Activity level confusion

I had a complete aortic dissection on a business trip to San Diego in 2015. It was a complete nightmare and I was in a cardiac ICU for three weeks spending two of those weeks in a coma. If I had known then what I know now, I would've immediately addressed my hypertension and would not have been 1600 miles from my house. You sound like you're an active guy and you travel a great deal. Before you get on another plane, like I had just had before I dissected, you may want to consider whether or not your medical insurance covers you in out of state locales. I can assure you it probably does not. You likely have medical insurance that will cover out of network and fight you like crazy if you have the kinds of medical bills emergency open-heart surgery cost. The way you're describing yourself. Sounds a lot like me in 2015. My bill from UCSD La Jolla was $1.4 million. I spent four months fighting with my insurance company to get my bills paid because they took the position that I had decided to go to California to have a sudden complete emergent aortic dissection which nearly killed me. The other thing you should consider before you get on a plane is whether or not you can get medical help if you suddenly dissect. Trust me. I suddenly dissected in my hotel room after dinner while watching CNN. My chest was cracked open 42 minutes later and I was undergoing a massive and life-threatening crisis. That's how fast it happens my friend.

In terms of activity level, what you're describing sounds a bit aggressive. I do not think that it makes good sense to do anything which involves lifting more than 10-15 pounds, raising your blood pressure, planking, or any other strenuous activity, which causes you to engage in the Valsalva type maneuvers. You sound honestly a lot like I did: tough as nails and bulletproof. I think it's really important for you to ask yourself whether or not you're engaged in any form of confirmation bias, namely, that you're completely healthy and you're going to be fine. Maybe. But the people that will be able to give you that answer are thoracic surgeons and radiologists trained in reading CT scans with contrast. I would caution you against being overconfident. I am overconfident by nature and it nearly cost me of my life.

It was extremely traumatic to have a sudden dissection for my wife and my children. It was really a life-changing experience for me. Think September 11. Knowing what I know now, I wouldn't be lifting any weight more than five or 10 pounds. You have to keep your blood pressure low and you can't allow it to spike. You'll never know that it's spiking because it's sudden and you're not constantly monitoring your blood pressure when your exercising. I want you to think of it this way: you walk outside and you see a giant bulge in the sidewall of your driver side front tire on your car. You are asking whether or not you should take that 1,000 mile road trip at 75 miles an hour. The answer is no, you need to get that tire fixed and drive very cautiously until you know it's safe.

The video below was posted in this forum some weeks ago, it is an interview with a cardiologist (by coincidence happens to be my attending cardiologist) regarding exercise and physical activity while having an aneurysm. I had a 5.2 cm TAA and bicuspid valve, it was found while preping me for leg surgery after a MTB accident. I was very active, weights, bike, swim, and luckily the aneurysm did not disect or burst. Had surgery 3 months after leg surgery as the Drs determined it was large enough for my body size and due to family history of burst aneuryms. That was 5 years ago, exercising, not smoking is important, you want your body in the best shape possible for surgery, but there are limitations and any exercise that makes you hold your breath or grunt while exerting (lifting heavy weights, crunches, etc) have to be avoided (vasalva as @moonboy pointed out in his response) as it is known your BP spikes significantly momentarily while making that effort, and high BP is the worst enemy of an aneurysm. Yours is already in the critical size if it is at 5.1cm, you gave a pretty wide range.

Find the best Surgeon and Cardilogist you can, a cardiologist who is an expert in aneuryms, they exist, and can give you the best advice taking into account your own situation. I am glad I found Dr Prakash (Dr in the video below) I see him every year to monitor my BAV (it was not replaced during surgery as it was highly functional). He also orders a full aortic path MRI (3 sections) every 4-5 years to ensure no new aneurysms ara appearing.

