Aortic dissection & aortic aneurysm information support group

Aortic dissection, aortic aneurysm - The aorta - Life after an aortic dissection

Hi guys,

In 2008, after experiencing a brief bout of atrial fibrillation, an echocardiogram revealed the presence of a mild thoracic aneurysm in the ascending aorta, measuring 3.8. Since that time I have been monitoring this condition with yearly MRAs which last year found my Aorta to be 4.17 (rounded off to 4.2) but just the other day, thirteen months later, to have progressed to 4.35 (rounded off to 4.4). Although still not considered to be at the point of requiring surgery, and being reassured by my Radiologist and Cardiologist that the risk of mortality is still very low, I am not so optimistic. The fact that the growth of this aneurysm increased by almost two centimeters in thirteen months and that I have been advised to cease even moderate weight training implies that I will be living with the sword of Damocles over my head, not a very pleasant situation to live with on a daily basis.

Although my physicians advise me to continue to have yearly MRAs, I intend to increase the frequency of these imaging tests to three a year. In addition, I plan to continue to lift very moderate weights and avoid heavy compound exercises that could result in an aortic dissection.

Do any of you guys continue to weight train with an aortic aneurysm? Do you folks monitor the growth of your aneurysm more frequently than once a year and what is your primary mode of doing so (ie, echocardiography, CT Scan, MRI, etc). Vinny

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I was a twice a year ct scan patient until my 2nd surgery this past July.  Now they say unless I have any issues, I don't need to go back until a year from my last ct scan in November.

The concern I know they have with doing all the scans is the dyes they have to use -- like in a ctscan -- just make sure your kidneys are doing well as they are the ones that can be affected the most.

As for weight training -- i only do 3 to 5 pound weights and it is just more light resistance.  I was told to not train for a marathon.  Not to do any shoveling or any exercises that would cause me to bear down.  Push mowing is also discouraged.  Just nothing that would cause me to exert myself as with aneurysms - we just don't know what the straw will break the camels back in a sense.

I still do the treadmill and take walks and such and do some light weights but nothing to encourage any more damage.  2 surgeries have convinced me not to risk it.  I survived the first dissection/aneurysm, my first emergency surgery, and recently my 2nd planned surgery.

All I can say is trust your gut.  I don't know if your doctors know what is causing your issue -- they don't have any answers for me as I don't fit the profiles - so I have to go with my gut and just trust it.

Keep tabs on your blood pressure and just be smart about your choices in regards to what exercises you do.  As for the scans, again, just watch for any damage that could be affecting any other organs.

I'm glad that they found this ahead of time as they will tell you, most aren't that lucky and most don't survive.  It does help to be in good physical shape to survive the surgery --- and yes, they get better at it every day.

It takes it's toll no matter what though -- especially mentally --- not to mention physically post surgery -- it is doable as you will read from any ones testament on this site.

But with survival does come challenges and everyones experience is different, but yet the same in other ways.

Positive thoughts your way - and we are always here.

Cher

Cher, thanks for yor excellent feedback. I am sorry to hear of your tribulations and truly understand the duress you have endured from this disease. Best wishes. Vinny

I have an echo every six months to monitor growth of aneurysm(which developed shortly have dissection was repaired) mine is at last echo 5.4cm. I do heavy lifting, I try to stick to my 10lb weight limit with daily events(sometimes going a little over) I also either walk almost everyday and on bad weather days Wii Fit or play Just Dance with my kids. Cardio is I have been told good as long as I monitor my heart rate and BP.  Hope this helps a little and if you any more questions just ask

*hugs*

Kimberlee

Kimberlee, did your surgeon give you any indication as to diameter of your aorta at which time he will perform a repair? Regards, Vinny

Hi Vinny,

 

Like Cheryl I had my second opp last August to repair a descending aneurysm which had grown to just under 6”.  I used to do weight training many years ago, probably to early to cause this condition.

The growth of an aneurysm is down to cause & effect. Blood pressure is the main enemy for all of us AD sufferers & I would suggest you regularly check this, before & after any exercise or strenuous activity. I presume you have also been put on Blood Pressure medication & again it’s worth checking with a specialist cardiologist to get the right combination & dosage.

