Have I interpreted my risk too high from my cardiac surgeon?

Posted by stevebn @stevebn, May 17 8:48am

68 years old. 6'1". 190 pounds. BP 85/125 almost daily reading average since diagnosed in 2019 with 43 mm ascending arch aneurysm. 2.5mg bisoprolol. 80 mg statin aneurysm after 2019 TIA (no deficits). Daily low dose ASA.

Skinny, physically hyperactive kid of the 1960s in rural Canada. 1980-2018 career climbing mountains on 3 continents as a professional prospector in the Canadian mining exploration industry. Cyclist.

Short story...I've been kept by my career to be physically fit and healthy my entire life. But I had a mild TIA in 2019 ( no deficits) determined to be a blood clot. Followup work found the aneurysm and subsequently also a stage 3 malignant tumour on a kidney with both surgically removed. No cancer indicators afterward and no longer monitored.

Sorry for the long build up.

Here's my concern. After reading so many cases on this forum of aneurysms that are far larger than mine, it supports my concern that my cardiac surgeon may have over emphasized my risk or that I have misinterpreted the level of risk.

I retired early because of the issues listed above, lead by the aneurysm. I've followed my surgeon's recommendations such as no explosive isometric exercise, stopped what was social level drinking and maintain my healthy diet. But my physical fitness is gone as I tend to worry about my aneurysm and have evolved into a couch potato who can list gardening as a pathetic apex of my physical activity. I also have never had to artificially maintain my fitness and the thought of a gym or a routine is crinchable. I'd like to go cycling again and back to climbing mountains found more than a couple hours away from a cardiac surgeon.

Sooo...is 43 mm in a guy my size reeeally something to worry about? It has been stable at that size since found in '19. I'm I worried or over worried at this stage?

Interested in more discussions like this? Go to the Aortic Aneurysms Support Group.

melcarey260846 | @melcarey260846 | May 17 1:51pm

At 4.3cm ....I would encourage you to take a balanced view and consider more activities in a controlled manner eg, no straining if possible. Life has to be lived and your confidence restored. My AAA is at 5.5+ and ever aware of BP spikes if I can avoid them.

lsrchevy68 | @lsrchevy68 | May 19 12:01pm

43mm? Mine was 5.1 cm. They will keep an eye on it and when it gets close to the size for men they will check it more often. Hope all goes well with you.

bignelie | @bignelie | May 22 10:40am

6'5" here and being bigger did help in risk assessment but doesn't elimate risk. The picture attached is on offer from the harvard study https://www.jtcvs.org/article/S0022-5223(17)32769-1/fulltext .

But it doesn't eliminate all risk. One of the best suggestions I got when going is to make sure they do a full 3d scan to look at the aotra from all sides. It was found randomly from a non-contrast CT at 4.3 cm, then it was found bigger at cross section during an echo but that was unreliable, and finally they did a contrast full 3d image and found part of my root had bulged out further then the my ascending aorta causing me to then need to consider surgery (7.5 months post op now). Also did genetic testing because genetic testing will make a 4.3 higher risk to dissect with some genetic markers.

And after surgery the doctor told me it was already tearing so we hit it perfectly.

Just do you do diligence to determine risk and change activity habits that make your blood pressure spike like HITT or weight lifting while you verify your risk from all angles. From all my consultation if you don't have high blood pressure (I didn't), the biggest concern is spikes.

Hope this helps

bignelie | @bignelie | May 22 10:42am

I fogot to mention to help maintain my fitness I trained at 120 bpm and below over longer distances like on an ebike and low weights. Yes you won't be mountain climbing levels but that is considered a high risk thing like basketball. One of the reasons I did consider the surgery was to not have any exercise restrictions which after 7 months I don't have limits but my body is rebuilding.

stevebn | @stevebn | May 22 2:53pm

Thanx for this. I think my concerns have been answered. At 68, I guess I just have to act my age in terms of exertion. Everything else seems to be in line with what you and others have said. It's not an exact science but more of a balancing act of factors. I guess I just never thought I'd be physically restricted in my older years.

I have hired a personal trainer who has focused on increasing my abysmal flexibility and strength maintenance over strength building. I've been at it since May 2 (3 weeks) and hate it when I'm doing it but at least I don't reach for the 3 foot long shoe horn to facilitate putting on laced shoes.

Again, thanx for all the great real world stories that translate to great advice.

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