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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Profile picture for andytheman @andytheman

I can’t believe that they made you wait so long and also the fact that you made it after all that waiting. That intense tearing type pain is a burst aneurysm. I have no pain so I guess they are waiting for it to burst and possibly kill me! I have a feeling that due to the fact that it isn’t bleeding they figured they were waiting for the last minute before they repaired it . I’m not comfortable with that. The first hospital last year found it by a cat scan for something else and panicked and sent me directly to a bigger hospital better suited to repair the torn aneurysm but that hospital cardiologist said “ well it isn’t bleeding but you will need to come back but you don’t need surgery today !”
Why not fix it now? Why wait? I couldn’t understand it. Here we are almost 2 years later and I just had an echo and even though it was at 3.9 2 years ago instead of the 5cm criteria they are doing nothing!! It could have grown. I’m so upset. It’s not burst and it’s not bleeding but it’s a good time to repair the torn aneurysm before a major event occurs. May be because I’m on blood thinners they fear going in. I don’t know. They act like it’s their little secret ! I am getting what feels like “heavy arms” which is one of the symptoms of a torn aneurysm but it doesn’t seem to be a big deal to my cardiovascular surgeon. By the way, he does have a specialty as an aortic artery specialist so I’m assuming he knows what he’s doing but it’s the constant exams I’m having and they don’t call me back to the office until “ see you in 3 months “ for a follow up. It’s killing me to wait.

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@andytheman
I have an aneurysm in the ascending aorta that measures 4.4 cm. I am monitored yearly by CT scan with dye to check for changes, am also told that 5 cm is the time they would operate as the repair surgery is also pretty serious. I am 75 and told by my thoracic cardiologisr that it’s possible to live with this issue for years without it ever getting large enough to require surgery.

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Correct. Last I heard my aortic artery aneurysm was at 3.9 cm. Not bad except for one thing. It has a tear in it and I’m 72 with an aortic mechanical heart valve and on permanent blood thinners. If my blood gets too thin I could bleed out. Thin blood with a torn aneurysm means I could leak out as my blood’s INR is below range and could bleed even from shaving. That’s what bothers me thin blood and a torn 3.9 aneurysm.

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Profile picture for tcrowe @tcrowe

@andytheman absolutely get a second opinion. November 9, 2025 I was getting ready for church, my family had gone a head of me because I was running late. Shortly after they left I felt a stabbing pain that went in through my chest and came out my back. The pain was indescribable. I can’t imagine pain being any worse than losing a limb or a burn. Something kept telling me it was not a heart attack, we went to the ER and after a 3 hour wait I was finally taken back, asked a few questions I was taken to have a CT scan. The tech immediately told me I had an aortic tear. They rushed me back to the exam room and told me I was about to have emergency surgery. An hour and half later I was under the knife. They told my husband that patients with this type of tear don’t make it to the hospital but those that do have less than a 1% chance of survival. But guess what I made it. I am healing well physically but struggling emotionally. I am a firm believer that ever doctor cannot know everything and apparently this doctor did not. I am an advocate for Aortic Dissections because they are over looked more times than they are diagnosed. Find yourself a thoracic surgeon, get a CT San and there be no more guess work. Go with the working signs you body is giving you. Cardiologist don’t know what they need to know about Aortic Dissections.
Do not wait!

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@tcrowe Wow! You are indeed very lucky to have survived that aortic tear, but now that you are on the other side if it, you should be ready to get back to exercising and strengthening yourself. I am almost 2 years post surgery and doing great. I agree it is always good to get a baseline CT scan when you get to be a 'certain age' so any structural problems in the heart can be addressed before they become an emergency.

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Profile picture for andytheman @andytheman

Correct. Last I heard my aortic artery aneurysm was at 3.9 cm. Not bad except for one thing. It has a tear in it and I’m 72 with an aortic mechanical heart valve and on permanent blood thinners. If my blood gets too thin I could bleed out. Thin blood with a torn aneurysm means I could leak out as my blood’s INR is below range and could bleed even from shaving. That’s what bothers me thin blood and a torn 3.9 aneurysm.

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Hi, I'm glad I came to this site so I can meet my soul mates with aortic aneurysm! Not a club we want to be in, but support helps!

