Can Coughing Increase Size and Risk of Aortic Anuerysm

I have a 4.4 ascending aneurysm and through the whole month of Dec , coughed like a demon! I used a lot of buckleys!!!! Cough and cold meds can be iffy for BPressure . I’m female and in the shorter side . I have an echo scheduled for June . So we shall see if it’s gotten bigger?? Did I worry ?? I sure did !!!!!

I’m not a doctor and I’m not giving medical advice, but I am a 10-year survivor of a complete and sudden aortic dissection, and I’ve spent a lot of time learning about aortic disease, navigating the medical system, and advocating for my own care.

ONE: You should also be getting a referral to a thoracic aortic surgeon as soon as possible. Cardiologists and primary care doctors play a role in monitoring an aneurysm, but they don’t fix them—surgeons do. A thoracic aortic surgeon is the only specialist truly qualified to assess the long-term risks, determine the best monitoring plan, and decide when (or if) intervention is needed. Many cardiologists, even very good ones, simply don’t have the expertise in aortic pathology to fully evaluate what’s going on beyond the standard “watch and wait” approach. Surgeons, on the other hand, spend their careers seeing how these aneurysms behave over time, understanding the subtleties of surgical timing, and weighing the risk of waiting versus intervening. Personally, I would not trust anyone but a surgeon who specializes in aortic disease to tell me whether I need surgery, how often I should be scanned, or what my true level of risk is. You don’t need to be scheduling surgery tomorrow, but you do need to establish a relationship with the specialist who will be responsible for making those calls down the road.

A 4.1 cm ascending thoracic aortic aneurysm falls into that gray area where it’s technically “mild,” but still something that requires monitoring. The real question isn’t just the size—it’s what else is going on with the aorta. Growth rate, family history, connective tissue disorders, blood pressure control, and valve function all play a role in risk assessment.

TWO: You’re absolutely right to push for a cardiologist. Aneurysms aren’t primary care medicine, and it’s frustrating when you meet resistance just trying to get in the right hands. A primary care doctor saying, “See you in 2-3 years” might be reasonable for a completely stable, slow-growing aneurysm, but it’s not a sufficient plan without deeper evaluation—especially if this was only diagnosed a few months ago. I get scanned every 12 months at a world class heart care center with state of the art CT with contrast, University of Minnesota - Minneapolis.

When you talk to your doctor on Monday , you might want to emphasize:

a. You want an aortic specialist or a cardiologist experienced in aortic disease. Not all cardiologists focus on aortic pathology, and a general cardiologist may not have the expertise to assess your long-term risk.
b. You need to know the growth rate. Did they compare this to any prior scans? Was it previously smaller, or is this a new finding?
c. You want a clear monitoring plan. Ask why they think 2-3 years is an appropriate timeline and if more frequent imaging (every 6-12 months) is warranted given your age and aneurysm location.

THREE: Exercise and Elevation
Again, not medical advice, but elevation and exercise are common concerns with aortic aneurysms. Some things to ask your doctor:
a. Blood pressure response at high altitudes – The body compensates for lower oxygen levels at high elevation by increasing heart rate and blood pressure, which can stress the aortic wall.
b. Valsalva maneuvers – Anything that causes sudden spikes in blood pressure (heavy lifting, straining, intense isometric exercise) can be risky for an aneurysm.
c. Cardio limits – Many doctors recommend low-to-moderate intensity exercise rather than pushing into high-intensity zones. Hiking is often fine, but with precautions.
d. Medication adjustments – Some people with aneurysms are put on beta-blockers or other medications to reduce stress on the aorta, especially if they are active.

FOUR: Coughing and Aortic Disease
A strong, uncontrolled cough can spike intrathoracic pressure and cause strain on the aortic wall. If you ever develop a chronic cough, shortness of breath, or any weird chest sensations, it’s worth bringing up. Some people with aneurysms (especially near the arch) have symptoms that can get dismissed as “normal” but are actually the aorta compressing nearby structures.

