What Is An Aortic Aneurysm?
Aortic aneurysm describes an aorta that is enlarged in size. If it becomes significantly large it can lead to catastrophic complications. The aorta is the large blood vessel that the heart pumps into via the aortic valve every time it beats. Incredibly the aorta pumps around 200,000,000 liters of blood around the body in a lifetime. The aorta supplies the body with blood and is the largest blood vessel. Many blood vessels arise from the aorta that supply various organs and parts of the body with blood, for example the carotid artery that supplies the head comes from the aorta. An aortic aneurysm is when the aorta is noted to enlarge. For example the normal aorta is about 2-3 cm wide. Some aortic aneurysms reach 5,6 or 7cm, or even larger.
Thoracic vs. Abdominal Aortic Aneurysm
Aortic aneurysms in the top half of the chest are generally known as thoracic aortic aneurysms and those in the abdomen are known as abdominal aortic aneurysms. The aorta leaves the heart, goes up to the top of the body then bends and goes down towards the legs. The part of the aorta that is in the chest is known as the thoracic aorta, the part that is in the abdomen area is known as the abdominal aorta. In the thoracic aorta, the part that goes up from the heart to the top of the body is known as the ascending aorta, the bend at the top of the body is known as the aortic arch, and the part that travels down towards the leg is known as the descending aorta. This is important in describing aortic aneurysms, for example, ascending aortic aneurysm vs. descending aortic aneurysm.
How Big Does The Aorta Have To Be To Be Called An Aortic Aneurysm?
Many aortic aneurysms will never become large enough to need any surgical treatment. Technically to be an aortic aneurysm the aorta just needs to be larger than the normal values for any given person. Importantly, however, many aortic aneurysms will never get large enough to worry about. There are various factors that determine the size of a normal aorta, these include age, sex and body size. The elderly, men and larger people will have larger aortas.
Symptoms Of An Aortic Aneurysm
Aortic dissection, the feared complication of aortic aneurysms may present with a tearing pain that is felt to go through to the back. Many aortic aneurysms will be clinically silent which means that there are no associated symptoms. These will just be picked up on routine scans. In some cases however symptoms may lead to the diagnosis. Pain may be present, in thoracic aortic aneurysms the pain will be in the chest, and in abdominal aortic aneurysms the pain will be in the abdomen. In a dissection, which is one of the most feared complications of an aortic aneurysm, there may be a tearing feeling and the pain often is felt through to the back and is intense in nature. Very large aortic aneurysms can cause compression of nearby structures, those in the chest for example can press on the food pipe and cause difficulty swallowing or persistent coughing. In large aortic aneurysms, the aneurysm may be felt to be pulsating on the physical exam.
Diagnosing Aortic Aneurysms – Tests
When it comes to diagnosing, characterizing and following aortic aneurysms, and planning interventions, CT scan is the most commonly used test.
Chest X-Ray – A simple chest X-ray may show widening of the aorta that can be suggestive of an aneurysm.
Echocardiogram – This is an ultrasound scan of the heart that looks not only at heart structures, but can also give excellent detail of the ascending aorta as it leaves the heart. This can show enlargement and may be used to assess changes in the aorta over time.
TEE – This is an ultrasound scan of the heart known as a transesophageal echocardiogram where a probe is inserted in to the food pipe to take close up pictures of the heart. The TEE is excellent in diagnosing structural heart disease such as thoracic aortic aneurysms and any associated complications.
Abdominal Ultrasound – This is an ultrasound scan of the abdomen that can look at abdominal aortic aneurysms, it is good for diagnosing and also looking at aortic size. It is painless and low cost and so often used as a screening tool.
CT Scan – This is the most widespread test used to diagnose aortic aneurysms, offers excellent detail and is widely available. The only downside to this test is the need for contrast dye and also radiation exposure, which means its not ideal in young people requiring repeated tests, or in those with kidney disease.
MRI Scan – MRI scanning gives excellent quality images of the aorta and aneurysms and is very reproducible and therefore good for serial imaging over time to follow size. Drawbacks include availability and the fact it is not very practical if needed for an emergency.
Key Factors In Imaging of Aortic Aneurysm
The measurements taken should be taken in the same place ideally each time the aorta is measured especially when looking at serial follow-ups over time. Risks of tests should be taken in to account, for example radiation risks, procedural risks and so on. If comparing aortic aneurysms on follow up scans, the same imaging tool should be used each time ideally. The aorta should be measured at many different levels.
Medical Treatment of Aortic Aneurysms
Blood pressure control and addressing common cardiac risk factors is the cornerstone of medical treatment of aortic aneurysms. The goal of medicines in the treatment of aortic aneurysms is to reduce the stress on the aorta by reducing blood pressure and the force of each heart beat. Blood pressure should at least be controlled to below 140/90 levels. It is critical that smokers stop smoking. Smoking has been shown to increase the rate of aortic aneurysm expansion. Treatment of cardiac risk factors such as cholesterol levels, diabetes and obesity should also be addressed.
Minimally Invasive Technique for Thoracic Aortic Aneurysm – TEVAR and EVAR
Minimally invasive options can avoid open surgery for aortic aneurysms and are commonly used, known as EVAR and TEVAR depending on the location of the aneurysm. TEVAR stands for thoracic endovascular aortic repair. EVAR generally refers to the abdominal aortic aneurysm repair. In the TEVAR, the procedure is performed through the artery of the leg and avoids the need for open surgery. In the TEVAR the aortic aneurysm is covered with a stent that is covered with a membrane and prevents enlargement. An appropriately skilled team to determine candidates for TEVAR reviews patients CT scans carefully. The stent graft is entered in to the body in a collapsed state, and then expanded when in the correct area of the aneurysm.
Open Surgery for Aortic Aneurysms
Cardiothoracic surgeons will typically operate on thoracic aortic aneurysms and vascular surgeons will operate on the abdominal aortic aneurysms. Sometimes in extensive aneurysms involving the whole aorta then both may work together. In surgical repair of an aneurysm, the aneurysm portion of the aorta is removed and replaced by a graft. The decision to perform surgery vs. a minimally invasive approach will be determined by specialists who are familiar with these techniques.