As a 23 year long Coumadin user, also due to mech.valve, Im wondering why you need to stay worried about thin blood as long as your INR is in range. I'm assuming your cardiac team is addressing both issues? Have they said you are at a higher risk for the tear to "bleed out", and if so, have they adjusted your range for your INR, to maybe allow it to stay a little bit thicker?
After 23 years with these issues and all the issues that always have to be arranged around a good Coumadin level...I know that Dr's sometimes have blinders on. They may only focus on your need for the meds, but not it's affect, either real, or just an anxious worry( which I totally get you would be anxious, me too!)
Have you discussed your worry and found out if they can offer a solution that eases your fear a little.
I am currently(2/12/26), living with some off putting readings ftom an EKG in Dec, that indicate mine may have enlarged again( it waa 4.3 at last echo). Due to shoulder replacement I desperately needed and was already scheduled for, I didnt make my scan appt. sooner than March 31. To double check. And like you, I'm anxious abt it but diff.reason. I was already a little out of breath when doing stairs, alot of yard work, etc. But since my surgery I am def.more out of breath doing things, especially any thing that requires me to lean over..And with cats, everything I do for them, requires leaning over, lol.

So I will try to move my echo up, but in the meantime. I hate this anxiousness!
I'm sorry I wrote so much, its always what I'm teased about! Guess I'm just glad I found my PEOPLE!😊
If I don't hear from you, it was nice to read your history/ issues with the Aneurysm. And I hope the outcome is good!

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Profile picture for patti1416 @patti1416

Hi, I'm glad I came to this site so I can meet my soul mates with aortic aneurysm! Not a club we want to be in, but support helps!

As a 23 year long Coumadin user, also due to mech.valve, Im wondering why you need to stay worried about thin blood as long as your INR is in range. I'm assuming your cardiac team is addressing both issues? Have they said you are at a higher risk for the tear to "bleed out", and if so, have they adjusted your range for your INR, to maybe allow it to stay a little bit thicker?
After 23 years with these issues and all the issues that always have to be arranged around a good Coumadin level...I know that Dr's sometimes have blinders on. They may only focus on your need for the meds, but not it's affect, either real, or just an anxious worry( which I totally get you would be anxious, me too!)
Have you discussed your worry and found out if they can offer a solution that eases your fear a little.
I am currently(2/12/26), living with some off putting readings ftom an EKG in Dec, that indicate mine may have enlarged again( it waa 4.3 at last echo). Due to shoulder replacement I desperately needed and was already scheduled for, I didnt make my scan appt. sooner than March 31. To double check. And like you, I'm anxious abt it but diff.reason. I was already a little out of breath when doing stairs, alot of yard work, etc. But since my surgery I am def.more out of breath doing things, especially any thing that requires me to lean over..And with cats, everything I do for them, requires leaning over, lol.

So I will try to move my echo up, but in the meantime. I hate this anxiousness!
I'm sorry I wrote so much, its always what I'm teased about! Guess I'm just glad I found my PEOPLE!😊
If I don't hear from you, it was nice to read your history/ issues with the Aneurysm. And I hope the outcome is good!

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@patti1416 I have been on Coumadin for years and my aortic artery aneurysm is at 3.9 until I have it checked in 2 months. Yes it has a
“Tear “ in it. My cardiovascular surgeon doesn’t seem to be too concerned about it.
I don’t like being on Coumadin due to my mechanical aortic heart valve with a torn aortic artery aneurysm. My last INR was 3.0 last week borderline high end. Thin blood with a torn aneurysm bothers me more than it does my cardiovascular surgeon apparently. He must know when it’s time to correct it? I don’t know. A few years ago they found a 3.7 cm with a tear in it during an unrelated CT scan and they were like “ oh my God we need this repaired now “. They dressed me back up and threw me into an ambulance for a quick ride to a higher rated trauma hospital and when I got there they took an immediate CAT scan and confirmed the torn aneurysm but the cardiologist for that hospital said “ well, yes you have one but it’s not bleeding and doesn’t need to be treated today” “ but you will need to come back later under a non emergency appointment “.
That was it. I was like “ look, it’s torn, and I’m Coumadin with an NRI that is always variable in thinness “ and he went on to another patient. I have great insurance so it wasn’t that! First thing I know I was being given my discharge paperwork and waiting for an ambulance to take me home. All because it wasn’t bleeding at the time.
One hospital took a fit and the second one was like “ well, it’s not bleeding!”
Are they waiting for an all out rupture that can be fatal quickly?
It looks like if you have a torn aneurysm but you’re not fatality bleeding because it’s less than 5.0 cm
(The golden number) you can be ignored other than a once in a year quick sonogram? Granted, it’s far from a 5.0 cm but why wait for a rupture??
These doctors aren’t so bright. My original cardiologist said “I don’t see anything!!!” The second cardiologist treated it like “ oh wow, we need to operate” the third cardiologist says yup it’s 3.7 cm and said “ see you next year “ my current cardiologist says “ it’s at 3.9” “see you in 6 months “.
It’s not like I had a poor insurance plan. My insurance covers everything 100% so why wait? Is it because I’m on Coumadin and they are afraid to go in?
That’s not an excuse. I’ve had surgery that required a 5 day hold on Coumadin and bridging with Levonox . So what’s the big deal?
Are they afraid that I may bleed to death and my family will sue him and the hospital for “ killing “ me?

