AAA at 45 ?

[ItalianRN, BSN, RN]

What was the youngest patient you had or have heard about with an Abdominal Aortic Aneurism? Did you feel the pulse just above the belly button? I had a female patient who was only 45 & the pulse was felt at 12:00 & 1:00 just above the belly button. She also experiences abdominal pain occasionally. Her B/P was low, which was normal for her. If it was an AAA shouldn't she have high B/P? You could only feel it when she was lying down. I'm a relatively new nurse so I haven't had much exposure with AAA's.

I only had her for 1 day & I felt it just before my shift was over. I notified my charge nurse & we put a call out to the doc & I gave the info in report. I won't be at work for the next month because they sent me to a class for the next month.

I was just wondering if anyone has had anyone so young with an AAA?

Thanks.

[Marie_LPN, RN, LPN, RN]

Youngest pt. i've seen with an AAA was a 41 year old male (he was getting it surgically repaired). He had other health issues, had high cholesterol for years, but when i saw him, he looked more like 71 instead of 41.

[Lacie, BSN, RN]

Feeling a pulse doesnt necessarily indicate a potential aneurysm depending on the size of the patient. I am thin statured and you can feel it very easily when I am laying down. In fact you can see the pulsation when I am supine. My mother went through a triple AAA repair 2 months ago at age 76. When she was first diagnosed 2 years ago it was entirely accidental. Most AAA go undiagnosed for many years and usually are found accidentally. She was having "back pain" believed to be a result of a fall at work in which she also broke her ankle. They had done a lumbar spine MRI and was evaluated by a neuro who gave her a clear sign and said no problems. It wasnt until 6 months later while at another consultation with another neuro that he just happened to notice on the previous MRI the AAA. That is when we were first able to seek treatment and monitor the growth. She's rather heavy so I can see how it went unnoticed physically but it was obvious on the MRI. When we inquired why the first doctor didnt bring this to our attention he stated "it wasnt what she was sent to me to evaluate as I was to evaluate her back not her cardiac problems"!!! Considering my mother had no cardiac problems in the first place this would have gone untreated if even found if not for the lumbar spine MRI and the second doctor's accidental finding of it. It wasnt even in the MRI report originally performed. We could have continued for years without diagnosis until a rupture occurred before it would have been found. She wasnt a canidate for the stint so she had to undergo a full graft and returned to work within 2 months postop. Back pain and maybe deep abdominal pain (more of a deep deep ache) is the primary symptom a patient will complain about.

[TachyBrady]

Isn't that what John Ritter (Three's Company) died from... a disected AAA? He was relatively young.

I had a patient last week with a AAA that progressed from 5 cm to 6 cm per her latest test (can't remember if it was an MRI or CT). She is not a surgical candidate so the remaining treatment is to keep her BP low. She would have periods of bradycardia down into the 30-40s, moreso while sitting up, and I asked the doctors whether this was possibly due to malfunctioning of baroreceptors/vagal response in the anurysm. They said no but it kinda made sense to me.

I never heard of pulses in the abd as a sign. I do know that abd/chest pain and sudden drop in BP are ominous signs.

[Marie_LPN, RN, LPN, RN]

John Ritter was 54.

Explanation of John Ritter's Death

[EmerNurse, BSN, RN]

AAA's can go undiagnosed for years and as stated above, are usually found accidently, during other tests. Large AAA's sometimes go exhibit a pulsatile mass in the mid/lower abdomen. Severe back pain and an ominous drop in bp are usually signs of dissection or rupture. Most AAA's are asymptomatic until something happens or until they get very large (and very dangerous). I've seen patients with a 9cm AAA that was found accidently , and intact! Youngest person I ever saw (not counting the congenital disease of aneurysms, name I forget) was in their low 40's.

Scary thing to "watch and wait",that's for sure!