Exercise and aortic root dilation

[HeartofClay]

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.

 

[Survived03]

Welcome HoC. The only advice I can provide is what my surgeons and cardiologists told me. Try to keep weights about half you body weight and do more reps. I follow this with the exception of leg workouts. Twenty one years ago I read a few publications that demonstrated a crazy spike in aortic blood pressure when lifting high weights especially when you reach full resistance. Now I was in a different situation as you with full aortic aneurysm repair and bicuspid aortic valve so a more conservative approach was warranted. Good luck.

 

[HeartofClay]

Thanks for the feedback. Is there anything specific to leg workouts that made you alter your approach?

 

[Survived03]

Not really. Except that the legs are my strongest muscles and I don’t feel like I come close to max resistance with 70-80% of my body weight.

 

[HeartofClay]

Makes sense, thanks.

 

[tjay]

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.

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.

 

[HeartofClay]

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.

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.

 

[carolinemc]

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.

Quit the caffeine. Better for your heart if you do. Good you gave up the alcohol. Keep up with the exercise. And welcome to the club.

 

[HeartofClay]

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

 

[tjay]

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.

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.

 

[pellicle]

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:

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.

the caffeine or the dilation?

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

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

 

[Croooser]

tjay covered things well. Only other comment that I might add is that my understanding is that there is some margin of error in testing. So. a difference of <.2 may be insignificant or may not even be at all.

Good job at being proactive. There are quite a few success stories on here and the common denominator seems to be adopting an active approach at being your own advocate for your condition.

 

[HeartofClay]

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

The dilation - had the test and then he took off for an extended vacation. Was only after I read my own data and compared it to previous data that I uncovered the dilation. Otherwise would have carried on blissfully with heavy weightlifting. True, coffee is probably pretty low in the grand scheme of things though I did see some clinical data that caffeine ingestion and weightlifting were the two highest correlates to dilation. Will see if I can locate the study.

 

[HeartofClay]

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.

Thanks, I'll do some more research on Losartan vs. Telmisartan and may switch when I use up my Telmisartan stock. I bumped from 20 to 40 on Telmisartan and have been able to avoid calcium channel blocker thus far though my bp is not 110/70 yet. More like 125/85 or a bit lower. Hopefully some weight loss will get me the rest of the way there. I saw some info that calcium channel blockers may contribute to elastin degradation even as they lower BP, so kind of a double-edged sword.

 

[pellicle]

Morning

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

Weight lifting is the key, coffee isn't even a significant factor. It was only the coffee I mentioned because you may enjoy your coffee. Now, having said that, it's coffee time here.

Best wishes

 

[pellicle]

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

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

 

[HeartofClay]

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

I'll look for the link, and post the article, just saw it yesterday and don't remember complete context.

 

[HeartofClay]

https://pubmed.ncbi.nlm.nih.gov/9854552/

 

[HeartofClay]

Cohen
Jul 29

Calcium blockers most likely decrease the levels of elastin in your body.

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.

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.

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).

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

PubMed

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

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

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.

PubMed

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

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...

 

[HeartofClay]

I'm not a scientist and one can create a hypothesis based on this but this was in-vitro so may not have any applicability to in-vivo human. Plus we know that uncontrolled blood pressure can accelerate aneurysm growth and many people (perhaps myself included) are not sufficiently controlled by one pharmaceutical agent (even at higher dosing) but rather complementary drugs such as ARB's and Calcium Channel Blockers (whole greater than sum of parts). So I would take this data with a grain of salt, however, if I can avoid calcium channel blockers I will. My cardiologist indicated that he would rather not pile on the drugs if I have a good chance of controlling BP with one drug given the always increasing chance of side effects with multiple medications.