Exercise and aortic root dilation

HeartofClay said:

Hi, I'm a new member - 62 years old - with a congenital, tiny VSD ( so far no problems) and an aortic root measurement of 3.99 (sinus of Valsalva). Aortic valve is fine with just trace regurgitation and a calcium score of zero. I'm 6 feet tall and 235 lbs so my doctor said that given my BSA that this is not a concern - come back in 2 years for another CT. Blood pressure is fairly well controlled with 40mg of Telmisartan. The doctor told me - no worries, you're normal for your age and size - go back to your regular life. However, when I mentioned weightlifting he waffled and said he had no problem with 50 pound lifts but sounded like he was throwing a dart. Prior to this I was repping 225 bench, etc. but have cut way back to high rep, low intensity machines and dumbbells and easy zone 2 cardio and distance walking. It's difficult to know what boundaries I should adhere to- whether breathing through lifts, etc. would allow me to go a little heavier. I'm a rounding error beneath 4.0 so he said I'm normal but it doesn't feel normal. 12 years ago I had a stress test/echo that showed my sinus of vasalva at 3.8. So it's only grown 2 mm in last 12 years. I quit drinking 3 years ago (history of occasional binging) and quit heavy lifting 3 months ago but there was a lot of prior reckless activity on my part and I'm fortunate that the growth rate is as slow as it's been. May quit caffeine. Feel like I'm at the beginning of a journey now but I found this dilation by accident and the doctor didn't even mention it. Was only after I read my own report and followed up. Any suggestions are appreciated. This is a great site.

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tjay said:

Looks like you've looked at this from all angles, are well aware, and have made appropriate adjustments. Your plan looks good. Rest you would be following up closely (CT or MRI) every 1-2 years anyway, so any further adjustments can be made then if necessary. Don't give up your passion completely, live your life, your adjustments sound very reasonable.

You're a big guy (6 feet), so 4.0cm isn't too bad. Plus at your age (62), it's progression would also be slow. As you noted, it grew 0.2cm in the last 12 years. You have enough runway left in terms of size concerns (4.0 to 5.0 can take a lifetime), longer than perhaps your leftover lifespan (in a good way ), so stick to your stated plan and you should be fine.

Lastly, is the BP med you're taking an ARB? Looks like it is (Telmisartan). ARBs are known to stabilize the aorta, so keep taking that too.... That may be in part why your aorta has been relatively stable for a while (and hope it continues that way).

And is your aortic valve anatomy BAV? If not, your dilations concerns may be lesser than that for a BAV tissue around.

All the best.

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HeartofClay said:

Hi, I'm a new member - 62 years old - with a congenital, tiny VSD ( so far no problems) and an aortic root measurement of 3.99 (sinus of Valsalva). Aortic valve is fine with just trace regurgitation and a calcium score of zero. I'm 6 feet tall and 235 lbs so my doctor said that given my BSA that this is not a concern - come back in 2 years for another CT. Blood pressure is fairly well controlled with 40mg of Telmisartan. The doctor told me - no worries, you're normal for your age and size - go back to your regular life. However, when I mentioned weightlifting he waffled and said he had no problem with 50 pound lifts but sounded like he was throwing a dart. Prior to this I was repping 225 bench, etc. but have cut way back to high rep, low intensity machines and dumbbells and easy zone 2 cardio and distance walking. It's difficult to know what boundaries I should adhere to- whether breathing through lifts, etc. would allow me to go a little heavier. I'm a rounding error beneath 4.0 so he said I'm normal but it doesn't feel normal. 12 years ago I had a stress test/echo that showed my sinus of vasalva at 3.8. So it's only grown 2 mm in last 12 years. I quit drinking 3 years ago (history of occasional binging) and quit heavy lifting 3 months ago but there was a lot of prior reckless activity on my part and I'm fortunate that the growth rate is as slow as it's been. May quit caffeine. Feel like I'm at the beginning of a journey now but I found this dilation by accident and the doctor didn't even mention it. Was only after I read my own report and followed up. Any suggestions are appreciated. This is a great site.

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HeartofClay said:

Hi, thanks for the reply. My value is tri-leaflet not BAV fortunately. I'm on telmisartan. I've only been taking it for 6 months - upping dose from 20mg to 40mg about two months ago. I should have started some years back as I was in that 140's/90's camp for way too long. Telmisartan seems to have some positive metabolic effects independent of blood pressure. Thought about losartan which has stabilized aorta's in some studies with people with Marfan's but doing telmisartan for now. Am taking a bunch of supplements to stabilize/enhance collagen and am interested in compounds that do the same for elastin though elastin is more difficult from the research I've done. I figure if I've only grown 2mm in 12 years but am now on BP meds, living a clean lifestyle and moderating but not eliminating lifts that maybe I can keep this progression at a snail's pace. That's the hope anyway! Thanks again.

