December 10, 2019. My cholesterol is about 6 but nobody has suggested statins and I am happy with that. Like most arteries, the aorta is elastic, which allows it to be filled with blood under high pressure. Dietary Dos and Donts for Migraine Sufferers, Shirshasana (Headstand) Versus Inversion Therapy Using Inversion Table, Understanding Joint Pain and Tips to Get Relief Using Home Remedies, Erectile Dysfunction: Does Opioid Cause ED, Libido: Opioid Induced Female Sexual Dysfunction, Less than diameter of 4cm has a risk of less than 1 among 200 in total, Diameter between 4cm and 4.9cm have risk between 1 in total 200 and 1 in total 20, Diameter between 5cm and 5.9cm have risk between 1 in total 30 and 1 in total 7, Diameter between 6cm and 6.9cm have risk between 1 in total 10 and 2 in total 10, Diameter between 7cm and 7.9cm have risk between 2 in total 10 and 4 in total 10. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. This article may contains scientific references. The Thoracic Aortic Disease Service at Liverpool Heart and Chest Hospital is a busy service that provides comprehensive care for patients with complex cases of the disease. Different factors may increase your risk, including: Heart disease: The most common cause of aortic aneurysms is atherosclerosis, also known as hardening of the arteries. Was 48 when I was diagnosed with both. These include pseudoaneurysms after trauma (aortic transection) and aortic cannulation (cardiac surgery and cardiopulmonary bypass). Aortovenous fistula, popularly known as the abnormal connection presents in between a vein and an aorta. Professor of Vascular Surgery The 32-year-old actress has started a charity to help others recovering from brain injuries and strokes. Bristol, Bath, United Kingdom If symptoms are present, they may include: If the aorta ruptures, youll feel a sudden, sharp pain in your chest that extends to your back, between your shoulder blades. The aortic diameter of more than 3.0 cm [1] . I would be so thankful if you all can provide some . At the last echo, the senior technician thought that I probably will never need surgery as the valve seems to be coping fairly well. Superior nationwide outcomes of endovascular versus open repair for isolated descending thoracic aortic aneurysm in 11,669 patients. These findings were borne out in the national data sets, which concluded that TEVAR can be performed in older, sicker patients with less perioperative morbidity and shorter length of hospital stay.23,24, The mortality risks from TEVAR are strongly related to timing of intervention and age. What should you not do with an aortic aneurysm? Unfortunately, there is no consensus or evidence that one criterion or composite of features precisely define such a group or predict within what time frame after diagnosis they are most susceptible to all-cause mortality. Save my name, email, and website in this browser for the next time I comment. Abdominal Aortic Aneurysm | Johns Hopkins Medicine A cerebral aneurysm (also known as a brain aneurysm) is a weak or thin spot on an artery in the brain that balloons or bulges out and fills with blood. Endovascular abdominal aortic aneurysm repair: type 2 endoleaks and risk of rupture . I had an echo and maintain yearly and a CT scan every 6mos. How Game of Thrones Actress Emilia Clarke Survived Two Aneurysms, Glycemic Index: What It Is and How to Use It. 5 Things You Didn't Know About Diabetes and Heart Disease, Finding the Right Doctor for Aortic Aneurysm Repair. Because patients with high rates of growth and large aneurysm size are selected out for surgery, following the natural history of the disease in an unbiased manner is difficult. I'll be happy to answer any questions you may have, if it well help.. Have bicuspid valve and thoracic aneurysm also . Infection: Sometimes, certain infections can also weaken artery walls, including those in the aortic arch. There are more than 10,000 deaths per year from ruptured abdominal aortic aneurysms. An example of data being processed may be a unique identifier stored in a cookie. The function of the normal sinuses is to prevent occlusion of the . An aortic aneurysm is a balloon-like bulge in the aorta, the large artery that carries blood from the heart through the chest and torso. The archs downward portion, called the descending aorta, is connected to a network of arteries that supplies most of the body with oxygen-rich blood. This