Aortic root aneurysm - or not

Just wondered if there are any experts around in this field as I have had nothing but conflicting advice.
After ten years complaing of chest pain and breathlessness, getting nowhere, I changed GP practice and got yet another echo which showed Aortic root 45mm.
Commented to new GP as to how long I had had this given several echos and multiple heart tests  in the previous 10 years. He retrieved my printed notes from the previous practice and there in the notes was half an A4 page highlighted in red from 10 years ago. I had however been told that there was "Nothing wrong with my heart",  during many visits to various GP's and consultants. I even suggested to one GP that I thought it might be an aortic root aneurysm causing the pain(also unexplained hoarse voice), to be told "No, they are as rare as hens teeth!".
Root is still 45mm after 12 years and probably many more,  although ascending has increased to 38mm recently. My resting BP has been up to 200/140 on occassion in the last 12 years when I had stopped my BP meds due to side effects, on the premise that my heart was OK. I have also smoked during this time which I noticed caused some pain thus thankfully stopped.
Why did it not dissect with smoking, drinking, stress and such high BP?.
Is it possible that 45mm root is not an aneurysm?.
Could a CT/MRI detect the original cause?.

Any advise appreciated as I am having a poor quality of life on BP meds.

[nickppatel]

Hello.  

1.  Why did it not dissect with smoking, drinking, stress and such high BP?

>>These things certainly are negative factors for someone with an aortic aneurysm (if your root is at 4.5cm, yes, you do have an aneurysm), especially smoking and (theoretically) high BP.  But these things in and of themselves won't guarantee a dissection.  Sometimes people dissect; sometimes they don't.  There are a lot of factors that go into it, including family history, reason for the aneurysm, etc.  Nobody can predict with certainty whether you will dissect.

2.  Is it possible that 45mm root is not an aneurysm?

>>No.  It's an aneurysm and you need to treat it as such.

3.  Could a CT/MRI detect the original cause?

>>Probably not.  A CT/MRI will detect the size, but will not necessarily detect the cause.  How old are you?  What is your body type?  Do you have any unusual features, eg, Marfan syndrome?  Any known degree of atherosclerosis?

You need to worry less about GPs and find a knowledgeable, competent cardiologist (not all of them are).  You have a serious condition and it needs to be monitored.  

Finally, like I tell everyone w/ this condition, certain people may benefit from groundbreaking research regarding angiotensin receptor blockers (ARB); these drugs have names that end in "-sartan."  Taken at high doses, they have been shown to significantly slow, halt, or even reverse aortic root growth.  View my old posts or send me a private message if you'd like to know more.

Jesus bless.
N

[root45]

Hi Nick,

Thanks for the response.
I'm 56, male, 6', overweight, BSA 2.25, aortic root  4.2-4.3, was 4.5, then 4.4, STJ was 4.3 now 4.0, but Ascending was 3.6 now 3.8 and tranverse 3.6 static.
When I found out about the aneurysm, I had also seen the research regarding Losartan so immediatley requested 100mg from my GP, which I have been taking for 18 months along with bisoprolol 5mg.  
Interestingly the root and STJ measurements seem to have reduced but I have my suspicions about the possible innaccuracies of trans-thoracic echo cardiography. I assume also that BP at the time of the echo must cause some variation in the results.
The gentleman who has done my last two echos is about to begin a research project into the effects of losartan on aortic root dilation for non-marfan patients and will be the only person taking the measurements in order to maintain consistent method.

Yes, I do have subtle Marfan signs, as well as, and possibly causing, obstructive sleep apnea(CPAP'd). I also have an Arnold chiari malformation(7-8mm), and what I believe are "Q" waves on my ECG's but no-one will tell me what they mean. They simply say my ECG is normal, just as they did my Cerebellar tonsils!!!. Oh, and compressed spine between CV 5 and 6.  Atherosclerosi unknown but probably significant  considering past lifestyle.
My brother also has an Arnold chiari malformation  and compressed spine, exactly the same,  and is just starting with chest pain and pre-syncope at 45 years, as I did.
My grandmother died at 47 from unkown heart disease, my father had MI at 47 and died from heart disease at 77(I now think it might have been a ruptured/dissected aneurysm), and my maternal grandmother had an aneurysm in her neck in the region of the collar bone. She lived to her 80's, but that was in Australia.

Thus I believe this is almost certainly a genetic problem, but getting anyone to listen is  another matter. I understand that recent genetic deficiencies have been found to be associated with Aortic root dilation but cannot remember the gene.

My imaging consultant said knew of a Marfan and aneurysm oriented consultant who he thougth would be my best bet, but this is England and here the GP rules I'm afraid,  in our bizarre system of health care professionalism!.

My last Cardiologist blamed my high alcohol intake over the years, but as I pointed out to her, my intake was at it's highest over the ten years that the aneurysm remained static!.

All very confusing!.

Best regards and thanks again,

   root45possibly43