am I exercising too much with a 4.3 ascending aortic aneurysm?

Posted by kmailloux @kmailloux, Mar 15, 2023

I am a 60 year old female, who has been very active her whole life. I was a very competitive gymnast, then moved to triathlons, then to cycling and running, strength training has always supported these activities. I am a certified personal trainer, and the aneurysm is a new diagnosis as of Dec of 2022. it was shocking - I now have a heart condition. I ran a marathon 2 weeks after I turned 60. My Cradic surgeon has stated that I can train for a 50k (31 miles) race, as well as a 150 mile bike ride. I have a 50 lb lifting weight limit. My BP is low and I am on no medications. My questions are .. is the activity too much? I run 5-6 days a week plus strength training and biking. I have mild chest pain - all of this has been told to my doc. they keep telling me everything is ok - I am just so nervous about all of this - but want to keep doing what I love. Any input will be appreciated.

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@upartist

Hello kmailloux. First I congratulate you on an amazing healthy life style! Your mention of mild chest pain caught my attention. I have a 4.3 cm ascending aortic aneurysm diagnosed a few years ago. I reduced my exercise after reading through people's experiences on this blog, but I am still very regular. I never exercised to your degree. My chest pain brought me in to get studies, where the aneurysm was discovered. My aneurysm is not what is getting treated, but the chest pain is. My angina results from cardiac micro spasm (diagnosed through an ACTH challenge test during a cardiac cath) along with endothelial dysfunction. I have very opened large arteries. Stress , both physical and perceived emotional/cognitive, are the main triggers. Sometimes its spontaneous. I would recommend to you to look deeper. Your chest pain may not be aneurysm related. Mine is not but it can still be fatal.. I am treated with two forms of nitro.... one for exercise (nitrobid ointment ... which is an old resurrected medication and extremely effective to allow me to do my cardio) and the other are sublingual tabs for rescue pain. I did have to redo my life style, but I can still actively participate in numerous cool activities and sports, just scaled back. I also chose to have the gold standard cardiac cath back when I did not know what was going on. It was recommended, and I was scared. Information can reduce stress and guide our decision making. It should be empowering. I think you need more information. Clarify that chest pain. Good luck! And keep on trekking !!!
UPArtist

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Very good advice. Since arteries have no nerves associated with them it is doubtful that aneurysm could be the culprit, as long as it does not burst, there is no pain. Angina on the other hand is painful and therefore most likely Kmailloux must have other issues possibly with her heart. I was surprised that her doctors did not put her on a statin and blood pressure meds, since those drugs are indicated in lowering blood pressure, one of the problems that go undetected until stumbled on as in my case.

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Even though your post is 2 years old I was taken by it. I also have a thoracic aortic aneurysm, in fact two. One 4.2 cm and one 4.5 cm with a valve prolapse. At 88 I am still going to the gym three times a week and am otherwise healthy. I also have been active most of my life in alpine skiing and other outdoor sports. I think your doctors have it correct: keep on with your sports because your strength will get you to 88 and beyond. I will not give up on my active life style because most of my peers are in heaven, those that did not exercise. So, don't worry, be happy and keep on with the things you love.

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@kkubsky

I too struggle with what is safe and what isn't. It can be very frustrating. I was basically told to live my life...don't lift more than 50 lbs, and do not strain. What exactly does that mean....do not strain? Sometimes getting out of bed in the morning is a strain! Fortunately my BP is not high and really never has been. Have had high cholesterol most of my life and am now on statins, which have lowered it to normal levels. I question everything I do now. I low snow shoveling (I know I am not normal...lol) but that seems to be a big No in general. My dr said it would be ok as long as I am not straining and it isn't too heavy. There's that word again...straining. Obviously it isn't like lifting a pillow, but then again it doesn't feel like I am moving tree stumps around (which I have done). Right now I have been stacking firewood....and alternating between thinking I must be nuts and I am not straining or lifting more than 50 lbs so it is ok. I just don't know. Have heard that tennis, golf, baseball are all not good. Don't feel like any of those involve "straining". This whole thing has caused me so much anxiety. I am constantly taking my blood pressure and checking my heart rate. I wish there was some type of test that could be done on a monthly basis that checks the aorta. Waiting a year between exams is kind of scary. I was diagnosed about 18 months ago. Have had 2 CT scans and am stable at somewhere between 4.3 and 4.5 cm. Going for my next exam end of May.

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I was in a car accident in 2017 I broke some ribs and was a little bit banged up. That’s when I learned I had an upper thoracic aortic aneurysm that measured 4.4 cm. I could just say to your whole post ditto, ditto, ditto. All the same concerns and questions. Over the past eight years, I have gradually increased the exercise I do and sometimes it is strenuous and leaves me a little bit short of breath, but nothing intense. I do a lot of exercises with exercise bands and also light dumbbells meaning 10 pound, 15 pound, and 20 pound. I am 70 years old and a couple of different cardiologist have given me a bunch of different recommendations about how much weight to lift and how often to get a CAT scan. After my first CAT scan, six months after my diagnosis, the doctor told me not to come back for two years. I thought, “no way“, I don’t feel comfortable going that long. So I came back in a year and nothing had changed. I started exercising more and therefore became more concerned about possible growth so I started getting a CAT scan every six months and still nothing has changed. I continue to increase the amount of exercise. I do still staying within the same weight limits and I am now getting a CAT scan every four months. I am doing this because I keep increasing the intensity and I walk for 30 to 40 minutes every day. (and my insurance covers it. ) So far so good. Just wanted to let you know I struggle with all the same stuff. Keep on going!