article does not provide medical advice. Our articles are resourced from reputable online pages. Aortic Diameter 5.5 cm Is Not a Good Predictor of Type A Aortic Circulation. The aneurysm can burst completely, causing bleeding inside the body. And the risk increases significantly when the diameter of the bulge exceeds 5.5 cm (more than 3 cm is considered an aortic aneurism, and 4 cm indicates "clinical significance"). The procedure can cause bleeding, respiratory complications such as pneumonia or even paralysis if not properly cared for afterword Enlargement in rupture or bulge tends to become highly rapid in smokers, while remain less rapid in diabetes mellitus patients. 3. Aortic Aneurysm: Symptoms, Causes & Treatment - Cleveland Clinic Aortic Aneurysm. Ann Thorac Surg. Population-based outcomes of open descending thoracic aortic aneurysm repair. Aorta Size: Is 4 Cm Normal? | Steve Gallik Sinus of Valsalva aneurysm (SOVA) is an abnormal dilatation of the aortic root located between the aortic valve annulus and the sinotubular junction. It is intended for informational purposes only. I have a 4.6 cm ascending aortic aneurysm 4.6 cm. and no plaque. Could Diameter of 8cm or higher than that have risk between 3 in total 10 and 5 in total 10. Am J Cardiol. Nonetheless I have stopped fussing over it and it hasn't grown anymore. 28. The two trials comparing early open surgical repair to surveillance found this result holds true regardless of patient age or aneurysm size (within the range of 4.0 cm to 5.5 cm diameter). Pivotal results of the Medtronic vascular Talent thoracic stent graft system: the VALOR trial. In some cases, they also replace the aortic valve with a synthetic valve. Dake MD, Miller DC, Semba CP, et al. Brown LC, Powell JT. 4. Aortic Aneurysms: The Most Dangerous Type. Patient does not provide medical advice, diagnosis or treatment. First question is: is there any possibility that it will never grow? Novel measurement of relative aortic size predicts rupture of thoracic aortic aneurysms. Endovascular treatment of thoracic aortic aneurysms: results of the phase II multicenter trial of the Gore TAG thoracic endoprosthesis. If you have a small aortic aneurysm (approximately 3 cm) at the time of diagnosis, your doctor may recommend healthy lifestyle changes or medicine to help prevent it from growing larger. Complications in frail and elderly patients can be the reason for loss of independence, and thus, quality of life should be an important consideration, especially in patients whose aneurysms were not symptomatic before surgery. Aortic aneurysms account for 40,000 deaths annually in the United States.12 Maximum aortic diameter is the key parameter used to predict rupture risk and is therefore central in directing clinicians whether to offer surveillance or surgical repair.13 However, despite the increase in patients undergoing operations, natural history data concerning the risk of aneurysm rupture and the evidence base for threshold diameters at which TAA repair becomes beneficial are limited. You are off to a good start by searching for information on the subject. Aortic Aneurysms: The Danger of Dilation - Gregory Koshkarian, MD, FACC Heres what some top doctors have to say about high cholesterol, or hyperlipidemia. Aortic Aneurysm | cdc.gov - Centers for Disease Control and Prevention The aneurysm is causing symptoms such as pain in the back, stomach . If you and your doctor agree that a watch-and-wait approach is best, you may be placed on medications to help lower your blood pressure and cholesterol. Recovery After Aortic Aneurysm Repair: What to Expect, An ideal These numbers are averages and vary by age and body size. All 13 families had multiple affected members, often in more than 1 generation, consistent with an autosomal dominant pattern of inheritance. I am hoping if I can hang out for a few more years they will have developed a stent to fix it without the requirement for open heart surgery like they have for the lower down ones, that would be good. Essential Elements of a Comprehensive Aortic Team, With Ali Azizzadeh, MD, FACS; Kendal Endicott, MD; Javairiah Fatima, MD, FACS, RPVI, DFSVS; Ross Milner, MD, FACS; and Brant W. Ullery, MD, MBA, FACS, FSVS, Panel Discussion: Decision-Making for Type B Aortic Dissection, With Tilo Klbel, MD, PhD; Tara M. Mastracci, MD, FRCSC; Christoph A. Nienaber, MD, PhD, FESC, FAHA; Germano Melissano, MD; Daniele