I was diagnosed after a CT scan on my annual check up & you’re wise to have this checked more frequently given its enlargement.

At some stage you may have to have the aneurysm repaired or replaced. Whilst its not the most pleasant experience, to put it mildly, at least you will have a chance to live life normally again. However I fear your days of heavy weight training are going to be left behind you.

Best wishes

Harry

Hi Harry,

My blood pressure is generally on the low side although under stress it does elevate temporarily to a high level. Although I requested that my Cardiologist place me on a beta or calcium blocker or another blood pressure med he has refused due to my very low heart rate, which is typically below 43 bpm. In short, I can lose consciousness if placed on one of these drugs. BTW, I have a tricuspid valve but nonetheless will obtain genetic testing to determine the presence of a connective tissue disorder.

Although I agree with you that I will require a surgical repair sometime in the future, so far the five surgeons, Cardiologist and Cardiovascular Radiologist I have consulted are divided as to whether I will require surgery. Significantly, I have been informed that ten to twenty percent of individuals with thoracic aortic aneurysms have brain aneurysms as well, necessitating my scheduling a brain MRI in the near future.

Regards, Vinny
Vinny,
I wouldn't recommend weight training at all. The weight training is probably the reason it is growing, i would say, at an alarming rate.
The problem with weight training is your physiological response to the initial exertion. Your blood pressure shoots up to well over safe levels during the "curl" - sometimes up as far as 250 systolic and 140 diastolic - and specifically with heavy weights. One day you will rupture your dissection if you continue.
Unfortunately, unless you have your entire aorta replaced, your weight training days are over :(
Sorry to be the bearer of bad news,
R

Hi Richard and thanks for sharing your thoughts and concern. I too am very concerned and am not discounting your feedback whatsoever. In fact, any caveats regarding weight training also pertain to cardiovascular exercise as I will explain below.

 

The issue of whether weight training should be stopped entirely is a highly contested one with several well respected Cardiothoracic Surgeons holding disparate recommendations regarding the continuation of this exercise. For instance, Dr. John A. Elefteriades, Chief of Aortic Surgery at Yale University, who first brought out the danger of HEAVY weight training and aortic dissections and rupture to the public, holds that as long as a patient with a thoracic aortic aneurysm does not lift more than half (50%) their bodyweight in compound exercises (ie, bench press, deadlift, squat, etc) they can continue to engage in weight training as well as include as much isolated weight training exercises (at a prorated amount) that exercise individual muscle groups (ie, curls, tricep pulldowns, lateral raises, etc) as they wish. According to Dr. Elefteriades, over fifty percent of bodyweight lifted creates an inordinate elevation of pressure in the aorta, potentially resulting in a dissection and rupture. However, he also notes that one highly emotional upset can also precipitate a dissection in vulnerable individuals!

 

Dr. Allan Stewart, Director of Aortic Surgery at Colombia Presybterian Hospital, also holds that weight training can be continued at a moderate level as long as the patient does not have a hypertensive response to exercise, has no connective tissue disorder (ie, Marfans, etc) and has a tricuspid valve. He indicates that it is essential that the patient exhale during the concentric (lifting) phase of the exercise while inhale during the eccentric (lowering) of the weight. In terms of aerobic training, Dr. Stewart holds that the patient should warm up for approximately fifteen minutes to prevent a surge of catecholamine that can contribute to the increase of the diameter of the aorta but can otherwise engage in fairly intense cardiovascular exercise.

 

On the other hand, some Cardiovascular surgeons at John Hopkins in Baltimore and Cedar of Sinai in California hold that weight training should be discontinued and that even cardiovascular exercise should be curtailed and that one should not get their heart rate over eight five BPM! However, if this were the case, the average person with an aortic aneurysm with a so-called normal heart rate of 70 BPM would have to walk and live their lives as virtual invalids, because their heart rates and blood pressure would surely surge to over a hundred BPM even if they walked at a moderate pace.

 

An excellent and comprehensive series of articles regarding this subject, as well as interviews conducted with highly respected Cardiovascular Surgeons concerning weight training and aortic dissections and rupture was written by Jillita Horton. These can can be googled if anyone is interested.

