At 4.1 you are still far from the critical size, it starts getting critical as it approaches 5.0. Unfortunately, currently the only effective way to repair an ascending aortic aneurysm is through open heart surgery. I had mine repaired 5 years ago at 5.2 cm.

The good news is that you know you have it and that is a blessing, you can monitor it and make decisions, a lot of people don't get that opportunity. My recommendation is to find a cardiologist who is an expert in aortic diseases, not all of them are and it does make a big difference. The Dr will help you through the process, frequency of monitoring, medicine regiment and feedback as to exercise and mainly controlling your BP. Your systolic looks good but the diastolic looks high. High BP is the main enemy of AAs.

You should also find the best thoracic surgeon you can find, someone who has done lots of these surgeries, and at least get seen by him/her, he/she will also give you their recommendations and frequency of monitoring.

Keep yourself healthy, stay active, exercise (with the limitations given by the cardiologist), it is important to keep your body at its best.

I know it is hard not to think about this and control the anxiety, exercise will help, a good cardiologist will also help you with answers and if needed think about a good therapist that can also help you.

I wish you the best!! I know it is hard but try to stay positive