Aortic Aneurysm and Aortic Dissection
Aortic dissection is the feared complication of an aortic aneurysm and is a tear in the wall of the aorta that can result in catastrophic outcome. Aortic dissection is the main reason a repair is performed. In aortic aneurysms the wall of the aorta becomes thin and more prone to tearing. An aortic dissection is basically a tear in the wall of the aorta that can extend all the way backward or forward, depending on the type of tear. The tear leads to rapid blood loss and also prevents blood getting to the organs. It is a serious condition with a high chance of death unless treated emergently. Even when treated, there is a high chance of complications. The most common symptom in an aortic dissection is a tearing type pain that extends through to the back.
When to Operate on Aortic Aneurysms
In general the decision to operate on an aortic aneurysm is based on the size of the aorta and also taking in to account other risk factors for complications if the aneurysm were to be left alone. So basically, the risk of operation must be less than the risk of leaving the aortic aneurysm alone.
Intervention on patients with Marfan syndrome and ascending aortic aneurysm
Marfan syndrome is a genetic condition where patients have weak connective tissue, such as that which holds the joints and tissues of the skin together including the blood vessels. This leads to weakness in the aorta and enlargement. Also there is an increased risk of aortic dissection given the weakness of the walls. In patients with Marfan, surgery should be performed in patients with aortic size ≥ 50mm. In patients with Marfan who have a family history of dissection, size increase of > 3mm/year, desire for pregnancy, or a severely leaky aortic valve, surgery may be considered in those with an aortic size >45mm.
Intervention on patients with bicuspid aortic valve and ascending aortic aneurysm
Patients with bicuspid aortic valve have 2 leaflets in the aortic valve rather than the normal 3. These patients are more susceptible to developing aortic stenosis that is a tight aortic valve, and aortic aneurysms. In general patients with a bicuspid aortic valve and aortic aneurysm should undergo operation for the aneurysm if the aortic size is ≥ 55mm. In patients with risk factors for complications such as those with rapid size increase, high blood pressures, family history of complications and others, surgery at an aortic size of >50mm is considered reasonable.
Intervention on patients who need aortic valve surgery and have an ascending aortic aneurysm
In patients already requiring surgery on the aortic valve, lower thresholds for aortic surgery may be used, such as 45mm. Decisions are regarding the need for and the type of operation should be made on a case by case basis by a specialist team.
Intervention on patients with descending aortic aneurysms
In general the minimally invasive TEVAR is preferred over open surgery in patients with descending aortic aneurysms. TEVAR is generally performed in patients with aortic size ≥ 55mm. If TEVAR cannot be performed for technical reasons in patients with descending aortic aneurysm and surgery is the preferred option then it is generally performed when aortic size is ≥ 60mm.
Intervention on patients with abdominal aortic aneurysm
In general, intervention is performed on patients with abdominal aortic aneurysm and aortic size of > 55mm or if the aneurysm displays evidence of rapid increase in size. Both the minimally invasive EVAR, and open surgery are seen as valid options depending on expertise available.
my aorta is at 4 how danagerous to me, I always have upper back pain and a pain in my left upper side , other than that my heart is good , Iam on a heart monitor right now and trying with meds to keep my blood preasure down, do you think I will have to have surgury?
A lot depends on the rate of growth and stability, an aorta of 4cm may never need surgery, a reliable form of imaging should be performed on a yearly basis and also control of blood pressure is critical. If it is stable at yearly intervals then that is highly reassuring.
My husband was just diagnosed with a bicuspid valve and also has an enlarged aorta, which I am assuming is called an aortic aneurysm. He has an aortic regurgitation as well. His cardiologist plans to send him to a surgeon at the Mayo Clinic in Rochester, MN to replace the enlarged aorta and the bicuspid valve. Is this procedure done as an open heart surgery? What is the typical time a patient is off of work if he has a desk job?
He has had two echocardiograms performed as well as a TEE most recently.
If replacing just the valve itself we typically use minimally invasive approaches in our center, when the aortic root or ascending aorta is significantly dilated then we use a sternotomy “full open heart” to replace the valve and the aorta. The time off depends on the operation performed and the approach. In the case of a desk job, it depends when the patient feels like going back, and can be back within a few weeks.
What about running if bicuspid aortic valve? Aortic aneurysm?
Depends on the associated disease of the valve (tightness/leak) and the size of any aneurysm. A bicuspid valve alone without any aneurysm is not of any significant concern in terms of activity restriction.
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Good evening Dr. Ahmed
I am so grateful for this site!
I am 44 year old, female. I had Echo in 2015 for murmur. Findings are 1)Interatrial septal aneurysm. Bi-directional doppler shunt. 2) BCAV. No stenosis or insufficiency 3)borderline dialated ascending aorta 3.8 4) Top normal to mild pulmonary HTN. R ventricular systolic pressure 28-33. 5) Normal left ventricular size and systolic function. Ejection fraction is estimated to be 60%
I have some PVC and occassional pounding. Normal range for blood pressure. Good Lipids. No medications. Regular exercise. Major heart disease on both sides of my family. Some anxiety about dissection as it was fatal for a close friend during her pregnancy. Neither survived.
My cardiologist has me on a 2 year recall so my repeat Echo is coming up.
This site has been helpful for me to manage my worry about dissection and timing for interventions. I am not clear though on how the septal aneurysm relates to BCAV in terms of risks. Are they mutally exclusive? Any suggestions on what I should be talking with cardiologist about after next echo?
The septal aneurysm is an entirely separate issue here and not related to the valve. It will not affect the clinical course related to an aneurysm.
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My child 9 has been diagnosed with mild ascending aorta dilation at the root 23mm
She is on bp medicine that is compounded. For the past for days she has complained of chest pain and of shortness of breathe. He bp is normal and heart rate is too. I left a message with her doctor. Could this be related to her heart condition or could it be getting bigger? Thank you
The aorta dilation is relatively mild however given the symptoms i think that you should touch base with a specialist sooner rather than later for risk assessment and reassurance.