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Your comments are very encouraging. I am in a similar situation only I am 67 with an ascending aortic aneurysm at 4.3 cm. This morning I had a CT scan to compare with the my original diagnosis CT scan when my AAA was discovered about 5 months ago. I am hoping to hear back that my AAA has not grown and is stable. I am looking forward to participating in a local charity 5k. We will be walking the 5k. Hoping for good news on the CT scan results.

I think you are doing all of the right things. Keep it up! I too have occasional chest pain if I over do it. Not sure if it is from my back or that AAA. I have been seeing a chiropractor who has been a God send and so far seems to be addressing this pain. My primary care doctor does not think the pain is from the AAA. I have been told not to lift anything over 30 pounds and to keep my BP as low as possible. The 30 pound limitation has really put a big crimp on my beekeeping but I am finding ways to get things done without over doing it.

Are you checking your BP everyday, morning and evening? I have been doing this not only to keep an eye on my BP but to adjust my BP safely as low as I can stand it with Metropolol and very small doses of chlorthalidone. Morning BP is usually around 90/58 and evening is around 116/65. I seem to be able to function just fine with my BP at this level. Stress is yet another thing to minimize. It is amazing how much stress can affect BP.

Best of luck training and competing in the 50K!

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@23997929

Mine was diagnosed at 4.0 almost 4 years ago and then went to 4.2 in a year. Now steady at 4.5 the last year and a half. Based on information from my local cardiologist and also from the head of cardiothorasic surgery at a university hospital who also reviews my scans, surgery is recommended at 5.0 cm (unless they see a rapid increase in readings). They explained to me that surgery is major and high risk, around 5% fatality rate, but depends on the hospital. Not having surgery before 5% the risk is down to well below 1%. They also told me that people who manage it (no heavy lifting, no strenuous exercise, keeping blood pressure low etc) have a low risk and as one of them said "you would go from something else totally unrelated".

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Are you talking about the open heart method of repair?

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@mackayverd

I 68 and had an ascending AA diagnosed at 4.2. I still have six months to go, but may do another ct scan to see where I am at.

What I don't understand is why in hell don't they just operate on it and fix it? It has risk, but it is better than this slow torture and not knowing how much you can really do. I hunt chukars, one of the most strenous outdoor sports. Walking up and down steep slopes. But no one can say do it or don't do it. Frustrating!

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Mine was diagnosed at 4.0 almost 4 years ago and then went to 4.2 in a year. Now steady at 4.5 the last year and a half. Based on information from my local cardiologist and also from the head of cardiothorasic surgery at a university hospital who also reviews my scans, surgery is recommended at 5.0 cm (unless they see a rapid increase in readings). They explained to me that surgery is major and high risk, around 5% fatality rate, but depends on the hospital. Not having surgery before 5% the risk is down to well below 1%. They also told me that people who manage it (no heavy lifting, no strenuous exercise, keeping blood pressure low etc) have a low risk and as one of them said "you would go from something else totally unrelated".

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@mackayverd

I 68 and had an ascending AA diagnosed at 4.2. I still have six months to go, but may do another ct scan to see where I am at.

What I don't understand is why in hell don't they just operate on it and fix it? It has risk, but it is better than this slow torture and not knowing how much you can really do. I hunt chukars, one of the most strenous outdoor sports. Walking up and down steep slopes. But no one can say do it or don't do it. Frustrating!

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It's my understanding that insurance doesn't want to cover surgery until you reach 5.0, unless something else is going on. I also asked my cardiologist about getting surgery earlier rather than later. I'm nearly 80 and don't relish having this major surgery when I'm even older. He said I should wait until the benefits outweigh the risks. This is a serious operation. Given what I know now about the long recovery for most patients, especially older ones, I may not have surgery at all. I'm at 4.2 and will have another CT scan in July. Fingers crossed it's still the same. I've never been keen on exercise but I try to walk most days, weather permitting. I've given up on gyms. Those of you who depend on exercise to stay sane and feel healthy--like my son and daughter--always amaze me. I guess it's how some folks feel about opera. You really like that? Anyway, common sense tells me that overdoing the exercise is asking for trouble. Move it or lose it, but don't push so hard you blow a gasket.

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I 68 and had an ascending AA diagnosed at 4.2. I still have six months to go, but may do another ct scan to see where I am at.

What I don't understand is why in hell don't they just operate on it and fix it? It has risk, but it is better than this slow torture and not knowing how much you can really do. I hunt chukars, one of the most strenous outdoor sports. Walking up and down steep slopes. But no one can say do it or don't do it. Frustrating!

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@upartist

Hi Will3886. I see you got checked because your brother had heart issues? That points towards a possible genetic component to your aneurysm. You need to have that discussion with your cardiologist soon. Some familial TAADs (thoracic aortic aneurysm disease) lead to early dissection. Not all, but some. If you show one of these genetic markers, the algorithm for the timing of repair is altered accordingly. I urge you, with a 4.5, to have this discussion in order to make informed decisions. I to love hiking! I used to run and I get your desire to let loose on those amazing trails! Good luck!!!
UPartist

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Thanks for the comments
I will have that discussion asap

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@will3886

Good info
Thank you
Glad your doing ok

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Hi Will3886. I see you got checked because your brother had heart issues? That points towards a possible genetic component to your aneurysm. You need to have that discussion with your cardiologist soon. Some familial TAADs (thoracic aortic aneurysm disease) lead to early dissection. Not all, but some. If you show one of these genetic markers, the algorithm for the timing of repair is altered accordingly. I urge you, with a 4.5, to have this discussion in order to make informed decisions. I to love hiking! I used to run and I get your desire to let loose on those amazing trails! Good luck!!!
UPartist

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