REPLY
Profile picture for andytheman @andytheman

@patti1416 I have been on Coumadin for years and my aortic artery aneurysm is at 3.9 until I have it checked in 2 months. Yes it has a
“Tear “ in it. My cardiovascular surgeon doesn’t seem to be too concerned about it.
I don’t like being on Coumadin due to my mechanical aortic heart valve with a torn aortic artery aneurysm. My last INR was 3.0 last week borderline high end. Thin blood with a torn aneurysm bothers me more than it does my cardiovascular surgeon apparently. He must know when it’s time to correct it? I don’t know. A few years ago they found a 3.7 cm with a tear in it during an unrelated CT scan and they were like “ oh my God we need this repaired now “. They dressed me back up and threw me into an ambulance for a quick ride to a higher rated trauma hospital and when I got there they took an immediate CAT scan and confirmed the torn aneurysm but the cardiologist for that hospital said “ well, yes you have one but it’s not bleeding and doesn’t need to be treated today” “ but you will need to come back later under a non emergency appointment “.
That was it. I was like “ look, it’s torn, and I’m Coumadin with an NRI that is always variable in thinness “ and he went on to another patient. I have great insurance so it wasn’t that! First thing I know I was being given my discharge paperwork and waiting for an ambulance to take me home. All because it wasn’t bleeding at the time.
One hospital took a fit and the second one was like “ well, it’s not bleeding!”
Are they waiting for an all out rupture that can be fatal quickly?
It looks like if you have a torn aneurysm but you’re not fatality bleeding because it’s less than 5.0 cm
(The golden number) you can be ignored other than a once in a year quick sonogram? Granted, it’s far from a 5.0 cm but why wait for a rupture??
These doctors aren’t so bright. My original cardiologist said “I don’t see anything!!!” The second cardiologist treated it like “ oh wow, we need to operate” the third cardiologist says yup it’s 3.7 cm and said “ see you next year “ my current cardiologist says “ it’s at 3.9” “see you in 6 months “.
It’s not like I had a poor insurance plan. My insurance covers everything 100% so why wait? Is it because I’m on Coumadin and they are afraid to go in?
That’s not an excuse. I’ve had surgery that required a 5 day hold on Coumadin and bridging with Levonox . So what’s the big deal?
Are they afraid that I may bleed to death and my family will sue him and the hospital for “ killing “ me?

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Oh my gosh, it sounds like what I' ve gone through many times since getting the mach.valve in 2003.
Luckily I'm a very pro-active patient! So I go into every situation loaded with questions, after I've read up on whatever is going on, First!
But obviously when its a sudden decision or an emergency, that doesn't help!
Coumadin RULES my life, as I'm sure it does your's too!
I will never understand why nothing has been done in regards to research, for finding a better way to control blood thickness or thinners, for Mech. Valve patients.
Mine RARELY stays in range, because everything we eat or take, can affect it! Even after 23 years, I'm never suprised when I test, and its too high or low!

And I aree with you abt. diff.reactions to the size of our aneurysm's, from diff.members of our cardiology teams! And that's maddening because we, as the patient's, are clearly anxious about having an enlargement in the 1st place, and they throw numbers around like its no big deal!🤷‍♀️😡

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Profile picture for patti1416 @patti1416

Oh my gosh, it sounds like what I' ve gone through many times since getting the mach.valve in 2003.
Luckily I'm a very pro-active patient! So I go into every situation loaded with questions, after I've read up on whatever is going on, First!
But obviously when its a sudden decision or an emergency, that doesn't help!
Coumadin RULES my life, as I'm sure it does your's too!
I will never understand why nothing has been done in regards to research, for finding a better way to control blood thickness or thinners, for Mech. Valve patients.
Mine RARELY stays in range, because everything we eat or take, can affect it! Even after 23 years, I'm never suprised when I test, and its too high or low!

And I aree with you abt. diff.reactions to the size of our aneurysm's, from diff.members of our cardiology teams! And that's maddening because we, as the patient's, are clearly anxious about having an enlargement in the 1st place, and they throw numbers around like its no big deal!🤷‍♀️😡

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@patti1416 I just read an article written by a police officer as I was one back in the day. He woke up in the middle of the night with mild chest pains and he ignored it figuring it was just heartburn. He briefly tried to get back to sleep but the pain was getting more intense. He got up and went to the bathroom and collapsed. His wife found him and called 911. When he got to the hospital they rushed him to the trauma unit of the hospital. His aneurysm had burst.
He ended up having 2 strokes and they had to paddle him twice to restart his heart. The hospital had to do many procedures to try to keep him alive although they weren’t sure if he was going to survive.