Hello I’m 41 yr old male with a bad and anyersum of aorta at 4.7 should I be having open heart surgery?
A vsd a heart murmur and aorta measured at 4.7 cm what should be done for it
The timing of surgery for aorta differs on many factors one of which is size alone. In terms of size 47 does not typically mean a trigger to surgery, 55 does, although factors such as rate of growth, need for concomitant other surgery for the heart, pain and others may expedite the decision. In some cases such as family history of sudden death an earlier surgery at a smaller diameter may be warranted.
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Hello, I am a 56 year old female, 4’8″ in height, with a neuromuscular dz , CMT. I was diagnosed with a 5.0 cm ascending aortic aneurysm in 2014. I presented with extremely high blood pressure, SOB, nausea, chest pain, and diaphoretic. I was placed on 20 mg Lisinoprhil . 12.5 mg Carvadolal . I also have sleep apnea and sleep under a C-Pap, had a stricture stretched x 2, have chronic stomach/bowel issues that are becoming severe to the point I cannot eat or drink much. I had a colonoscopy done in 2015, had eleven polpys removed, one measured 9cm and one measured 6 cm, and stomach was inflamed. I am a retired LPTA, worked in acute for 18 years, retired secondary to all the above. Suffer from chronic fatigue, insomnia, and pain, both neuro and arthritis. Tend get anxious easily. The doctors feel I need to exercise to increase my HR for wt loss, despite my mm wasting, it very difficult to explain that my mm are wasted and feels like moving concrete to move my LE’s, I would very much love to exercise to that degree, but just doing approx. one hour of house work and I become weak, sweaty, very SOB, nauseous, and sometimes become sick and have to throw up. I have checked my HR at that time and is any where from 110-120 bpm. Being that I am considered a Little Person, dwarf, I am proportional. I read where Little People, have smaller organs. Does the impact my aneurysm ? What is a safe HR? I have also had Lung Function Test and they were OK. I also have chronic mm spasms in both sides and rib cage to point I cannot sit at times, lay down and just have to deal with it, I feel that my case is hopeless.
Thank you for your time, I appreciate you opinion.
What opinions have you been given so far? What is the stability of the aneurysm (is it the same size every year)?
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If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
Hello
My dad has a bicuspid valve and a acending aortic anyursum that has been the same size for 28 years 5.4. We have been every where and no one can say to have surgery or not. What is your opinion?
I am 31 year and i had BAV replaced with artificial valve at age of 23. Now i have Ascending Aortic Aneurysm of 5.2cm. Does i need immediate surgery or should i wait till 5.5 cm?
Surgeons are ready to perform surgery at this time but due to my second surgery , surgeons are not sure when to intervene?
Christine can you tell how was the growth before it reached 5.4cm
Hello- I am 33 years old- 5’4 140lbs with a trace of mitral regurgitation and now a mildly dilated aortic root at 40mm. Is pregnancy something that is dangerous for me to do? Will it make the aortic root dilate more?
i have a 4.5 descending anuerysm, i have a yearly check and it hasnt grown in 4 years, stays same, at what size do they recommend surgery and what are my chances of it rupturing, I quit smoking over 4 years ago, and keeping my bp under contro, with medications.
You are taking all the right steps. A lot depends on the nature of the aneurysm itself. If felt to be a relatively low risk aneurysm in terms of its size and shape, then a size of around 5.5 is often used although many factors as described in the article play in to that decision and close follow up and evaluation is always recommended.
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Hi Dr. Ahmed,
I just got the result of my echocardiogram. My ascending aorta measured at 3.8cm. I am a 52yr old male, 5’11” and weight 175lbs. The rest of the test was normal. Is this something I should be concerned about? I have high blood pressure and take 5mg Norvasc and 20mg Lisinopril. My pressure normally runs in the 120’s/80’s, sometimes a little lower and sometime a little higher. I am a non smoker. The Cardiologist that read the test, did not advise or make any recommendations, which I found odd. Any advice you can give is greatly appreciated! Thank You.
It needs to be monitored periodically by a specialist, in our aortic clinic we would do at least yearly imaging to ensure stability, discuss symptoms that could present and control blood pressure and other cardiac risk factors.
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I’m being induced Monday, and have been having so much trouble breathing, heart racing, pulputations for over a year. I just found out over the weekend we have a family history of abdominal arortic aneurysm. I’ve called my doctor twice this week about it. Not returning my calls. I was on heart monitor last week for a week. And had echocardiogram done few weeks ago. But not on my stomach. I have a strong feeling I have the answers after a year and they just haven’t found it. I’m terrified to be induced Monday. I’ve been telling everyone I think I’m gonna die. I cannot breathe. When I lay on my back at night it’s much worst I have to sit up to breathe.and sleep. I finally looked up about it online and weirdly enough. I’ve been seeing my heart beat pulsating in my stomach a lot. I dunno what to do. I left a voicemail again today to ask if the doc was gonna order a abdominal ultrasound. I’m only 32 this will be baby number5. I’m so scared I’m gonna be taking from my kids. We live in a small town and I dunno if they just don’t have time for me or can’t get me in soon enough.
Mention your concerns to the anesthesiologist and obgyn prior to induction. The symptoms you mention are not typical of abdominal aortic aneurysm.
Tammy, can you post an update?
Dr. Mustafa what might it be? I’m experiencing a lot of the same things, but have EDS, POTS, and Raynaud’s (not sure if that plays into anything). I do however tend to have low blood pressure.
Thanks!
Tammy, can you post an update?
I have a few questions concerning my TEE. It states that the aortic root is 4.4 cm and the aortic root is mildly dilated The right ventricular cavity size is mildly dilated and systolic function is mildly reduced. It also states interatrial septal aneurysm with fenestration versus PFO. It also states states aorta mildly dilated measuring 3.8 cm. I just had a second cardiac ablation for Afib and Aflutter. I am supposed to see a vascular doctor in Dec. My question is what does all of this mean and what precautions do I need to be taking. Also what concerns and questions should I have for vascular doctor. Thank you so much and any advice would be greatly appreciated.
