Bicuspid valve and dilated aortic root

Hi,
I recently found out I have a bicuspid valve and an enlarged aortic root currently measured at 4.5cm. I'm going for an MRI scan soon to get another more accurate measurement of this but I have a few questions that I hoped somebody might be able to help me with.
I am a professionally qualified scuba diver and was hoping to take this into a long term career but I wondered if there may be any pressure issues that might cause any problems for me?
Also I regularly go to the gym and before my diagnosis decided I would like to start training for marathon and Iron Man events, would this still be possible or would the exertion placed on the heart be dangerous?
Finally, on occasion, I do smoke cannabis, I am more than aware of the risks this involves to an average person but I wanted to know if there would be any implications specific to my condition?

I would really appreciate any information on these topics as to be honest, it is constantly on my mind whether I need to be doing anything about it.

Many Thanks

JAmes

[SLadylani]

Ok, to start, it is not the aortic valve that the physicians are concerned about, but rather the aortic root which has a higher risk of dissection in a patient such as yourself.  You may know that dissections may be fatal, which is the extreme case of this condition. You should, if not already, be on heart medications to decrease your risk of disssection. Being that your an athlete, Your heart I'm sure is otherwise health, and blood pressure low, which are good things in this case. In reality, the relation of the bipuspid valve, the aortic root, and exercise, is not well known yet, and is based on your cardiologists judgement. Some specialist say that there are no restrictions if measured less than 4.0cm, but yours is 4.5. I am not sure if any, how increased your restrictions would be. As far as the smoking cannabis, that can have varriable effects, but it can effect blood pressure which is something you want to watch out for. I do hold concerns for scuba diving, as I think your heart should be in perfect standing for that, but again, many of this is not well understood yet and is based on cardiologist oppinion. If I personally had this condition, with my little knowledge about it as an RN, I would not pursue the scuba diving, as hard as that may be. I hope your doctors can help provide more answers as well, and let us know if you have any more questions! Best wishes!

Sara RN

[nickppatel]

Click on my screenname and read my prior posts regarding angiotensin receptor blockers (ARBs) and how these drugs can treat aortic root aneurysm.

[SLadylani]

Hey, I clicked on your screen name but did not find any previous posts. Can you just list the meds your on and I can check them out?

Sara RN

[nickppatel]

I assume you directed your post to me.  If you click my screenname and then look toward the top where it says "Posts," click on that and it lists all my posts.  Everything I have to say on the topic is there.

But basically, angiotensin receptor blockers (losartan appears to be the weakest; the rest are good; telmisartan appears to be strongest) and ACE inhibitors (perindopril - not the others) have been shown in recent years to halt and even reverse aortic root dilatation.  The key is that the drugs must be taken in sufficiently high dosages, which often means the maximum FDA-approved dose or higher.  

One recent study showed that the general population's risk of cancer is 6%, but among ARB patients, it is 7.5%.  So balance the additional risk of cancer with the risk of aortic dissection or rupture and make the call.  

Most cardiologists will continue to prescribe beta blockers when ARBs appear to be the superior therapy, so finding a knowledgeable cardiologist is the toughest hurdle.