Mascia, MD; and Eric E. Roselli, MD, FACS, Medical Management of Acute and Chronic Type B Aortic Dissection, By Christina L. Fanola, MD, MSc, and Eric Isselbacher, MD, MSc, BEST-CLI Shows Lower Incidence of Major Adverse Limb Events or Death With Surgical Bypass Versus Endovascular Treatment in CLTI Patients With Adequate GSV, With Alik Farber, MD, MBA; Matthew Menard, MD; and Kenneth Rosenfield, MD, MHCDS, Current Evidence for Catheter-Based Renal Denervation for Hypertension, By Anna K. Krawisz, MD, and Eric A. Secemsky, MD, MSc, RPVI, FACC, FAHA, FSCAI, FSVM, Panel Discussion: Perspectives on Applying BEST-CLI in Practice, With Daniel Clair, MD; Sanjay Misra, MD; Leigh Ann O'Banion, MD; and Mehdi H. Shishehbor, DO, MPH, PhD, By Anahita Dua, MD, MBA, MSc, and Eric A. Secemsky, MD, MSc, RPVI, FACC, FAHA, FSCAI, FSVM, Tackling Acute-to-Chronic Thrombus and Embolus. Evidences have suggested that expansion of aneurysms takes place at the average rate from 0.3cm to 0.4cm yearly and tends to expand at the fastest rate as compared to any small aneurysm. Therefore, guidelines have suggested that repair is appropriate for saccular aneurysms > 2 cm or saccular aneurysms associated with a total aortic diameter > 5 cm.16, The latest ESVS guidelines suggest that based on the size differential between men and women at baseline, the threshold can be reduced to 50 to 55 mm for women. Your doctor inserts a tiny, flexible catheter into an artery in your leg and guides the tube up to your aorta. When the vessel is significantly widened, it's called an aneurysm. The normal abdominal aorta measures approximately 2.0 cm in most people (range 1.4 to 3.0 cm). Thoracic aortic aneurysm - Symptoms and causes - Mayo Clinic Medical Videos Privacy Policy, Images and Text Policy Editorial Policy, Information Policy Advertising Policy, Financial Disclosure Policy Cookie Policy, About Us Contact Us. Thoracic Aortic Aneurysm | 6 Symptoms, Is a TAA Serious, & Surgery We want the forums to be a useful resource for our users but it is important to remember that the forums are 2010;252:603-610. May I ask you what kind of medicines are you taking? My consultant tells me they are well on the way. Abdominal aortic aneurysm - Treatment - NHS (2017). Take illicit drugs. 2008;48:821-827. I had a follow up CT scan and then an MRI. I am in the US.. My surgery was in a veterans hospital. Eagleton M. (2017). And make an appt with cardiologist. It will be fine. debris or blood clots from AAA that causes blockage in the blood flow into the legs. as being in breach of those terms. Previous Article. Management of diseases of the descending thoracic aorta in the endovascular era: a Medicare population study. We and our partners use cookies to Store and/or access information on a device. Nonetheless, when the size of an aneurysm is greater than 5 centimeters, the only way to attend to it is through surgery. 2007;50:209-217. Now all the time I'm on internet searching and looking in to videos with TAA surgeries and Im freaking out The difference though is that you are now 68 yrs and yours TAA might not growing any more, I'm still 53 Let's hope for the best, thanks again. Primary form of aortoentric fistula or an abnormal connection in between the bowel and the aorta, Thromboembolism i.e. The consent submitted will only be used for data processing originating from this website. Abdominal Aortic Aneurysm. Thoracic aortic aneurysm: Symptoms and diagnosis. Both showed the aneurysm to be 4.1 whereas the echo had stated 4.6. i was diagnosed with a 4.3, annerysm in dec, 2months ago. The aneurysm has grown quickly (more than 0.5 cm in six months or more than 1 cm in one year). Thanks again. Centers for Disease Control and Prevention. Thirty-five percent (39/110) of family members had BAV/AAT or . She is also an Associate Professional Counselor and Clinical Rehabilitation Counselor, adding mental health and wellness to her area of expertise. Trouble swallowing due to pressure on the esophagus. Monitoring the biological activity of abdominal aortic aneurysms beyond ultrasound. Bahia SS, Vidal-Diez A, Seshasai SR, et al. Family history: About 20 percent of all thoracic aneurysms develop in people with a family history of thoracic aneurysms. How Dangerous Is A 4 Cm Aortic Aneurysm | FollowMDA The likelihood increases by up to 4% every 10 years of life. . Ruptured form of AAA thus forms a surgical emergency that requires medical treatment