Ask the following:
What is the stability and management of the aortic dilation?
What is the mechanism of the right ventricular dilation anD dysfunction?
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Good Evening Dr.Ahmed,
I am a 63 year old lady,I have hypertrophic obstructive cardiomyopathy.I have a 4.2 aneurysm in my ascending aorta,I am thinking maybe was caused by this heart issue.I have a echo once yearly and an EKG 2x yearly.However I have to have iron infusions, or blood transfusions at least once yearly.Do you think I should have a surgery on this? I have shortness of breath often,but could be blood or heart related….Just interested in your thoughts.
I cant give recommendations regarding surgery in such a forum. The aneurysm is not particularly large at 4.2 however certainly warrants surveillance. In terms of the hocm, there are indications for treatment of that, however maximum medical therapy is needed. The treatment of both problems is the same, which if tolerated entails maximum dose of a beta blocker in the first instance.
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I was born with aortic arch was too narrow and was not pick up till i was 15 years old causing before two aneurysms to brain follow after brain surgery stroke right side.
My life has been heath up and down but going good until the last four years when a echo gram show desending Aortic Aneurysm 10mm x 8mm.
Blood pressure control doctors say still wait and see then …….last week with ct scan the found next to aneurysm 9mm x8 mm i have a noticeable blood showing but again wait and see is what my answer.
i feel i am living with a time bomb and scare to go out.
should i go for second advice or listen to them as i am 52 years old and they kept me alive this long
thank you in advance
Karen
Hello, 28 yrs old here–I have mild BAV, 3.6 aortic root and 4.0 ascending aorta, mildly high blood pressure and occasional sinus arrythmias. My cardio recently suggested moving my appts to every 2 years based on stable testing over this year…(ekg,echo,stress test, 24hr monitor, blood test)… We got a CT scan which she said “looked really good” but I was hoping you could help clarify the CT results … Is this CT scan encouraging? My cardio says theres a good chance neither of these dialated spots on the aorta every require surgery…do you agree that is possible? IF it does, how much more dangerous would that make BAV repair? Would it change my life expectancy?
“Cardiac pulsation artifact limits evaluation of the aorta at the level of the aortic root, aortic valve sinus and sinotubular junction. There is NO CALCIFICATION of the aortic valve leaflets. The mid ascending thoracic aorta at the level of the right pulmonary artery measures 39.0 X 39.0 There is also pulsation artifact within the distal ascending thoracic aorta somewhat limiting evaluation within the transverse plane, however measures 27.6 in AP diameter. The Thoracic aorta at the level arch between the bovoine arch and left common carotid artery measures 22.8 X 23.2 mm. The mid descending thoracic aorta at the level of the left pumonary vein measures 21.0 X 22.0 mm. The descending toracic aorta at the level of the hiatus measures 20.6 X 21.8 mm. There is no pericardia effusion. There is a bovine configuration of the great vessels of the aortic arch with common origins of the brachioecphalic and left common cartoid artery.
No pathologically enlarged mediastinal, hilar or axillary lymph nodes are present. The thyroid gland enhances homogeneously. The lungs are clear without pulmonary nodule, mass or focal airspace consolidation. There is no pleural effusion or pneumothorax. The trachea and main segmental bronchi are patent without endobronchial filling defects.
The is mild scoliosis of the upper thoracic spine. The osseous structure of the thorax otherwise appear unremarkable.
You have dilation of the ascending aorta and BAV and so the aorta is prone to dilation and there the need to survey things closely. The need to replace or repair the valve would be dependent on the valve itself and the presence of leak or tightening. Its a process that needs to be monitored closely. In our center this is followed in the aortic clinic as decision making can be complex. The need for length between follow up appointments should be determined by the stability of the process. For example if between 2 follow ups there is very little change then the follow up can be potentially extended out. In terms of operative risk i will ask our aortic surgical specialist Dr Kyle Eudailey to comment.
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Hi Dr. Ahmed,
My 8 year old son had an open heart surgery at age one for a supracristal VSD. He is a healthy child. His last echocardiogram done in 2017 showed the aortic root at upper limits of normal, at 2.42 cm aortic root Z score 1.96. It grew .17 cm from 2015 to 2017. The genetics doctor did not diagnose him as having Marfan, Ehlers Danlos or Loeys Dietz based on the physical and mental evaluation. We don’t have a family history of aortic dilation, rupture or dissection. My husband’s and mine echocardiogram are normal. Question: Is a supracristal vsd considered a conotruncal defect? Can his vsd, even after being fixed, cause a structural fragility that could lead to dilation of his aortic root or we are definitely dealing with a connective tissue issue? I would like to thank you in advance for your support.
I will ask Dr Mark Law our pediatric heart specialist to comment.
Hello Dr. Ahmed:
I recently had a Calcium scan CT as part of a preventative screening. I am 62 yo, in excellent shape, no meds, etc. My Calcium CT score came back as a zero, but the radiologist noted that I had a 41mm mildly aneurysmal ascending thoracic aorta. I was referred to a cardiologist who recommended watchful waiting over the next year, followed up with a retest, and then every two years if no increase in size.
My question is this, my BP currently runs in the 120 to 132 range over 70 to 78. Should I be on a BP med as a preventative, or am I ok as long as it stays at this level? I desperately want to stay off all meds as long as possible, but have seen conflicting advice about this. What is your opinion? Regards
I would say lifestyle medication i.e diet and exercise etc is a reasonable step with regards to blood pressure control, although with the aortic dilation there is a case for initiating beta blocker therapy to reduce pressure and wall stress on the aortic wall.
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I have been diagnosed with Bicuspid Aortic valve and Aortic root aneurysm at 47 mm. I am 60 years male. I have been on norvasc 5 mg as part of my hypertension regimen along with lisinopril 2 * 20 mg. Now beta blocker has also been added after AA diagnosis. My question is whether Norvasc, which tends to dilate blood vessels should be avoided given that I have AA.
