A hernia, aneurysm, on the large body pulse vein in the abdomen means that a section of the pulse vein dilates. This can weaken the vessel wall. Most people who have such a hernia have no trouble with it, but if the hernia breaks it is life threatening because you get internal bleeding.
Risk factors for getting the disease increase if you
- have close relatives who have or have had the disease
- has angina in the heart or legs
- have high blood pressure
- eat unhealthy foods
- has abdominal obesity.
More men than women get heart disease and rarely before the age of 60. Pulmonary artery disease is not as common a vascular disease as heart attack or stroke.
Not smoking is especially important as it is more common for smokers to get body artery hernia than non-smokers. Women who smoke have almost twice the risk of getting the disease compared to men who smoke. Quitting smoking also reduces the risk of a pulmonary artery rupture in the stomach.
Abdominal obesity and unhealthy diets are other important causes for the disease to develop. There is also a hereditary component, so if you have parents or siblings with the disease, the risk is clearly increased.
In all county councils and regions, all men at a certain age, usually at 65, are called for an ultrasound examination to detect early pulmonary artery rupture.
For the most part, you cannot feel a heart ulcer in the stomach. But if the hernia grows unusually fast, you may feel that it hurts, feels tender or pulsates in the stomach.
When the rupture ruptures, you often experience sudden pain in the abdomen or lower back. Due to the bleeding from the large body pulmonary veins, you can simultaneously come in a shock state. Then you get pale, cold sweaty, get a high pulse and maybe faint.
You can live with a moderately large pulmonary artery in the stomach with minimal risk if it is checked regularly. If the hernia grows in size to a certain limit, prevention is most often used to avoid a rupture.
If the hernia breaks, it is important to get to the hospital quickly and be operated on.
When to seek care
If you suspect that you have hernia in the large body pulse vein in the stomach, you can call the health information or contact a health care center.
What happens in the body?
Fracture on large body pulmonary artery
Large coronary arteries lead the blood from the heart into the body. A hernia on the large body pulmonary artery means that the vein expands and expands. Another word for hernia is aneurysm and if the vein dilates in the abdomen, where the hernia is usually located, it is called abdominal aortic aneurysm. One can have such a herd for a long time without the trouble of it. But the pulmonary artery wall is weakened by the rupture and if the vein breaks, you risk a life-threatening bleeding.
More men than women get heart disease and most often it is men over 60, but heart disease is not as common a vascular disease as heart attack or stroke.
Large body artery veins go behind the stomach
Large aorta, the aorta, is the body’s largest artery. It carries the blood from the heart into the body. Large body pulmonary veins pass from the heart down through the chest. From the chest down to the abdomen, it passes behind the stomach and liver.
Out of the coronary artery in the chest above the heart, blood vessels go to the head and arms. At the bottom of the abdomen, the large body pulse vein is divided into two slightly narrower pulse veins leading down into each leg.
Where the large body pulse vein passes through the abdominal cavity and where the hernia is most often located, just below where the pulmonary veins go to the kidneys, the diameter of the veins is usually one and a half to two centimeters. It is slightly wider in men than in women and is slowly increasing in width with age.
What is a heart disease?
A pulmonary artery rupture means that the pulse vein is expanded at least one centimeter to over three centimeters in diameter. The enlargement may be either rounded or more elongated and bobbin-shaped. The vein can be stretched four or five times its usual width. The enlargement of the vein is due to the weakening of the connective tissue in the outer and middle layers of the vein.
A hernia can sit on any pulmonary vein, for example, on small vessels in the brain where it can cause brain bleeding or on a smaller blood vessel in the knee joint. On the large body pulmonary artery it is usually located in the stomach and sometimes in the chest.
The cause is not entirely clear
Why you get hernia in the big body pulse vein is not entirely clear. Some of the most common risk factors that can contribute to herniation of the large arterial artery are
- age, over 60 years for men, over 70 years for women
- close relatives who have had hernia on the large body pulmonary vein
- angina in the heart or legs
- unhealthy eating habits
- abdominal obesity.
Pulmonary artery rupture can be caused by, for example, Marfan’s syndrome and other hereditary diseases that weaken the connective tissue of the vessel walls, among other things, but it is very uncommon. Other unusual causes are, for example, inflammation of the blood vessels called arteritis and bacterial infections of the vessel wall.
More common in men
Most people who have a hernia on the big body pulmonary vein in the stomach get no trouble from it. If you are under 50 years of age your body pulse vein is very uncommon while about two, three out of a hundred men in the age of 65 have a hernia in the large body pulse vein in the stomach. With reduced smoking, the incidence has decreased over the past twenty years.
Significantly fewer women than men experience a pulmonary artery hernia and, moreover, only at a significantly higher age, over 70 years. However, the risk of rupture is slightly higher than in men. Fractures on large body artery arteries in the stomach are not as common cardiovascular disease as angina, myocardial infarction, heart failure and stroke.
Smoking increases the risk greatly
Not smoking is especially important as it is two to three times more common for smokers to have broken body pulmonary artery hernia than non-smokers. If you also have the disease in the family, there is even more reason not to smoke.
