My husband, who just turned 62, told me that he occasionally feels something like a strong heartbeat in his stomach. Is this possible—and what could it mean?


Yes, your husband could be feeling a pulsating sensation in an area more accurately known as his abdomen. Does he notice it after eating? If so, it could be a symptom of gastroesophageal reflux disease (GERD), a condition that occurs when the valve between the top of the stomach and the bottom of the esophagus doesn’t close properly, allowing stomach contents to flow back into the esophagus. Sometimes patients report that the discomfort caused by GERD feels like a pulsating sensation. However, pulsating sensations in the abdomen can also signal an abdominal aortic aneurysm (AAA), a potentially fatal condition. The aorta, which is about the diameter of a garden hose, is the largest artery in the body, running from the chest to the abdomen. When a section of this blood vessel weakens, it can swell and even burst. Men who are over age 60 have a higher risk for AAA, especially if they are current or past smokers, have high blood pressure or elevated cholesterol and/or have a family history of AAA. (Women also can suffer an AAA.) To clarify what’s going on, your husband’s internist should examine his abdomen. An AAA can sometimes be felt by a physician, but an imaging test, such as an abdominal CT scan, is needed to make a diagnosis. If an AAA is detected and it is two inches or smaller, it is more likely to be slow-growing and should be regularly monitored—typically at six-month or yearly intervals, depending on the aneurysm’s size—to track its progression. Aneurysms that are bigger than two inches or that are growing rapidly (about half an inch or more per year) are much more likely to rupture, which can lead to fatal internal bleeding. These aneurysms may be treated with a procedure called endovascular repair. With this procedure, the surgeon makes a small cut in a leg or groin artery and threads a thin, flexible tube through the artery, through which a fabric-covered wire frame (stent) is sent so that it can be placed within the aorta where the aneurysm is located. The stent reinforces the aortic wall so that blood can flow through the artery without rupturing the aneurysm. The feasibility of endovascular treatment depends, in part, on the shape and location of the aneurysm and the presence of any other chronic conditions, such as kidney disease. In some cases, medication to lower blood pressure, such as ACE inhibitors or beta-blockers, is prescribed. These drugs have been shown to reduce arterial wall stress and can prevent progression of an aneurysm. Risk factors should also be managed. For example, it’s critical that smokers give up their habit and that blood pressure and cholesterol levels are well controlled. To learn about a type of aneurysm that occurs in the brain, click here.

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