Amlodipine use is typically ok and should not be an issue.
My mom is 65 and has ascending aorta dilated. She is waiting for CT scan and echocardiogram. Do you have any care tips? What is the survive rate for people with aortic aneurysm? Have you seen any patients with aortic aneurysm with no burst for their lifetime?
Thanks.
First step is to see its size and features. Many people will have mild dilation only that can be observed.
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Hello Dr Ahmed
I had Bicuspid Aortic Valve replaced at age of 23 and echo report shows my Aorta was 3.9cm at that age , no CT Scan was performed at that age till now. My Dec 2017 Echo report showed aneurysm of 5.1 and followed by CT Scan showed aneurysm of 5.2cm. My valve is working fine.
I met couple of surgeons and few are of the opinion that i should get my second surgery soon while some other feel it can be delayed till 5.5cm.
Considering i am just 31 yrs of age and second surgery (Bentall Procedure) , few says its likely i can need third surgery also in future . So i am in too much dilemma what to do.
It depends on the rate of growth, the presence of symptoms, and the risk of surgery. You should be managed by a specialist aortic team, in our center all such patients are through the aortic clinic where a surgeon and cardiologist with special interest in aortic disease determine the risk and evaluation. In BAV, the aorta in many cases is operated on with dilation 5 – 5.5.
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I am 68 years old. New dr heard a heart murmur, which I had been told several times about but no dr had suggested even checking it out. He did. Start with echo. BAV and 5cm ascending aorta, root is fine. BP has always been normal to low. I checked tonight and it is 100/70. Since it was just discovered about 6 months ago we have no historical data on it. I am in good physical shape – still play high level tennis after 45 years. Cholesteral is normal to low as well.
Just had an MRA last week. Nurse said there was a small change but would not say what. Cardiologist is out of town and I cannot get in for three weeks. Just waiting on info sucks with HCA. He has me on a beta blocked just to be safe. Take aspirin as well.
I have never had any symptoms or tiredness. It is quite frustrating to be told there is a problem — but getting info on how serious it is seems incredibly difficult ?? The cardio guy said not play tennis TOO hard.
My primary care dr, who I have seen for 30+ years had not even put in my chart that I had a murmur — would have been nice to have at least had a base line to know more about the growth of the aorta.
My personal advice is IF you have a murmur, at least talk to a cardio guy, don’t relay on a GP, particularly one that is older.
Any thoughts?
i am 62 years old my aorta is currently at 4.5 mm its been that way for two years now.
it was 4.3 before that.
i am obese, had the lap band done eight years ago and in the last two years i have gained back 50lbs of the 112 lbs i lost.
i have sleep apnia but it has been under control the last two years.
i am on a severance team for the past two years.
so my question is can i fly in a plane to Europe for eight hrs
and spend two and a half weeks there
i know i cant lift real heavy things and use a jack hammer but im very active with automobile and home construction projects.
is it safe to do that kind of work with in reason
thank you for your time
R Stark
You need to be under the care of a specialist that will document the stability of the disease and also the symptoms status. They can assign you risk and flying etc. In general if symptom free and stable then there would be no contraindication to flying.
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hi, i’m female 52 years old, non-smoker, non drinker, active as i can be. i have been told that the 37 mm thoracic ascending aortic dilation does not need to be checked so long as my blood pressure is kept low, since it was found 14 months ago my med have been increased, i also have several auto immune diseases.
do you think this is a reasonable strategy, as i feel that unless a scan is done at some point how will they know if the size has changed and the meds are effective as bp fluctuates?
Blood pressure control is important and appears a reasonable strategy. Periodic follow up of the aorta over the years may be likely also.
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Dr. Ahmed,
Good evening! I’m a 38 yr old nurse, no family history of aneurysm, slightly elevated bp- controlled by lisinopril 10 mg daily. I’m 5’9 and overweight.
History of idiopathic pulmonary embolism, geneticist fu no clotting issues. Hx pvcs, pacs, atrial tachycardia not medicated.
In September 2018 I went in for my annual echo and they noted a 3.7 ascending aortic dilation, and what they thought was a small pfo.
I requested a fu cardiac MRI, this test was done in December 2018
Findings: no pfo noted, 4.4 ascending aortic aneurysm, and a severe focal subendocardial scar to the basal inferolateral wall. Currently being worked up for cardiac sarcoidosis.
My question is should an echo and an MRI have such a large discrepancy? Or is my aorta simply growing rapidly? I believe the exact dimensions were 4.3 x 4.4 so I’m assuming it’s fusiform.
In general I follow such cases in the setting of a dedicated aortic clinic to ensure follow up, multidisciplinary approach and such. The MRI is the more accurate here and should be used at the baseline. It’s important that this is characterized and followed serially for stability to characterize the rate of growth. The work up for sarcoid and causes of scar is important and appropriate.
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Hi,
I’m a 61 year old male on 10mg’s of statin with good BP, no other meds.
Anything to be concerned about here from my CT with contrast results?
Aorta: There is a normal configuration three-vessel left-sided aortic arch. No atherosclerosis of the visualized aorta.
Aortic measurements:
Sinuses of Valsalva: 4.1 cm
Sino-tubular junction: 3.3 cm
Mid-ascending aorta: 3.8 cm
Arch: 2.7 cm
Mid-descending aorta: 2.4 cm
Diaphragmatic hiatus: 2.2 cm
Heart/Vessels: The heart is normal size. There is no pericardial effusion. There is mild coronary atherosclerosis. The main pulmonary artery is normal in caliber.
Thanks Steve!
Its important to always discuss the results of a scan with the ordering physicians office. The results typically depend on the reason it was ordered. In terms of the aorta here, there is some aortic dilation And while immediate action may not be required this should be followed over time.
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I am a 54 year old female, diagnosed with a bicuspid aortic valve 12 years ago. I am at a healthy weight, active, good BP (100/70).
My BAV has been monitored with echo periodically, every 2-3 years. I’ve had trace regurgitation in multiple valves, but no other issues on the echo.