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HeartofClay said:

May quit caffeine. Feel like I'm at the beginning of a journey now but I found this dilation by accident and the doctor didn't even mention it.

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HeartofClay said:

Caffeine is the last hurdle but you are right (as I type this with my morning cup). Thank you.

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pellicle said:

Good morning,

I didn't think I had anything to add to this as everyone's answers seemed to be what I'd have said, but:


the caffeine or the dilation?



I'm not sure why you're even considering quitting it. I can't think of a single reason. Now sure, if you're a habitual 10 coffee a day guy, you may want to reduce. But I have one in the morning and one around lunch (nothing after that because "sleep")

Best Wishes

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tjay said:

Once again, you've a good handle over things and will do fine monitoring every 1-2 years going forward.

My choice for ARB was Losartan for the reason you mentioned above. And I went aggressive with the dosage since my aortic dilation/aneurysm was at the borderline (unlike yours which are just fine right now). May be pick a dose which keeps your BP in the 110/70 range. Ask Cardiologist to switch to Losartan

Let me know if you need to discuss further. I dealt with a lot of scenarios like that last 10-20 years before doing my aortic surgery very recently, but that story is for another day.

All the best.

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HeartofClay said:

the dilation. Otherwise would have carried on blissfully with heavy weightlifting. True, coffee is probably pretty low in the grand scheme of things though

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HeartofClay said:

saw some info that calcium channel blockers may contribute to elastin degradation even as they lower BP, so kind of a double-edged sword.

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pellicle said:

Link to a citation would be useful, or I'm calling BS on that.

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Aims: Abdominal aortic aneurysms are characterised by changes in the extracellular matrix of the arterial media, in particular a reduction in elastin concentration. These changes are mediated by increased levels of endogenous matrix metalloproteinases (MMPs). Recently, calcium channel blockers have been shown to increase the proteolytic activity of MMP-2 secreted by vascular smooth muscle cells. It may therefore by hypothesised that calcium antagonists may potentiate the activity of MMPs in aneurysmal disease and thus accelerate AAA expansion. In this study, the ability of amlodipine–a calcium antagonist–to influence elastin degradation, was assessed in a previously described model of aneurysmal disease.

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Methods: Porcine aortic segments (n = 8) were pre-incubated in exogenous pancreatic elastase for 24 h prior to culture in standard conditions for 6 days with 10 and 100 micrograms/l amlodipine. Control segments were cultured both with and without amlodipine and without elastase. At the termination of culture MMPs were extracted from the tissue and quantified by a combination of substrate gel enzymography and immunoblotting. The volume fractions of elastin and collagen were determined by stereological analysis of EVG stained sections.

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Results: Gel enzymography demonstrated significantly increased MMP-9 activity in the amlodipine treated segments, median 4.218 vs. 2.809 arbitrary units (p < 0.01) and this elevated activity was reflected in a significant destruction of medial elastin 27.0 vs. 40.5% (p < 0.05).

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Conclusion: Therapeutic ranges of amlodipine significantly enhanced elastin degradation and potentiated MMP-9 activity within the aortic organ cultures.

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Amlodipine potentiates metalloproteinase activity and accelerates elastin... 2​

Elastin synthesis in cultured smooth muscle cells was inhibited by one fourth in the presence of 0.1 M K+ in the medium. The degree of inhibition paralleled the decrease in the steady-state levels of elastin mRNA. The inhibition of elastin synthesis was blocked by addition of 1 microM nifedipine, a Ca2+ antagonist. Comparable inhibition of elastin synthesis was observed by addition of A23187, a Ca2+ ionophore. In contrast, collagen synthesis and thymidine uptake were stimulated threefold and twofold respectively in the presence of 0.1 M K+ with a concomitant increase in collagen mRNA. The stimulation of collagen synthesis was also blocked by nifedipine. These results indicate that K+ modulates elastin and collagen synthesis and their gene expression reciprocally, and these effects are mediated by Ca2+ influx. Thus K+ exerts profound effects on the composition of extracellular matrices in aorta.

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Inhibition of elastin synthesis by high potassium salt is mediated by Ca2+...​