immediately. Cardiologists know cholesterol is a key factor in reducing risk of heart attack. Dissection greatly increases the risk of rupture and reduces blood flow to the rest of the body. Cardiovascular risk prevention and all-cause mortality in primary care patients with an abdominal aneurysm. Ann Thorac Surg. The aorta is the lifeblood of our body and aneurysms can put pressure on it from all sides. Abdominal Aortic Aneurysm Repair With Stent, Best Hospital For Ascending Aortic Aneurysm Surgery, Life After Abdominal Aortic Aneurysm Surgery, Life Expectancy After Thoracic Aortic Aneurysm Repair, Is Non Allergic Rhinitis An Autoimmune Disease. An aortic aneurysm occurs when the aorta's wall is torn open. Nevertheless, thoracic aneurysms feature a distinct pathobiology, as they are characterized by medial necrosis and mucoid infiltration, as well as elastin degradation and vascular smooth muscle cell apoptosis. The situation of aortic aneurysm burst depends on several other related complications along with the ones mentioned before in the blog post. Could my rheumatic fever as a child cause this? Our website services, content, and products are for informational purposes only. Patterson B, Holt P, Nienaber C, et al. Other groups have demonstrated similar results. have had chest pains, for months,..went to a boston hospital, had a catherization,..& had 2 stents put in, had a heart attack, & 2 100% blocked arteries. In a recent study, Patterson et al aimed to determine the rate of TAA expansion.18 After analyzing CT scans from nearly 1,000 TAA patients, an aortic expansion rate of 2.76 mm per year was reported for all patients. These include longer delivery systems and more accurate deployment systems (necessary in tortuous anatomy with very high blood flow and exceptionally large forces and motion). N Engl J Med. 2007;84:1180-1185. upmc.com/services/heart-vascular/conditions-treatments/pages/ascending-aortic-arch-aneurysm.aspx, vascular.org/patient-resources/vascular-conditions/thoracic-aortic-aneurysm, mayoclinic.org/diseases-conditions/thoracic-aortic-aneurysm/diagnosis-treatment/treatment/txc-20122075, escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-10/Ascending-aortic-aneurysms-pathophysiology-and-indications-for-surgery, my.clevelandclinic.org/health/articles/thoracic-aortic-aneurysm/symptoms-diagnosis, Debra Sullivan, Ph.D., MSN, R.N., CNE, COI. How Dangerous Is A 4 Cm Aortic Aneurysm The aortic aneurysm is the most dangerous of all vessel diseases. Aortic Aneurysm: A difficult disease with a high mortality rate Read More Created for people with ongoing healthcare needs but benefits everyone. Sinus Of Valsalva Aneurysm - StatPearls - NCBI Bookshelf Likely secondary to the destructive effects of tobacco use on connective tissue, a history of smoking is also strongly associated with the development of TAAs and is a predictor for aneurysm rupture.28. I am very well and keep fit in case I need it done. Next Article Intact form of AAA i.e. I am 56 yrs, no other health issues. Living With Aortic Aneurysm - CardioSmart I am 50. Once formed, an aneurysm will gradually increase in size and get progressively weaker. The aorta is the largest blood vessel in the body. Aneurysm may takes place in almost every area present in aorta, but abdominal area is the common one. Aneurysms expanding in a rapid way for instance of higher than 0.5cm for more than 6 months may involve relatively higher risk related to rupture. Talk with your doctor about the different surgery options, along with other treatment measures, to find out whats best for you. This new procedure has been found highly successful by many doctors across America so get your self into consultation soon before theyre gone forever!. It's probably nothing serious. The content on Healthgrades does not provide medical advice. 18. An abdominal aortic aneurysmis dangerous because it is a weakening of the wall of the main blood vessel in your body. Most of the patients have relatively longer periods with lesser changes in the size of aneurysm. The DOT Guidelines: Allow a 1 year card for asymptomatic AAA over 4 but less than 5cm but only with clearance from cardiovascular surgeon. I have an Abdominal Aortic Aneurysm measuring 2.5 x 2.14 CM proximal, mid aortic measures 4.0 x 3.6 CM , the distal aorta measures 5.0 x 4.7 CM. You dint mention how big is your aneurysm at the moment? 