However, compared to my previous echo (3 years ago), the latest shows a number of small differences: mild enlargement of left ventricle, minimal annular calcification of the mitral valve & borderline mitral valve prolapse, mild dilation of the aortic root and mild dilation of the ascending aorta, measuring at 4 cm.
While the ‘minimal’ and ‘mild’ language should be reassuring, taken together these have me ‘mildly’ worried. My doc has suggested monitoring every 2 years. Does that seem reasonable? Any other follow up recommended?
Thank you.
Appears reasonable. I would suspect that the prior echo if re read may have shown some mild calcification also.
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I’m a 43 y/o male and had a recent echo the reveal dilation of my aortic root at 45mm. The doctor stated the the echo can sometimes over call the root dimension and therefore wants me to get a CT scan to confirm the size.
Can the there be a difference in measurements between the Echo and CT?
The CT will be more accurate.
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GOOD AFTERNOON
IM A MAN 28 YEARS OLD. I HAD A MOTORCYCLE ACCIDENT AND I HAD A RUPTURE IN THE AORTA. THE DOCTORS DID A TEVAR PRECIDURE. THEY HAD TO BLOCK THE FLUID TO MY LEFT ARM BECAUSE THE POSITION OF THE RUPTURE. THAT HAPPEND ON MARCH 3, 2018.
I HAVE A QUESTION SINCE THE ACCIDENT I GET TIRED VERY EASLY, I DON’T KNOW IF IT HAS TO BE WITH THE TEVAR OR NOT. WHAT DO I HAVE TO EXPECT AFTER THIS?
THANK YOU
Have you followed up and asked these questions from the treating physician?
Could an asymptomatic 8.5 cm AAA which has been repaired via open surgery caused a heart murmur?
It shouldn’t.
I am a 68 year old male with ascending aortic aneurysm that measures 4.2 centimeters. My doctor says I shouldn’t worry about this as it is to small for intervention. I am scheduled for another CT scan in 6 months. I read that the artery normally grows with age. My health is good with BP about 128/85. What are the odds of this becoming a life threatening condition?
The key is follow up and blood pressure control. If it stays stable for a few years there may be no cause for concern. If it grows it will need watching closely and possibly intervening on at some point. Follow up is aimed at preventing any life threatening occurrence.
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I went to the hospital with my boyfriend this weekend and he had a CT Scan done. the doctor said he needed to see a cardiologist because his Aorta (ascending i’m pretty sure) was measuring at 3.7cm. He is only 23. How worried should I be?
HI. I am 42 years old male. my height is 183cm and my weight is 90kg. I am Caucasian. I had two echocardiogram in the recent months with the below results:
First One: Date: 25/07/2018M Mode/2D Aortic Root ( Range for Echo: 20-37)Result 35mm Conclusion: Normal biventricular size and systolic function, Trivial aortic Regurgitation
Second One: Date 07/03/2019 M Mode/2D Aortic Root ( Range for Echo: 22- 34) Result 42mm
Conclusion: Normal biventricular size and function, Morphologically normal valves and function, Mildly Dilated Aortic Root I have a few question and will appreciate if you kindly answer them:
1- I am very worried because my aorta size increased in 7 months from 35mm to 42mm. Is it dangerous for me.
2- Can I continue going to Gym and continue normal daily activities
3- What can I do for recovery
4- I am active and have healthy lifestyle except I am light smoker ( 10 cigarettes daily)
I thank you for your favour to me answering my question. Regards, ALAN
Just I have on Blood Pressure medication Caveram 10/5 However my blood pressure is in normal range
The first step is to reconcile the difference in readings of the aorta, a CT or MRI scan.
The smoking is a risk factor for aortic complications.
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I got diagnosed with a mildly dilated ascending aorta, coincidental with a CT scan I had done recently for a “calcium screen” (where I scored a zero, i.e. no plaque). I am asymptomatic. My BP is typically about normal, ordinarily around 120/80. I have never smoked, but I could stand to lose a few pounds (BMI 29.9) and my total cholesterol number has hovered in the low 200s for years. My A1c is normal. My PCP referred me to a thoracic/cardio surgeon, but of course the surgeon is out of network. I don’t really want to be on beta blockers or ACE inhibitors the rest of my life, which is what I suspect would likely happen. I don’t really think I have all that much to worry about, but what would you suggest?
What were the dimensions, if only mild dilation most likely observation over time would be suggested.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
No actual dimensions were provided from the CT/calcium scan, doctor, only that it was a “mildly dilated” ascending aorta. The PCP referred me to an out-of-network thoracic surgeon for follow up.
is it dangerous to have a nuclear stress test performed if I have an thoraic aortic aneurysm? Its size is 4.1. My doctor wants to check for any blockages since ivhave swollen ankles. I am worried.
I have an ascending aortic aneurysm (4.5) and a thoracic (4.7), both dilated. I can’t seem to find any information out here about both issues together. Can someone lead me in the right direction? Thank you so much.
If of the ascending and thoracic descending aorta the issue can be managed by a cardiac dedicated specialist. We follow patients in the setting of an aortic clinic. The management of these is often similar in terms of a time to intervene approach depending on size.
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Would a nuclear heart scan be contraindicated for a patient with an aortic aneurysm sized at 4.4?
Not in general no.
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Hi I have a enlarge aorta of 4.2 cm I’m 45 year female I’m due to fly soon will it b safe
A stable aorta in the absence of symptoms, of 42mm only isn’t going to affect flying.
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I have a BAV and 5.1cm ascending aneurysm. I will fly soon for 10 hours in the air. Is it safe?
Hello doc, I’m a 35 year old male having an ascending aorta of 5.1 cm and BAV with mild-moderate regurgitation. I’m about to fly for 10 hour plane travel. Will it be safe? Thanks
Hello Doctor Ahmed!
I have been suffering from aortic valve regurgitation since I was born.I had receive the most recent letter from.my cardiologist and one the findings was ascending dilated aorta at 3.7 cm but last year my ascending aorta was olat 4.8 cm. Can you tell me if there was possible shrink? I am feeling in general worse (breathless,tired,chest pain…)
I would be grateful for you answer!
