Aortitis - Symptoms, Causes, Diagnosis and Treatment

What Is Aortitis?

The suffix “-itis” means inflammation. So the term aortitis refers to inflammation of the aorta, which can occur either due to trauma, infections, connective tissue disorders, or autoimmune disorders. If the cause of aortitis is unknown, then it can be called “isolated aortitis.” As the aorta is the main blood vessel in the human body, any inflammation of the aorta can affect the entire system.

The inflammation can restrict blood flow which can be a threatening condition for all the vital organs. It can also cause aortic insufficiency in that blood flows in the reverse direction during ventricular diastole due to dilation of the aorta. The aortitis also leads to decreased pulses in the upper extremities. Depending on the involvement of other blood vessels, symptoms can vary in aortitis. It is generally treated by curing the underlying pathology that causes aortitis.

What Are the Symptoms of Aortitis?

As aortitis can be due to various pathologies, symptoms also vary depending upon the underlying conditions. Generally, aortitis has three phases. At the earlier phase, aortitis is very much asymptomatic. The three phases of aortitis are;

• Phase 1 - It is characterized by nonspecific symptoms like fatigue, arthralgia, weight loss, and fever.

• Phase 2 - It involves tenderness of arteries associated with pain.

• Phase 3 - It involves permanent injury to walls leading to symptoms of ischemia, occlusion of vessels in extremities, etc.

Depending upon each phase, symptoms will vary; general symptoms include;

a)Abdominal pain.

b)Back pain.

c)Severe headaches.

d)Aortic insufficiency.

e)Chest pain.

f)Fatigue.

g)Pain and weakness in extremities.

h)Dizziness.

i)Pain in the scalp over the temples.

What Are the Causes of Aortitis?

The causes of aortitis fall mainly into three categories. But the exact cause is still unknown. The causes can be categorized as;

a)Infectious - Caused due to bacterial infections, viral infections, tuberculosis, and syphilis.

b)Non-infectious - Takayasu arteritis, giant cell arteritis, ankylosing spondylitis, rheumatoid arthritis, systemic lupus erythematosus, Behcet’s disease, etc. This category is mainly responsible for chronic pain in the case of aortitis.

c)Idiopathic.

What Is Takayasu Arteritis and Giant Cell Arteritis?

These are the most common causes of aortitis.

a)Takayasu Arteritis - It is also known as Martorell syndrome or pulseless disease. It generally occurs in young women. It often appears as a secondary reaction to an autoimmune disorder. It has two stages; the first one is a pre-pulseless phase which is generally asymptomatic, and the second is a pulseless phase which includes symptoms related to stenosis, occlusion, or dilation of the aorta. The pulse is very feeble and almost nil in Takayasu arteritis. But we can hear bruits over narrowed arteries and brisk pulses in the legs on auscultation.

b)Giant Cell Arteritis - It is often identified as a systemic vascular disease. It is seen in age groups above 50 years. It is not just limited to cranial arteries. The main symptoms include severe headaches that are persistent, vision loss, scalp tenderness, etc.

The difference between the Takayasu and giant cell arteritis lies in the clinical pattern of vessels involved. Giant cell arteritis mainly involves the temporal artery, whereas Takayasu arteritis involves the aorta and its branches. This is the main reason for the difference in symptoms among them. The pathologic changes are the same for both.

When to See a doctor?

If you suddenly develop persistent headaches, decrease in vision, shortness of breath, any symptoms of stroke, and a sudden increase in blood pressure, seek medical attention as soon as possible.

What Is the Prognosis of Aortitis?

Affected people with the disease identified at the earlier stages, have a high chance of survival. As the disease progresses, the complications involved are also high, which can lead to an unfavorable prognosis.

How to Diagnose Aortitis?

For the diagnosis of aortitis, understanding the medical history of the patient, physical examination, laboratory studies, imaging studies, and biopsy should be done. It is very important to identify the cause of aortitis to initiate the proper treatment as the use of immunosuppressants is contradictory in the case of aortitis caused due to infectious disease.

a)Physical Examination - Any alterations in blood pressure and pulse can be identified. Physical examination also reveals bruits in narrowed blood vessels and diminished pulse in any of the limbs.

b)Laboratory Studies - Blood tests are done to estimate levels of erythrocyte sedimentation rate and C-reactive protein, which are indicators of inflammation.

c)Imaging Studies - Magnetic resonance angiography (MRA) and computed tomography angiography (CTA) are widely used. It is useful in finding out acute and chronic changes in the arterial walls due to inflammation, edema, and fibrosis.

d)Biopsy - The tissue from the arterial wall is taken for biopsy. The characteristic feature of aortitis is the inflammation of all layers of the aorta.

What Is the Treatment for Aortitis?

The treatment for aortitis can include both medical and surgical management.

The primary objectives of the treatment should include:

• Preventing the progression of inflammation.

• Treating the complications.

• Preventing the chances of reappearance of the disease.

The management will vary according to the cause of the disease.

a)Medical Management - The aortitis caused by gram-positive and gram-negative bacteria can be treated with antibiotics like Minocycline. In the case of non-infectious aortitis, corticosteroids form an integral part of the treatment. Corticosteroids are known for their anti-inflammatory properties. They mainly suppress the activity of leukocytes and decrease capillary permeability. Drugs like Prednisone are generally recommended in corticosteroid therapy (corticosteroids are a class of drugs that lowers inflammation in the body. They also reduce immune system activity). Another class of drugs that play a vital role in the treatment of aortitis is immunosuppressants. Immunosuppressants like Methotrexate, Mycophenolate, and Cyclophosphamide are usually advised for the treatment.

b)Surgical Management- When there is a narrowing of the blood vessel due to aortitis, angioplasty or stents or bypass grafts are the surgical options available. Surgical repair is indicated when there is no response to medical treatment, significant hypertension, and cerebral ischemia.

Conclusion

If you could relate the above-discussed symptoms and your condition to aortitis, do not panic. Identifying and treating the underlying cause can improve your condition and prevent you from encountering life-threatening complications. Contact our online specialists to rule out the condition now.