@scottbliz My husband was recently diagnosed with 4.6cm ascending aorta aneurysm and just last week consulted with cardiologist. My husband has no family history of aneurysms, normal BP and calcium CT score a year ago was zero so no worry about cholesterol. Given all the positive aspects of my husband's health the cardiologist wasn't concerned about his 4.6cm scan. He was very reassuring about my husband's case and said typically these types of aneurysms grow slowly ... a rescan w/ contrast in 1 year was advised. With your family history you are likely in a higher risk category therefore a different protocol might be in order. Nonetheless, the one thing the cardiologist stessed to my husband is to be very careful of lifting heavy weights/objects and activities that require "straining" ie. holding your breath and then lifting ... think body builder techniques used for lifting. The cardiologist actually said they see a higher number of ascending aorta aneurysms in body builders and weight lifters.

Below, I've listed the talking points we were prepared to discuss with the cardiologist during my husband's initial visit. I hope in some small way these talking points can help guide you.

1. Imaging Follow-Up
- Repeat CTA or echocardiogram every 6–12 months (confirm exact interval).
- Use the same imaging center/protocol if possible for consistent measurements. Ask if echocardiography can substitute for CTA/MRA between detailed scans.
- Frequency of follow-up CT scans? Longterm affects of CT w/ contrast on kidney function?

2. Blood Pressure Goals
- Target: below 120/80 mm Hg.
- Discuss whether a beta blocker or ARB (e.g., losartan) is appropriate or necessary
- Monitor blood pressure at home once or twice daily at rest.

3. Lifestyle & Activity
- Avoid heavy lifting, straining, and high-intensity contact sports.
- Continue moderate aerobic activity (walking, swimming, cycling)
- Ask for safe lifting limits and guidance for playing sports eg. pickleball, hiking etc.
- Ask about acceptable exercises - dumbbells, pushups, planks, squats, yard work, mowing, mulching, topsoil, raking leaves, snow shoveling etc.
- Sleeping habits - snoring, mouth breathing, chest/head elevation on adjustable bed - do these sleeping habits affect aneurysm growth?

4. Risk-Factor Management
- Maintain healthy cholesterol and inflammation control
- Ask if statins or other medications are recommended even with normal cholesterol.
- Follow a heart-healthy diet rich in vegetables, fruits, and lean proteins, low sodium, sugar etc.
- Ask about coffee, alcohol?

5. When Surgery Might Be Needed
- Typical threshold: 5.0–5.5 cm, or earlier with certain risk factors (bicuspid valve, rapid growth, family history).
- Ask your doctor about your personalized surgical threshold considering: age, family history, height/weight, overall health and fitness level
- Ask about genetic testing - if there is a family history of aneurysms (not just aorta aneurysms but anywhere in the body)
- Consider a baseline consultation with a cardiovascular surgeon specializing in aortic aneurysm?

6. Red-Flag Symptoms
- Seek emergency care for sudden severe chest, back, or upper abdominal pain (especially tearing).
- Watch for fainting, shortness of breath, or new hoarseness.
- Call 911 immediately if any of these occur
- Consider a personal medical alert ID such as a bracelet or necklace to alert others in case of emergency situation.