Dilaltion of Aortic Root

[Debbie810]

I went for an MRI of my breast and found out that over the past four years my aortic root has dilated from 3.3 in 2005 to 3.7 in 2009. The biggest jump from 2008-2009  3.4 to 3.7cm. Does this mean I have an aneurysm? I don't have any of the risk factors. I am not overweight, have low blood pressure, never smoked, don't drink over 1 glass of wine. So what is the risks and what is the prognosis?

[nickppatel]

3.7cm generally is not considered an "aneurysm," but is certainly larger than normal if you are an average-sized woman.  The fact that you had such a large jump in 1 year is quite concerning.  The risk, as you may know, is that the aorta will get large enough and/or expand quickly enough to cause a tear or rupture, which is a major emergency.  

The prognosis depends on what you decide to do with my message to you.  I have been telling people on these boards for a long time to investigate angiotensin receptor-blocker (ARB) (any ARB except losartan is preferable) or ACE-inhibitor (ACE-i) (perindopril is the only one I know of that really works) therapy with a cardiologist at a major medical center/university who is UP TO DATE on the latest research.  These drugs, already on the market for treating hypertension, have been shown to stabilize and in many cases (like mine) reduce aortic root diameters, depending on the dosage you take.  The studies generally indicate that the higher the dosage (at least maximum FDA-approved dosage or higher), the better the results.  Sufficient dosage is key; if you don't take enough of the drug, you will get no results.

The majority of cardiologists are too busy to read the latest studies in the major medical journals.  As a result, they will continue to tell patients to take beta blockers and wait until the aorta is big enough to justify major open heart surgery.

That is ridiculous in my opinion because a simple daily pill can keep you off the operating table.  Why spend $100k+ and risk open-heart surgery and all the attendant risks when you can just drive to Walgreens or CVS and pop a pill everyday that will keep you off the operating table?  

That is why I stress that you need to educate yourself on this topic and find a cardiologist who knows about these studies and, if appropriate, is willing to prescribe these medications for you.

I know many, many people, including myself, who have experienced either stabilization or major reducations in aortic root diameters with these drugs.  Personally, I take valsartan, but my friends have experienced similar success (or better) with candesartan, telmisartan, losartan (although this drug is surmountable and thus theoretically not the best one to take), irbesartan, and, for ACE inhibitors, perindopril.  All these people take at least the maximum FDA approved dosage or more, and nearly all of them are prescribed by cardiologists who are up-to-date on this topic and know that these drugs are far superior to beta blockers in slowing, halting or even reversing aortic root dilatation.

I've spoken enough; the choice is yours.  Feel free to send me a private message if you want more information.

God bless
NP

[nickppatel]

PS - this goes without saying, but given the fast rate of dilatation, you need to be imaged FREQUENTLY, e.g., at least every 6 months until the aorta stabilizes or reverses itself.