 

Although I do not doubt that my earlier years of heavy lifting contributed to my aortic root dilitation, I am not certain whether it was the sole factor increasing the diameter of my aorta or if if it was due to a "flying" fall I took in November while taking a brisk walk resulting in a significant injury to my knees and my blood pressure soaring. Perhaps it was due to the continuous duress over a period of years due to my serving as a caretaker to my ill wife, father and mother resulting in a lack of sleep or to a gastrointestinal condition that resulted in severe nausea, vomiting and abdominal distress that lasted ten weeks prior to resolving in January. Even if not the primary culprits, I am fairly certain that these factors played a role in the increase diameter of my aorta.

 

So I may need to abandon weight training entirely. However, due to this activity mantaining lean body mass and strength, which is vital as we age, as well as lowering my resting blood pressure (yes, it has this effect) and my blood glucose as well as increasing levels of deep sleep, I will surely miss this form of exercise.

Regards, Vinny

 

 

 

Richard, as an addendum to the above, although you thoughtfully mentioned that continued weight training can cause a rupture of my dissection, fortunately at this point I have not sustained a dissection and am hoping to avoid this experience. Sorry for not clarifying this point in my earlier posts.

 

In addition, although you note that my aorta is growing at an alarming rate, according to the physicians I consulted it really hasn't. The initial echocardiogram in 2008 indicated that I had a mild aortic dilitation of 3.8 BUT did not note the specific location on the aorta where this measurement was made. In fact a subsequent examination of the same echocardiogram by several independent readers ( two Cardiovascular Radiologists and three Cardiologists from different hospitals) showed that the measurement was actually around 4.1, not 3.8. So I have no idea how long a period I had a 4.1, which according to these experts may have been for a significant period of time. In fact, my current measurement taken of 4.35 (rounded off to 4.4) in March 2012, approximately three and a half years later, reveals a growth rate well below the annual growth rate of five millimeters annually which is considered a serious rate of growth.

 

Furthermore, according to my Cardiovascular Surgeon and Cardiovascular Radiologist, the current measurement (as are all others) is open to a margin of error of approximately 10%, which would potentially bring this measurement to just under 4.3. Although not a safe measurement by any means and not providing me with any level of security or comfort, it is not currently growing at an alarming rate although I totally agree that ANY level of growth is not a good sign. Regards, Vinny

Hey Vinny,

I guess i should have qualified "alarming rate" as my personal opinion - any growth is alarming as far as i am concerned, but if you are willing to accept below average growth as ok, then more power to you. I should also mention I am only a sufferer of a condition, not any sort of doctor. I only have the benefit of my experience, and experiences that i get to read here, to share. there are an awful lot of people here, me included, who are restricted in their weight "lifting" allowance, mostly 10 lbs (5kgs). i know i don't stick to this limit, as it is nigh on impossible living alone - but i don't weight train over this limit as i have a weakness in my aortic wall which caused the dissection, and would also cause an aneurysm if my dissection was fully repaired.

The only alternative to weight training you have is cardio-vascular exercise and provided only the plumbing is faulty, and not the pump itself, i see no reason why you cannot step that up as a replacement. I do more cardio now than i ever did before my dissection, heart valve implantantion and subsequent operation. my heart was 15% dead after my dissection, and over the 3 and a bit years since then i have, predominantly through cardio-vascular exercise, managed to get this down to 8%, and i am hoping my next check up will bring a further reduction.

we are all different and what works for me, might not work for you or anyone else for that matter - but at least it is there as an option.

take care,

r

RIchard, good chatting with you today. With your perseverance and tenacity I am very certain that you will steadily improve your heart function.

I am scheduled to meet with another Cardiothoracic Surgeon this week and a Geneticist next week. I was also planning to have an updated echocardiogram but decided against it because of the lack of reliability of the echo to provide an accurate measure of the aorta. All indications are that the MRA provides the most accurate measure.

As mentioned, Jillita Horton has written extensively and objectively on weight training and aerobics for individuals with aortic aneurysms. The link is as follows: http://voices.yahoo.com/aortic-aneurysm-lifting-weights-research-sc...

 

Best wishes,  Vinny

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