I'm sorry to hear your news. My brother died last October of a sudden heart event. Unfortunately there was no autopsy performed so we don't know if it was a dissection or some other heart issue. He had no known heart or other health issues at the time. He died immediately. I went in for a heart check up after that, and they have found two aneurysms. Ascending aorta at 4.2, and another at the aortic root is 4.8. I've got some recommendations based on my learnings and the advice I've gotten from the Mayo Clinic. 1) Buy a blood pressure cuff if you don't already have one. (they are less that $100, I like the wireless Omron one which is very portable and helps me keep track on my phone.) Take your blood pressure every morning for a few weeks (three readings back to back each morning) Blood pressure control is the most significant proactive measure you can take) 2) Get a DNA test done if you haven't already. It sounds like you know that it's most likely genetic, but my understanding from my DNA testing results is that some genetic mutations are more dangerous than others. Mayo believes that my aneurysms are genetic in nature, but since I tested negative for the known mutations they are not recommending surgery for me now. Their plan for me right now is here:
"Since hypertension is the #1 population-attributable risk factor for aortic dissection worldwide, it is of utmost importance to maintain normotension. Would recommend maintaining blood pressure at 130/80 mmHg or less. He is presently already at this target.

We discussed exercise recommendations in the presence of aortic disease. It is certainly my recommendation that the patient should remain physically active, but exercise according to the following guidelines:

1. Avoid heavy weightlifting. For patients who have sustained an aortic dissection during heavy weightlifting, average aneurysm size is only 4.3 cm, which indicates the heavy weightlifting can predispose even small aneurysms to dissect. In this case, it is recommended to avoid heavy weightlifting but it would be perfectly acceptable to lift moderate weights with higher repetition counts (12-15), which can be done safely.
2. Avoid any sports with potential for heavy blows to the chest.
3. Avoid extremes of exertion and high-intensity intervals. Aerobic exercise in continuous, moderate effort is safe.
4. Avoid any sports activities with abrupt acceleration or deceleration.

Given evidence from large population based studies indicating increased events of aortic dissection and rupture in the population after fluoroquinolone use, my advice to the patient and care providers is to avoid fluoroquinolone use if possible. In the case of a future bacterial infection, preference should be given to non-fluoroquinolone antibiotics unless it is necessary for a serious or life-threatening indication, or if bacteria is resistant to all other alternatives.
The next follow-up appointment will be in 1 year with transthoracic echocardiogram (TTE) at the time of the appointment."

My understanding of the lifting restrictions is that lifting heavy objects causes a short but significant increase in blood pressure. It is magnified if you hold your breath while lifting which is something all of us tend to do. I've greatly restricted my lifting and I'm very intentional about my breathing when I do it. I do 30 to 45 minutes of aerobic exercise 5x a week and keep my heart rate no higher than 130 ( which is based on my blood pressure reading during my stress test echo, and is still a very good workout for me)
Of course your doctor tomorrow may recommend surgery sooner given your family history. This is certainly not a condition to be complacent about. If you're uncomfortable with your doctor's plan, Cleveland Clinic has an easy virtual path to get a 2nd opinion from them.
Best of luck to you!
Best of luck to you