody that may want to check if they could be at risk for an aortic aneurysm?
06:44So doing a CT scan.
06:46So imaging that takes a look at the inside of and we can get better pictures of what your aorta looks like.
06:54Okay.
06:54And so earlier we talked about, you know, what you got in, how you got into this and everything that you like doing, how you help people before, during, and after.
07:05When is it that you yourself get involved in patients' care for this condition?
07:08So I get involved when we do find an aneurysm and it reaches a certain point of size.
07:15So, and if it's growing rapidly and we're concerned that it's growing to a point that it does need surgical intervention, but I do see patients in surveillance.
07:24So I'll see patients, you know, they'll have a CT scan that shows the aneurysm.
07:29They come to me and then we start monitoring the size of it.
07:32I become part of your monitoring care team.
07:34It doesn't necessarily mean that you need surgery, but I do start talking to patients about surgery.
07:40If it reaches a certain size, which is usually five centimeters.
07:44Is surgery really the only option?
07:47Because when you say monitoring, does that mean, all right, you are on pace for at one point you're going to get surgery?
07:53Or could you monitor it and change some lifestyles and then all of a sudden that's not a risk anymore?
08:00So there are plenty of patients that I see in my clinic every year and they're not growing because we do keep their blood pressure under good control.
08:06They've chosen to stop smoking, their cholesterol is under good numbers.
08:12So, you know, I do have patients that I have not operated on and we continue to say, okay, we're going to see you in the next year.
08:19So surgery is not the only answer.
08:22We do surveillance because we want to make sure we're not at risk of it getting larger and being at risk of rupturing or tearing.
08:28I feel like if somebody's watching this, they may be scared, right?
08:32Like whenever we talk about health, we get scared.
08:35You've been doing this for years now.
08:36Can you tell the people that may be a little nervous, shaking watching this video?
08:41Maybe this is something that I've dealt with with my family.
08:43Maybe this is something that I'm at risk for.
08:45Maybe some success stories because it's not just leading to death.
08:49Like what are some success stories that you have from your career that might put somebody at ease watching this?
08:55I think the most important thing, and I start a lot of my clinics off by saying this, just because you're seeing a surgeon doesn't necessarily mean that you need open heart surgery.
09:03Again, I see patients for surveillance, and if it grows, then we have to talk about doing surgery.
09:10I have patients that come, and they present to the emergency room with chest pain or shortness of breath.
09:17They get a CT scan, and we find that they have an enlarged aneurysm, and I operate on them, and they're back home to their family members within a week feeling better.
09:27And that chest pain is gone, and their risk of it tearing or rupturing is gone because I've removed that aneurysm and that risk.
09:34So if somebody's watching this and they say, all right, I smoke, I have high blood pressure, or maybe somebody's watching this and says, I don't have any of these issues.
09:45Are there any other life's choices that you can make?
09:48We always hear about, hey, just exercise.
09:51Like, what other life options are there to try to make sure that you don't put yourself at risk?
09:57I think it's decreasing your risk in any health situation is eating a healthy diet, heart-healthy diet, exercising, and keeping up with your appointments and taking your medications as you need them absolutely can decrease your risk.
10:13So before I let you go, and I really, really appreciate the time.
10:17I know I've learned a lot.
10:18I hope everybody that's been watching has learned a lot, and I hope your success stories have put people at ease.
10:23What other final words of advice would you have somebody that's watching this that, A, may be hesitant to get screened, or B, may have had issues in the past, but they say, ah, I'll be fine.
10:34If you could give some word of advice, if you're sitting down with a family member and you wanted to sort of shake them and say, hey, get yourself checked out, what would you say?
10:43Don't ignore your heart.
10:44There are so many conditions that are silent, like aortic aneurysms.
10:49If you have the risk, go see your primary care doctor, one of the physicians, and take care of yourself.
10:57Keep your appointments, keep a heart-healthy diet, exercise, take your medications, and don't wait until you're not feeling right because, you know, it's important for surveillance.
11:07There's reasons why we do it, and it really does and can save a life.
11:12Absolutely stay on top of it, and everyone here at Virtual Health, we're here for you.
11:16We're here to keep ahead of it and keep you safe and healthy and keeping up with your family.
11:22And I think that's an incredible message to end it with because Virtual Health, really, every single month I do one of these Stay Well Health Chats, we talk about heart, we talk about lungs, we talk about aortic aneurysms, we talk about brain, we talk about skin.
11:35We've talked about it all during these Stay Well Health Chats, I've learned a lot, I hope you all have learned a lot as well.
11:41Doctor, seriously, thank you so much for the time today.
11:44I hope somebody learns from this and maybe takes care of themselves so that we don't get to the point where maybe it leads to surgery or maybe even worse.
11:52Thank you so much for the time today.
11:54We appreciate it.
11:55Thank you so much for having me.
11:56Thank you so much for having me.
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