If you smoke and have a hernia in the large body pulse vein in the stomach, you can reduce the risk of it getting bigger by quitting smoking . Smoking causes almost twice as much increased risk of getting the disease for women as compared to men. Therefore, the benefit of smoking cessation is even greater for women than for men.
Operation prevents rupture
Usually, a rupture does not occur on large body artery arteries in the stomach. It usually expands at a slow rate and if you have a hernia you usually get to go on regular checks when the doctor measures the enlargement.
Going for controls for a small pulmonary artery in the stomach is very safe. There is no reason for concern or to avoid exertion or sexual intercourse. On the contrary, one should live as usual, except that one should, as everyone, live healthier by, for example, quitting smoking.
However, if the diameter of the hernia exceeds five and a half centimeters for men and five centimeters for women, the doctor usually suggests a preventive surgery to avoid a rupture that can cause life-threatening internal bleeding.
If a pulmonary artery rupture breaks
If the hernia breaks, it is very important to quickly get to the hospital and be operated on. Ruptures are life-threatening because you get internal bleeding. If you go to hospital quickly, chances are that you will survive significantly, yet fewer than half of those who experience a rupture of the large coronary artery will survive outside a hospital.
Read more: Heart and blood circulation
Symptoms and diagnosis
Usually no symptoms
You can have a hernia on the large body pulmonary vein in the stomach for a long time without having any trouble with it. But if the hernia grows unusually fast, a symptom may be that it hurts or feels sore in the stomach. You may also feel that it pulsates in the stomach more than usual, it may feel like the heart is sitting in the stomach instead of in the chest.
Usually you cannot feel a hernia in the stomach. If you are thin, you can feel the pulse of your body pulse if you push your stomach. It does not mean that you have hernia but only that you feel the healthy body pulse artery pulse.
Fractures can be detected during a medical examination
A rupture of the large body pulmonary artery can be detected, for example, when a doctor at a health center examines the stomach for soreness or if a doctor does a body examination or orders an x-ray or ultrasound examination for some other reason.
During a physical examination, the doctor presses and squeezes with both hands on the abdomen to feel if it is sore, hard or soft. The examination is done if you seek treatment for stomach pain yourself, but are also included as part of the body examination that is done if, for example, you are admitted to a medicine or surgery clinic.
Occasionally, the doctor may detect a hernia on the large body pulmonary artery by feeling a pulsating bump in the middle of the abdomen, above the navel. You can usually not feel the bulge yourself. If you are overweight, it can also be difficult for a doctor to feel the pulsating bump.
An ultrasound examination is often performed
To know for sure if there is a rupture of the large body pulmonary vein in the stomach, the doctor usually does an ultrasound examination that is simple, completely harmless and does not hurt.
With the help of the examination, a hernia is easily found and it is easy to measure the expansion of the pulmonary vein. The width is what says most about the risk of a rupture.
Although the physician assesses that there is no risk of the hernia breaking within the near future, it is necessary to examine every half or full year with ultrasound or x-ray. It is to check if the hernia grows. If the enlargement is small, you can safely wait two or even five years with a new ultrasound examination. Each unit examining the body’s pulmonary artery has routines for how often the checks should be done.
Most hernias are slowly increasing in size, with between one and five millimeters per year. The speed depends on the diameter of the hernia, the larger hernia the higher the speed. Therefore, after a coronary artery hernia is found in the stomach, it may take several years before an operation is required.
65-year-old men are offered a survey
In all county councils and regions, all men who are 65 years of age are offered an ultrasound examination of large body pulmonary arteries in the stomach. In some county councils, older men also receive an invitation.
The examination is done with ultrasound, is completely painless and takes about five minutes. You are told immediately whether the size of the vein is normal or not. If there is a rupture of the coronary artery, you may need to consult a nurse or physician for more information, discuss checks or the treatment that may be needed.
If the rupture breaks
If the rupture ruptures, you often experience sudden pain in the abdomen or lower back. Due to the bleeding from the large body pulmonary veins, you come in a shock state at the same time. You get pale and cold sweaty, get high heart rate and blood pressure drop. The drop in blood pressure makes you feel tired and dizzy and you can faint.
Read more: Ultrasound examination
Care and treatment
When to seek care?
If it feels sore in the stomach, you can go to a doctor at a health care center . The doctor then does an examination and suspects a body pulmonary artery hernia can be referred for an ultrasound examination.
If it turns out that you have a coronary artery hernia in the abdomen but that the enlargement is not so great, you have to go on regular checks and measure the size of the hernia. The checks are done with ultrasound or x-rays at intervals of between half and one year.
If it turns out that the hernia is larger than four and a half centimeters in diameter, you will receive a referral to a specialist for vascular surgery.
Operation or not
For men, an important limit is reached when the hernia has been widened to five and a half centimeters in width. For women, the limit is about five centimeters. If enlargement is smaller, the risk of rupture is small and the rupture is usually not operated. but regular checks are continued. If you have a small pulmonary artery hernia, the risk of surgery is greater than the risk of having the hernia.
