It Can Be Complicated

Ask the DOC

The human body is an amazing but very complicated organic machine. For this reason and others, doctors and healthcare professionals never stop learning about it. Most states require those with professional licenses, like doctors and nurses, to show proof of learning when applying for and renewing their licenses. For doctors, it’s called CME, short for continuing medical education. This is one of the reasons I enjoy writing this column. Most of my columns come from articles in medical journals. After reading an article, I usually do additional research, all of which provides me with knowledge that I then share with you, my neighbors.

Blood pressure and the maintenance of it is usually something that most of us take for granted. But it is really quite complicated. When we stand up from lying down or sitting, for example, our blood pressure should plummet because gravity forces blood to rush into our abdomen and legs. But usually our blood pressure doesn’t drop precipitously. If it does, it’s called postural hypotension, which can cause dizziness and/or loss of consciousness. Our blood vessels, especially the aorta and heart, have sensors called baroreceptors that sense a drop in blood pressure. This triggers the baroreceptor reflex which, via a complicated mechanism that includes several nerves, causes arteries to constrict, or narrow, thereby raising the blood pressure. This happens in the blink of an eye. As we age and our blood vessels get stiffer, the reflex may not work as well, which is why some older people get dizzy if they rise from a bed or chair too quickly.

The aortic arch is located in the upper chest. It starts at the heart, then curves downward towards the abdominal aorta. Four major blood vessels originate from the aortic arch—the left and right subclavian and common carotid arteries. The subclavian arteries supply blood to the chest and arms, and the carotid arteries to the head and brain. Aneurysms of the aortic arch are not uncommon. Aneurysms are areas where the artery wall has weakened and ballooned out and are caused by hypertension and atherosclerosis, or hardening of the arteries. Numerous nerves are found near the aortic arch including nerves that go to the larynx, or voice box. Damage to these nerves may cause hoarseness.

All of this leads me to a review article I read recently. It was a case study about an 80-year-old man with a history of an aortic arch aneurysm. After he was discharged from the hospital for an episode of chest pain, he returned to the E.R. after a fall. He stated that after getting up from a chair, he became dizzy and fell, hitting his head. After the fall, he noticed that his voice had become hoarse. Shortly after appearing at the hospital he suffered a cardiac arrest and died. But before he died, X Rays and a chest CT scan revealed that his aneurysm had ruptured. The title of the article was “A Hoarse Warning: Ortner's Syndrome.” Ortner's syndrome is a combination of chest pain, postural hypotension, and hoarseness in someone with an aortic arch aneurysm. As the aneurysm expands, it causes chest pain, the baroreceptors in the aorta fail and the surrounding nerves are damaged causing dizziness upon rising, plus it presses on the nerves to the larynx causing hoarseness. Like I said, complicated.

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