2005;111:816-828. Continue with Recommended Cookies. The hemorrhage most likely will lead to death. Do you feel the same as before surgery? Until now, quitting cigarette smoking has proved to be the best and known way to reduce the problem of aneurysm enlargement. 7. More importantly, once it has widened, it will continue to do so. An aneurysm is a weak spot in a blood vessel wall. How long can u live with an aortic aneurysm? However, the most common arteries include the brain and in the abdominal aorta. Objective: This study was performed for the determination of the expansion rates and outcomes and for recommendations for the surveillance of the 3.0-cm to 3.9-cm abdominal aortic aneurysm (AAA). Heart. Like you, I was in such shock because I only went for an echo as I had been having some irregular beats. A thoracic aortic aneurysm is also called a thoracic aneurysm. What Is Abdominal Aortic Aneurysm, and How Do You Treat It - GoodRx I find when I do have an appointment with him it is very rushed so it was worth the money. Risk of aneurysm rupture annually depends on its specific size, according to which- Less than diameter of 4cm has a risk of less than 1 among 200 in total Diameter between 4cm and 4.9cm have risk between 1 in total 200 and 1 in total 20 Diameter between 5cm and 5.9cm have risk between 1 in total 30 and 1 in total 7 This occurs as a consequence of the weakness of the elastic lamina at the junction of the aortic media and the annulus fibrosis. How dangerous is a 4 cm aortic aneurysm? 22. Aortic Aneurysm Size & What It Means for Treatment - Healthgrades However, regular monitoring must be done to look for leaks through the graft. Three in four aortic aneurysms are AAAs. This article on Epainassist.com has been reviewed by a medical professional, as well as checked for facts, to assure the readers the best possible accuracy. Incredibly the aorta pumps around 200,000,000 liters of blood around the body in a lifetime. 2005-2023 Healthline Media a Red Ventures Company. I am a healthy 67 yr old female with a 4.6 cm ascending aortic aneurysm 4.6 cm. This aneurysm is considered large and therefore at high risk for rupture. They affect only about 1% of men aged 55 to 64. However, your doctor may recommend surgical repair of a small aneurysm thats growing more than 0.5 cm per year. How dangerous is a 4 cm aortic aneurysm? Explained by FAQ Blog Aortic Aneurysm. Outcome in patients with a large abdominal aortic aneurysm - PubMed How dangerous is a 4 cm aortic aneurysm? - janet.hedbergandson.com The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers. Only have mri once a year now. respect of any healthcare matters. 23. In this procedure, the weakened portion of the aorta remains in place. I changed my activities at the advice of my doctor, which I think prolonged the need for surgery. The catheter then deploys a graft that surrounds the vulnerable part of the aorta to strengthen it. The thoracic aorta begins where the left ventricle ends at the aortic valve and continues down through the chest. A small 4 cm sized aneurism has very little chance or likelihood for bursting, but larger 5+ inch dia. Copyright 2023 Healthgrades Marketplace, LLC, Patent US Nos. Coarctation of the aorta is a congenital malformation of the aorta in which part of the aorta is constricted or narrowed. The question is: is it enough to see a cardiologist or I should considering see a vascular surgeon as well? Aside from morbidity and mortality rates, which have widely been published, few available data exist on the quality of life of patients who have undergone TAA repair. Ascending aortic aneurysms: Pathology and indications for surgery. Jovin IS, Duggal M, Ebisu K, et al. 12. 2016;103:1823-1827. Expansion rate of descending thoracic aortic aneurysms. 1996;61:935-939. The iliac arteries measure around 1 CM. It also will decrease the risk of aneurysm complications. A diameter greater than 3.5cm is considered to be an aortic aneurysm. How dangerous is a 4 cm aortic aneurysm? - ler.jodymaroni.com Hello Sonia, thank you so much for the information, I'll keep this in to my list. I recently had by-pass surgery there. J Vasc Surg. There are some promising developments, such as molecular imaging and new insights in medical therapy, that may also help in this process when they become available for clinical use. Adopt a healthy diet rich in fruits and vegetables, and low in cholesterol and saturated fats. how to shrink an aortic aneurysm naturally - senorzorro.com And if surgical repair is advised, dont put it off. Ann Thorac Surg. Ascending aortic aneurysms are the second most. Diehm N, Dick F, Schaffner T, et al. 2008;48:546-554. Stanford Healthcare. Background: The risk of rupture of large abdominal aortic aneurysms (AAAs) remains uncertain. 