Decision on preventive surgery
If the doctor considers that it would be good to have a preventive surgery, you decide it together. An operation can be risky in itself and you may feel doubtful about the decision. It is therefore important that you ask your doctor how much the risk is that the hernia will break if you do not operate it. You can also ask to have time for reflection in order to think about the matter calmly and discuss with your relatives.
It is good to have a relative or close friend when talking to the doctor. You should not hesitate to ask as many questions as you need. Some of the most important can be:
- How big is my heart disease right now?
- What is the risk of life-threatening rupture if you do not operate?
- If surgery is relevant, what type of surgery does the doctor recommend and what is the risk of not surviving such an operation?
- What types of complications can occur after such an operation, and how large are the risks of these being assessed in my particular case?
The results are even better if the pulmonary vein operation is detected in conjunction with being called at the age of 65 and having undergone an ultrasound examination. On the other hand, if you are very old and may have other serious illnesses, you may choose to completely refrain from surgery as well as continued control of the pulmonary artery, in consultation with the doctor.
Further examinations before surgery
Prior to surgery, the ultrasound examination is usually supplemented with computer tomography or magnetic camera examination. This is done so that the appearance and distribution of the hernia can be determined more precisely, which is important for the operation planning.
Before the operation, more examinations can be performed. It is usually the question of the examinations that are always done before a major operation. It can be a heart examination with ECG, a heart-lung X-ray and blood tests, sometimes also an ultrasound examination of the heart.
Operation via the groin
In the past, both acute surgeries after a rupture and preventive surgeries of pulmonary veins were performed as an open operation via a large opening in the stomach. Today, more than half of the operations are done as a so-called endovascular operation. This is a much smaller procedure as you usually only need local anesthesia. Endovascular surgery is usually used for prevention, but more often even in emergency surgery.
Endovascular means inside the vein and refers to an artificial blood vessel attached inside the large body pulmonary vein where the hernia is located. It is not always the standard method that suits, for example, if the hernia is too far in the stomach and engages the blood vessels of the kidneys or intestines. But with modern endovascular technology, branches can be created in these blood vessels and almost all pulmonary hernias are technically feasible to endovascularly.
The operation begins with a small incision being made in the groin and then the artificial vein is inserted into the vessel, compressed into a sleeve. To help, doctors have an X-ray camera attached to a monitor. By following the images on the screen, the doctor can determine when the artificial vein has gotten right. Then it expands inside the hernia and with a kind of metal springs, the artificial vessel is sealed up and down. In this way, the new artificial vessel ends up inside the old widened vessel, as a reinforcement, which is allowed to remain.
This method involves less number of complications after surgery because one is fast on the legs and has less pain afterwards. Usually you can leave the hospital after one to two days. A week after the operation you can be up and running as usual.
An so-called open surgery is still done, especially when the patient is young and has a healthy heart. It is called open surgery because the doctor operates through a large opening in the stomach. You are anesthetized with anesthesia before the operation. The intestines are removed so that large body pulmonary arteries can be operated. It is a major procedure in which the enlarged pulse vein is replaced by an artificial vein, a so-called graft.
The walls of the hernia remain after the operation, but the blood now goes instead in the artificial vein. The new vein is sewn together with the large body pulse vein above and below the enlargement.
Most people go through the operation without complications and can leave the hospital after a week. You get tired for a while afterwards but you should get up and keep moving as much as possible to counteract blood clots and pneumonia. The stitches in the skin are removed after about two weeks. They usually recover fully after a few weeks, but many experience some fatigue for 3-6 months after the operation.
This major surgery involves a slightly greater risk of complications early after surgery. However, it is more sustainable in the long term than endovascular surgery and is therefore often offered to younger patients with healthy heart and healthy lungs.
Risks with the operation
It is in the case of an emergency operation that you run the greatest risk of complications. If it is a preventive operation, the risk is small. The complications you can have are, for example, myocardial infarction, pneumonia, blood clots in especially the legs but also in the lungs and bleeding and infections in the operating area. These are complications that can occur after all major surgeries, especially if you are a little older.
The risk of early complications is less if operated with the endovascular method than with the open surgery. But a longer-term complication with the endovascular method is that the artificial vein may begin to leak at the attachment points, which may cause the pulmonary artery rupture after surgery. This risk does not exist after an open operation, and explains why the open method is still used. In order to be able to detect in time if it starts to leak at one of the brackets, you must be examined with x-ray or ultrasound about once a year life.
After an operation, one can usually return to normal life. The risk of a new rupture or a large leakage bleed is small.
If you are older and operated for hernias of the large body pulmonary artery in the stomach or if you have a hernia that is not so large that it needs to be operated, you risk getting other vascular diseases such as stroke and heart attack. Depending on the diseases you are at risk of, you may need medication to prevent these diseases.
Often, you get antihypertensive medication, but you can also get cholesterol-lowering medication or medicine that prevents blood clots.