If you’re not getting the answers you need, keep pushing. Many of us with aortic disease have had to advocate hard to get the right specialist. Aneurysms are serious, even when they’re considered “mild,” and getting ahead of the game now can make all the difference later. Peace.

I'm 62 years old and was diagnosed August 2024 with a "4.1 cm mild ascending thoracic aortic aneurysm".

Have had sonogram, CT scan, PET scan, and Echocardiogram.

The Echocardiogram was only a few days ago and produced what I thought was an amazing 79 measurements.

All I've heard back from the primary doctor is an email stating to be sure and schedule another echocardiogram in 2-3 years

I've put in request to hear from a cardiologist, their perspective on the 79 echocardiogram findings.

This request seems to be meeting with some resistance?

Have a phone call appointment with the primary doctor on Monday 2/3/24 about getting approved to speak with a cardiologist.

Your situation with coughing is a thought that hadn't occurred to me. Glad you mentioned it. I'll add that to my Monday 2/3 phone call appointment questions.

Among my questions is what is an acceptable level of cardio exercise, if any limits?

Is hiking above the 14,000 foot elevation a concern?

Please let me know what you find out on both the cough and the elevation hiking. I look forward to hearing what your doctor says.

I dissected completely and suddenly in 2015. I am very lucky to be alive. It is a horror show, I can promise you. I'm not sure when you got that 4.4cm reading, but if it was more than a year ago, I'd get a CT scan with contrast done immediately at the best imaging center you can find in a major heart care center (Mayo, Cleveland Clinic, UCSD, U of Minnesota, U of Texas - Houston, etc.). Just saying...peace.

@moonboy you are certainly a wealth of information. Thank you!

I have to say navigating the healthcare system is daunting. I have spent my career in healthcare, I am not clinical, but when health systems started hiring physicians rather than the physician being independent, I have sadly seen doctors more interested in their paid time off rather than their patients.

I had a 6 month CT Scan w/out contrast, which was different than the first one in June which was with contrast on 1/17. I received the results on 1/19. My care team never reviewed the results until 1/21. I messaged twice with no response, this was my thoracic surgeon’s office who ordered the scan. I called on 1/27 and was told someone should have contacted me but I had to schedule an appointment for 2/18 to meet with the doctor to review the results and answer my questions. Today, 1/31, someone finally responded who said someone would be reaching out to schedule an appointment. Grrrrr. Needless to say I responded. I hate to have to be snarky but it is all frustrating when you don’t feel valued or you are a bother but from some of the posts, others are experiencing similar situations.

Don’t even get me started on cardiologists. The second doctor I saw prescribed Crestor, and said if the joint pain is too bad, stop it for a few days then start. BTW I am on Letrozole for Breast Cancer , which causes joint paint and can affect your heart. Also, I did some research on Crestor, which can be linked to causing aneurysms. I stopped the Crestor after 2 weeks and have been taking CoQ10. I really would love to find someone who takes into account all of me so I can manage all of this. Hopefully, I will get some answers on 2/18.

Regarding exercise, that too is all over the place regarding what physicians say, I did get a smart watch. If my heart rate gets into the anaerobic or maximum, I slow down. Although, vacuuming, bending over to clean a tub, lifting my 7 month grandson, all life activities effect your heart rate. BTW my aneurysm went from 4.1 to 4.3. I do use my elliptical and do Pilates but modified the intensity. I feel being in the best shape you can is a positive.

Some days, I can manage all this, today, apparently my anxiety is getting to me. Oh yeah, anxiety creates stress hormones that are not good for your heart. Some days, the bad ones, I wonder if I should just stay in bed not to exert my heart, but I get up anyway and go on with my daily life. Staying busy for me is important. Idle time makes my mind go to places it should not go.

I do find this site helpful and that I am not alone. I am strongly considering contacting the Cleveland Clinic, it is the closest to me. I am in PA.

We all have to continue to advocate for ourselves, do our research so we have a fighting chance so we can asks questions, and when we get scared, suck it up and keep going😊💕. Sorry for the rant.