19 Aortic Aneurysm Symptoms, 7 Causes, Treatment - eMedicineHealth If left untreated, it can be life. In 6months. I was diagnosed with the same condition four years ago when I was 64. The reported 30% to 50% short-term mortality in patients with aortic aneurysm diameters >6 cm was, until fairly recently, the basis for recommendation of elective aortic surgery at 6 cm. The one-year incidence of rupture is 9 percent for aneurysms 5.5 to 6.0 cm in diameter, 10 percent for 6.0 to 6.9 cm, and 33 percent for AAAs of 7.0 cm or more. I am a bit careful lifting things though, but that is probably because of my age! Can I fly if I have aortic aneurysm with 4.3 cm in size? - Quora Circulation 2010], which recommend "avoidance of strenuous lifting, pushing, or straining" to reduce the risk of aortic dissection. Doctors also call an aortic root aneurysm a dilated aortic root. Thoracic aorta. 5. Help Millions of people find the right doctor and care they need, Get immediate care and visit with providers from the comfort of your home, or anywhere, Urgent care centers can be faster and cheaper for situations that are not life threatening, Doctors and patients discuss the latest medical treatments and health tips, Search prescription drugs for why theyre used, side effects and more, Back and Neck Surgery (Except Spinal Fusion), https://my.clevelandclinic.org/treatment-guides/14-0028-aortic-aneurysm-treatment-guide?_ga=2.207135571.1301545328.1606747543-1151960348.1604337613, https://www.nhlbi.nih.gov/health-topics/aneurysm, https://www.cdc.gov/heartdisease/aortic_aneurysm.htm, https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/abdominal-aortic-aneurysm.html, https://www.merckmanuals.com/professional/cardiovascular-disorders/diseases-of-the-aorta-and-its-branches/abdominal-aortic-aneurysms-aaa, https://pubmed.ncbi.nlm.nih.gov/29268916/. right-arrow I am 6'2, about 245lbs, early 40s. The risk of a fatal bleeding event is high if bleeding is not treated promptly. The end-graft consists primarily in reinforce the walled with stainless steel wires, helping to keep any further damage at bay while also aiding recovery time considerably shorter because theres no needGreat news! Risk of aneurysm rupture annually depends on its specific size, according to which-. Susan Fishman, APC, CRC is a veteran freelance writer with more than 25 years of experience in health education. The only meds were for pain, no meds for life. I have a thoracic aortic aneurysm. Can I continue my firefighting Patterson BO, Sobocinski J, Karthikesalingam A, et al. Abdominal Aortic Aneurysm Repair With Stent Based on this, they stratified patients into three groups: those with an ASI < 2.75 cm/m2 who were at low risk for rupture (4% per year), an ASI of 2.75 to 4.25 cm/m2 was considered moderate risk (8% per year), and those with an ASI > 4.25 cm/m2 were at high risk (20%25% per year). [13] In regard to TAA outcomes, the growth rate of the aneurysm is a relevant parameter for risk assessment and monitoring. How is a Thoracic Aortic Aneurysm Repaired? Aortic Aneurysm - What You Need To Know MyHeart Natural history of thoracic aortic aneurysms: indications for surgery, and surgical versus nonsurgical risks. An abdominal aortic aneurysm is also called AAA or triple A. Patients with a maximum aortic diameter of 50 to 54 mm had a 74.5% risk of expanding to > 55 mm in the subsequent 2 years. hello Gigi, thank you so much for your msg. In this procedure, a surgeon opens up your chest and replaces the damaged portion of your aorta with a synthetic tube called a graft. Pity because I wouldn't have taken up a job which required me to lift as much. This is because an aortic diameter of 5.5 cm is associated with much greater likelihood of rupture. Gopaldas RR, Huh J, Dao TK, et al. Expansion rates and outcomes for the 3.0-cm to the 3.9-cm - PubMed . If thoracic aortic aneurysms are severe enough to cause symptoms, you may experience severe chest or back pain, shortness of breath, coughing or wheezing, difficulty swallowing, hoarseness, numbness or weakness in one or both arms, and loss of consciousness or low blood pressure.