Its more likely one of the tests is an error. I would recommend having the films reviewed, then if there is a lack of clarity considering a test such as CT or MRI that can measure this accurately.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Hi Doc,
I recently diagnosed for bicuspid valve with mild aortic stenosis and regurgitation with 4.9 ce
I am 43 old male who never been went to hospital except for routine eye and dental vision through my life. I do run at least 20 miles a week, no sign of tiredness. If I run 12 miles a day, the second 6 mile is much easier for me than the first portion. I just went to routine health check at age 43 and the doctor found heart murmur. She asked me, “do you know about that?”, I said no and asked her to refer me to cardiologist. After, a week the cardiologist order and Echo in her office and later on found the problem of specified, followed intimidate CT scan within the same week.
Initial result: Echocardiogram Comp with Color Flow Doppler and Spectral Doppler
murmur
BP: 138/100
HR: 53
Summary:
1. The left ventricular chamber size is normal. There is normal left
ventricular systolic function. The EF is estimated at 60-65%.
2. There is trivial mitral and mild tricuspid regurgitation.
3. There is severe dilatation of the ascending aorta 5.0 cm
4. The aortic valve appears bicuspid. There is mild aortic stenosis. The
mean gradient across the aortic valve is 19mmHg. The peak gradient
across the aortic valve is 31mmHg. Mild to moderate aortic regurgitation
is present.
Findings: Study type fair, The left ventricular chamber size is normal, The left atrial chamber size is normal, The right ventricular cavity size is normal. The right ventricular
global systolic function is normal, The right atrium is mildly dilated, The mitral valve leaflets appear normal, The tricuspid valve leaflets are morphologically normal. There is mild
tricuspid regurgitation. The right ventricular systolic pressure is calculated at 32mmHg. The pulmonic valve is not well visualized. There is no evidence of pulmonic regurgitation. The pericardium appears normal. There is no pericardial effusion
Aortic Valve:
The aortic valve appears bicuspid. There is moderate sclerosis of the
aortic valve cusps. Mild to moderate aortic regurgitation is present.
The peak gradient across the aortic valve is 31mmHg. The mean gradient
across the aortic valve is 19mmHg. There is mild aortic stenosis.
Aorta:
The aortic root appears normal. There is severe dilatation of the
ascending aorta.
Venous:
The inferior vena cava is dilated.
Measurements
Chambers
Name Value Normal Range
IVSd (2D) 1.05 cm (0.6 – 1.1)
LVIDd (2D) 4.62 cm –
LVIDs (2D) 3.12 cm (2.2 – 4)
LVPWd (2D) 1.1 cm (0.6 – 1.1)
Ao root diameter (2D) 3.9 cm –
Ascending Ao 4.99 cm –
LA dimension 2D 3.6 cm –
SV LVOT 85 ml –
LV FS (Teichholz) (2D) 32.5 % –
Aortic Valve
Name Value Normal Range
AV peak gradient 31 mmHg –
AV mean gradient 19 mmHg –
Result CT1:
IMPRESSION:
1. Aneurysmal dilatation of the ascending aorta measuring up to 4.9 cm.
2. Sclerosis noted along an aortic valve leaflet.
CT Chest Double R/O after a month:
Stable aneurysmal dilatation of the ascending aorta. No dissection .
No pulmonary embolism.
Angiography:There is no pulmonary embolus involving the main, lobar, segmental, or proximal subsegmental pulmonary arteries. Stable aneurysmal dilatation of the ascending aorta up to 4.8 cm. There is no dissection. Cardiac size normal.
Pulmonary: There is no pulmonary nodule or airspace disease. There is no pleural effusion
Lymph nodes: There is no mediastinal, hilar, or axillary lymphadenopathy.
Finally: I have seen the cadiotheracic surgeon and he said , I measured the aorta at 5cm, I will do the open hear surgery operation with mechanical valve, call my secretary if you decided and gave me his contact. At that time I haven’t prepared about the valve option have no question to ask. After that, I read a lot of cardiotheracic research papers and see a lot of scary staff about the complication with mechanical valve due to long term blood thinning medication. I am considering to try the following:
1. The risk of aortic rupture is 3.8% /year after it reached >5.3cm on ascending aorta from many years research data based on the paper from Cleveland clinic paper. Most of the high risk is when the root of aortic involved. My root of aorta is normal. I have contacted a guy who did surgery after the ascending aorta become 6cm+, of course the risk varies from person to person.
2. My aortic stenosis is still mild according to the first Echo (Zero symptom except blood pressure, currently taking blood pressure medication to control it). I am still running at least 20 miles a week and have feel excellent after each run.
I decided to take 3.8% risk instead of being on blood thinning throughout my life until I see observable sign ( I heard it is a silent killer), BUT I will continue to do echocardiogram every year. If the stenosis will go to medium/sever range OR the echocardiogram shows type I dissection , I will go to surgery option. Otherwise, I will forget it and continue to my routine life.
If I am lucky, I will delay the surgery with few years and pick the INSPIRIS RESLILIA tissue valve. https://www.umms.org/ummc/pros/physician-briefs/heart-vascular/aortic-disease-hypertension/new-valve-enhances-durability-early-replacement
I will of course going to continue to get second opinion from Cleveland clinic cardiotheracic surgeon soon?
What is your though about the valve and my educated decision if you don’t mind?
Sorry for long message, this all happened into months. My other health condition and blood work are excellent!!!
This is an evolving scenario in terms of the interplay between technology available and clinical experience driving decision making.
Importantly there is no such thing as telling someone what valve they will have. While yes in terms of longevity it may make sense for younger patients to have a mechanical valve, the choice of valve is a lifestyle decision as much as medical decision and the patients wish s and preferences are paramount.