He ended up in the ICU and it took almost two months before he was released to rehab as his right arm didn’t work. He wanted to be able to resume being a police officer but his right arm had to work perfectly in order to qualify for the ability to use his sidearm. I will tell you that he is back to being an officer. He said that we should never take chest pains lightly and go to the hospital promptly.
He is ok now but the two strokes still haunt him as he still shakes at times. Good advice even though I always write off my occasional mild chest pains. It is a happy ending story.

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Profile picture for andytheman @andytheman

@patti1416 I have been on Coumadin for years and my aortic artery aneurysm is at 3.9 until I have it checked in 2 months. Yes it has a
“Tear “ in it. My cardiovascular surgeon doesn’t seem to be too concerned about it.
I don’t like being on Coumadin due to my mechanical aortic heart valve with a torn aortic artery aneurysm. My last INR was 3.0 last week borderline high end. Thin blood with a torn aneurysm bothers me more than it does my cardiovascular surgeon apparently. He must know when it’s time to correct it? I don’t know. A few years ago they found a 3.7 cm with a tear in it during an unrelated CT scan and they were like “ oh my God we need this repaired now “. They dressed me back up and threw me into an ambulance for a quick ride to a higher rated trauma hospital and when I got there they took an immediate CAT scan and confirmed the torn aneurysm but the cardiologist for that hospital said “ well, yes you have one but it’s not bleeding and doesn’t need to be treated today” “ but you will need to come back later under a non emergency appointment “.
That was it. I was like “ look, it’s torn, and I’m Coumadin with an NRI that is always variable in thinness “ and he went on to another patient. I have great insurance so it wasn’t that! First thing I know I was being given my discharge paperwork and waiting for an ambulance to take me home. All because it wasn’t bleeding at the time.
One hospital took a fit and the second one was like “ well, it’s not bleeding!”
Are they waiting for an all out rupture that can be fatal quickly?
It looks like if you have a torn aneurysm but you’re not fatality bleeding because it’s less than 5.0 cm
(The golden number) you can be ignored other than a once in a year quick sonogram? Granted, it’s far from a 5.0 cm but why wait for a rupture??
These doctors aren’t so bright. My original cardiologist said “I don’t see anything!!!” The second cardiologist treated it like “ oh wow, we need to operate” the third cardiologist says yup it’s 3.7 cm and said “ see you next year “ my current cardiologist says “ it’s at 3.9” “see you in 6 months “.
It’s not like I had a poor insurance plan. My insurance covers everything 100% so why wait? Is it because I’m on Coumadin and they are afraid to go in?
That’s not an excuse. I’ve had surgery that required a 5 day hold on Coumadin and bridging with Levonox . So what’s the big deal?
Are they afraid that I may bleed to death and my family will sue him and the hospital for “ killing “ me?

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@andytheman You mentioned having good insurance. Could you go for yet another opinion at a different facility? Maybe that would be too confusing, but might be helpful...Three times the charm?? Wishing you peace about this. I have an aortic aneurysm too, but do not have the tear and the Coumadin issue that you have that complicate things.

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Profile picture for luhn @luhn

@andytheman You mentioned having good insurance. Could you go for yet another opinion at a different facility? Maybe that would be too confusing, but might be helpful...Three times the charm?? Wishing you peace about this. I have an aortic aneurysm too, but do not have the tear and the Coumadin issue that you have that complicate things.

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@luhn thank you for the suggestion. I plan on seeking an opinion from a different cardiologist as this cardiologist is standing firm about the “ no need to worry “ mindset. I don’t like him as he tends to be dismissive of my issues. All he’s good for is monitoring my INR Coumadin level

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Profile picture for andytheman @andytheman

@luhn thank you for the suggestion. I plan on seeking an opinion from a different cardiologist as this cardiologist is standing firm about the “ no need to worry “ mindset. I don’t like him as he tends to be dismissive of my issues. All he’s good for is monitoring my INR Coumadin level

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@andytheman
Hi...not sure if you want the extra expense, but Cleveland Clinic offers a "Virtual Second Opinion" on line. Your case is reviewed by an aortic specialist MD and written analysis is provided. Your allowed to ask questions prior to and after the "opinion" is sent to you. Best wishes to you and loved ones!

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