5 years later I'm doing great exercising a lot still,

I was able to locate an exact specimen of the Dacron aortic graft that was sutured to my heart and implanted in my chest in 2015. See picture. I paid $40 for it off an expired medical device website. (Stapler is for scale. ) It is humbling to have the greatest medical technology known to humankind inside your body carrying all of your blood --every day , every night , every month , every year. I want to thank the team at WL Gore (Gore-Tex ! ) company for the graft , Medtronic, St. Jude Medical, 3M, Baxter, and the hundreds of other medical and pharmaceutical companies who helped save my life. I also want to thank all of the first responders, hotel staff, cardiac ICU nurses, all of the doctors, all of the therapists, and all of the orderlies, who brought me back from the dead. I am forever grateful to UCSD in La Jolla, California and to all the people of San Diego.

@moonboy You continue to educate us all and I am grateful
a. that you pulled through and
b. that you so freely and completely share your knowledge and experience.

Thank you. And I wonder if my aortic graft will look different or the same? AA at 4.4 cm now. Maybe I'll see if it comes in different colors ... 🙂

My surgeon showed me a sample of what they were going to use on me, it kind of look liked that but it had smaller branches, I imagine maybe depending on where your aneurysm is and which arteries branch out in that section they need to pick the right configuration

thank you for the feedback. The immediate lifestyle change has been tough but it's reality for me. My upcoming tests should provide a better time line of things to come. My discovery of this happened after a 5 hr flight a few days later. Lead surgeon believes I was going into heart failure mid-flight, losing breath, sweats, pains, etc. Had no idea I had an issue until that flight.

Dude. You do NOT want to be at 34,000 feet when you have this problem. I had gold medallion status but that would not save me if I had dissected on the plane. It's a nightmare on the ground. In the air it's not survivable. because there just isn't enough time to get you the help you need. Finding out you have this issue is like winning the lottery. It's like KNOWING that there is a 300 foot waterfall a mile downriver as you drift toward it. You can do something about because you know what's ahead.

Thank you Houston13, for reposting this video, as I missed it before. It is extraordinarily informative with great guidelines for anyone with aortic disease, dissection survivors, and post-repair. I have shared it with a friend, only 48 years old, who had a surprise aneurysm pop up, caught secondary to symptoms, and repaired. She and her family will benefit from these parameters and guidelines. Her siblings have now discovered their surprise aneurysms, as genetic studies were recommended. Now on to her kids. Maybe by posting this video, you saved a life!! I personally continue to try to stay active safely, as my aneurysm grows. So thank you for posting this video!!!
UPArtist

Hey PenaltyBox24, could you tell us a bit more about your symptoms during your plane flight that preceded the discovery of your aneurysm? I have had cardiac symptoms during the decent from high altitude flights. I have previously posted my concerns about a possible relationship with cabin decompression and my aneurysm, plus asked my cardiologist about it. There seems to be no known relationship, but I am still suspicious and spooked. Do they know if you are having heart failure? Is it from your aneurysm? MoonBoy, do you have insight into this? I remember that yours occurred during traveling. I fly in 6 weeks. Thank you for any info, and PenaltyBox24 I really hope you have good results with your upcoming appointments! And MoonBoy, thank you for your ongoing informative posts!!!! Your perspective is very energizing!!!!

I am trying to think about this logically, think about the heart like a pump and the aorta is the pipe the fluid flows through from the pump, a dialation of the pipe should not affect the function of the pump. Now changes in altitude in a flight may affect the levels of oxigen in your blood, if your body has a need for extra oxigen the heart does try to compensate by pumping harder (high altitude sickness is an extreme example of that) and cause distress in the heart, obstructions would also cause the heart to pump harder (but you are being seeing by s a Cardilogist, so I assume he/she has checked you for possible obstructions). Anxiety may also be a factor, are you stressed during flights? High level anxiety may feel like your heart may explode. Now stress and anxiety may raise your BP and that would have a negative effect on the aneurysm. I just can't think how it can be the other way around (an aneurysm affecting cardiac function during specific moments), but I am not a Dr (I am an engineer by training) maybe there are fisiological factors I am not considering, but your Cardiologist would know those