In terms of the aorta, further information would be needed as to characteristics and rate of growth over time prior to a truly informed decision. The valve itself although bicuspid does not warrant isolated intervention at this time and the aorta if stable truly may be managed with a watchful waiting approach vs. an earlier approach depending on interpretation of the literature and patient preference.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
BAV with mild stenosis and dilated 47mm root. Height 167cm – Weight 93kg LV function good as is bp and have no existing symptoms.
Will I need surgery at this point or is it quite possibly it will be a watchful waiting situation and that it might not grow any bigger?
How was this measured?
Has a CT or MRI been done?
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
I am a 34 year old female, non-smoker. I have been having numbness, tingling, headaches, pressure in the back of head, neck pain, shortness of breath, and chest pressure. I had my 3rd baby a year ago. 4 days after giving birth I went to the emergency room for high blood pressure. 186/116. My blood pressure was that high for at least 10 hours, not including the couple of days I was feeling bad before I checked it. I also was experiencing neck pain, tingling in my face, head, arms, and sometimes legs (mostly on my left side). They did an MRI and had no findings of anything abnormal. Diagnosis was postpartum preeclampsia and I was prescribed procardia for a week and my blood pressure went back to normal. They said it was unusual that I hadn’t had preeclampsia throughout any of my pregnancies and I also didn’t have any other symptoms other than the high blood pressure. No protien in my urine and no swelling.
My blood pressure slowly started rising again and I was prescribed procardia around August or September and referred to a cardiologist due to family history of heart problems. I have still had the tingling and numbness as well as nausea and dizziness, pressure in head, shortness of breath, and chest pressure. It seems to be getting more and more frequent. I also started having migraines every day. They switched my blood pressure medicine to Propranolol 20mg twice daily. It seemed to help with the headaches and my BP has usually been around 106/65.
I have seen a cardiologist and neurologist and have had a few tests done. There have been findings, but nothing of significance, according to the doctors. I am waiting for the referral to be sent to a larger facility for a second opinion. I am wondering if any of the findings could be related to each other or caused by the postpartum preeclampsia. Here is a list of the tests I have had done and the findings:
Echo:
trivial mitral regurgitation, trivial aortic insufficiency and no systolic gradient, mild tricuspid insufficiency, trivial pulmonic insufficiency
Ascending aorta is mildly dilated at 3.8cm
There has been an increase in size of the ascending aorta, previously noted as measuring 3.2cm in August 2018.
MRI brain:
There is a moderate sized right posterior communicating artery. There is no definite anterior communicating artery. The vertebral arteries are very asymmetric. The left vertebral artery is much smaller than the right, which can be seen as a normal variant.
MRI cervical spine:
Adynamic alignment due to diminished cervical lordosis.
C0-C1: normal position cerebellar vermis with mild cerebellar tonsillar ectopia.
Right vertebral dominant, dolichoectatic vertebrobasilar system.
C1-C2: posterior translation of the right lateral body of C1 relative to the superior articular surface of the lateral body of C2. This could be positional but could represent counterclockwise rotation of C1 which can create craniocervical junction syndrome, which can account for the extensive and unusual symptoms in this patient.
C4-C5: Ectasia of the V2 segment of the dominant right vertebral artery in the lateral aspect of the right lateral canal which could potentially encroach upon the exiting C5 nerve rootlet.
C5-C6: Ectatic V2 segment of the right vertebral dominant vertebral artery could potentially encroach upon the exiting C6 nerve rootlet at the distal aspect of the right lateral canal.
Nerve Test: waiting on results
MRI cervical spine C1-C2 more detailed: to be done march 5th.
The cardiologist says that my heart looks great and they don’t do anything about the ascending aorta until its at least 4.5cm. I go for a follow up visit in 6 months.
Neurologist is looking more into the C1-C2 for the tingling I am having, but isn’t concerned about any of the other findings.
My concerns:
The amount of growth for the ascending aorta in a years time. 3.2cm-3.8cm
I feel the Dolichoectatic vertebrobasilar system should be looked into further based on my symptoms and family history of stroke and aneurysm. I keep getting told that it “could” be normal.
I had a friend in the medical field tell me to ask the doctor about FMD (Fibromuscular Dysplasia). What are your thoughts?
I plan on getting a second opinion from a Cardiovascular Surgeon. Would that be the right kind of doctor to see?
Thank you for your time.
Would start with a CT or MRI to accurately characterize the aorta.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
I was advised the I had heart anuerysm ascending In March of 2010 via CT Scan for another reason.
I had regularly yearly CT Scans by primary care physician.
Cardiologist did not do thorough testing, one EKG in 09/ 2015,
one EKG in 09/2018 and an ECHO 11/2018.
I underwent emergency surgery for Aortic Intramural Hemotoma 1/19/19. I had 3 grafts. ( 5.5cm)
I went by ambulance to emergency diagnosis by CT Scan.
My anuerysm was 4.8 cm for over 10 years.
Hi, I have a Aneurysmal dilatation of the ascending thoracic aorta measuring up to 4.2 cm, I also have afib, and I also have my right leg, more around the knee that seems to be numb 24/7, could the last 2 conditions be affected by the first condition?
Aortic root was 3.0 cm on echo 2 years ago. Last week on chest mri 3.86. I have BAV. I have had occasional chest pain over the past year, attributed it to the stress of single parenting in a pandemic. Grew concerned after a bad episode during an intense workout. I have history as a competitive athlete.
Following that, I became aware of the discomfort daily—chest pain, not sharp just constant, extending to left arm at times, below sternum, and coughing. All are worsened by activity/stress and seem unrelated to anything else. No fever or other respiratory symptoms. Better with rest.
Is the most likely explanation that the echo measurement was inaccurate and my chest pain is unrelated to the size increase? I am a 32 year old female.
If seeing this in aortic clinic, typically i would check the old measurements personally to look for accuracy. In general the MRI measurement will be the most accurate here. I would recommend seeing a specialist that has a specialist interest in aortic disease. Its not possible in this setting online to comment on the cause of the chest pain.
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had CT and shows 4.4 cm aortic aneurysm. I do non-stop heavy pulling, pushing
and lifting as well as stairs/ladders with boxes that are heavy. is this wise?