50 yr old healthy and active male - 5.0 in root - exercise or not?

I had a complete type A1 aortic dissection starting at the root when I was 50 back in 2015. It was an absolute unmitigated disaster. If I had known what was inside my chest, I would not have pushed myself the way I was pushing myself with work, travel and stress. I don't know what my aortic size was before I dissected because it was sudden and I had absolutely no idea that I had an aneurysm inside my chest. All of that is to say that if I were you, I would eliminate any kind of planking, grunting, dead lifting, or any other kind of valsalva maneuver type exercises. Eliminate all stress. Get your blood pressure down right now and listen to your doctors. If you've got a family history of this, like I do, then you understand that you are a candidate for surgery at 5.0 cm. I would make a very specific plan with a cardiothoracic expert in aortic repairs at a major heart care center near you. I'm not going to lie: it's a tough surgery and a tough recovery, but I'm here right now 11 years later, talking to you about it. You're going to be fine but you need to avoid adding any blood pressure spikes to you heart. Walking and maybe gentle pool work. Peace.

Agree as always with @moonboy, being 50 and active works in your favor. Mine was 5.2 when found at 54 yo, I was very active and in good shape, also with family history. My cardiologist who is an expert in aortic diseases told me to stay active, but eliminate any exercise that leads to hold your breath or grunt (as Moonboy mentioned, heavy weights, pushups and even crunches ) but walking and even lightly strenuous aerobic activities were fine. Is not the HR but the BP that is a problem, holding your breath makes your BP spike a lot for a few seconds but even those few seconds can be disastrous.

My family history, size of my aneurysm (especially compared to body size), and my good physical shape led my surgeon to recommend repair as soon as I could. Had my surgery 2 months later. It is tough as Moonboy says but being in good shape will help you get through it fairly easily. I was in the hospital for 5 days, back to work in 3 weeks. It is likely the recommendation for you will be surgery sooner than later.

Keep taking care of your body, all the best

My root had an apparently good trileaflet valve and 4.8 at the root and 4.7 at the mid ascending aorta. I had to have a complex coronary fistula from the RCA and LAD to the Pulmonary artery dealt with. It was essentially a cor medusae that was congenital. It had steal phenomenon going on and the midLAD became 100% chronically occluded due to the reduced flow to that area. In addition I had huge aneurysm on the proximal RCA that had to be resected. After the fistula, RCA and double bypass was done, the root disintegrated and aorta tore. Fortunately we had discussed options before surgery with 3 scenarios with materials available. It was still an emergent situation with a Bental procedure and lose of 3.5 liters of blood and over 14 hours of surgery. Turns out the leaflets were friable and the root tissue fragile. Those things weren't detected via CT-contrast nor catheter angiogram. It is extremely important to work with people that specializes in these things. I still have a 4.6 aneurysm on the remaining part of the ascending aorta at the distal end. The arch is excellent at this time.

I agree with others who say you should not push yourself so strenuously. When My Dr confirmed mine at 4.8cm, up from 4.5 about 6-7 months later, she upped my BP med and recommended no strenuous activity. Light swimming, walking, biking, or anything that won't raise the BP. I have a follow up CT scan tomorrow to check the size. Grown any more or not. I must say- in the 6 months from 4.5 to 4.8, I had fallen on my chest and broke several ribs, so that probably contributed to the enlargement.
Best of luck

@moonboy Much appreciated, thanks for the words of wisdom. Will do, all the best!

@houston13 Thanks so much!

@hollikal Praying your scan comes back with little to no movement and that guidance and wisdom are given to the doctor(s) caring for you. All the best!

@mcardleclan thanks

@mcardleclan I'd suggest you might check out the Aortic Athletes group on Facebook. It's a community of people with concerns similar to yours and they have a number of helpful YouTube videos with presentations on the subject by some of the leading doctors around the country who specialize in the subject (e.g., Drs. Churchill, Braverman and Prakash) and provide the sort of guidance you are seeking. An example of one such video by Dr. Prakash, who I believe advises @houston13, is listed below as an example and may be helpful. https://www.youtube.com/watch

@pittsburghdad correct, Dr Prakash is my cardiologist