My 13 year old son has aortic enlargement

[rosern1]

Hello, I was hoping I could get some more answers as to my son's heart issues. The last day of school 2010, he fainted at a school activity after a bunch of running around and activity. 911 was called by the principal and he had come around by the time paramedics arrived. They took his BP and gave him some oxygen and by that time, I arrived at the park (they were having a last day of school party at the park). I opted to take him to see his pediatrician instead of the hospital. They did an EKG there and told him to get lots of fluids because they said he fainted from being overheated and because he was dehydrated.

Flash forward to Oct 2010. He was laughing one evening in an unusual manner and inappropriately as there was really nothing funny. When we asked why he was laughing, he kept repeating what we said and then would laugh. My older son, 19, told him to knock it off if he was fooling around. This went on for a few minutes. I took him to the pediatrician again the next day. His doctor thought it was cardiac related and apparently in looking at his chart, found the EKG from last May. He noted that it was an abnormal reading but wasn't reported to me nor was it followed up. I really don't know how it was abnormal.

He was referred for a head CT (normal) which was done Nov 3. He finally was seen by pediatric cardiology today Nov 5. He had a stress test done. Pretest BP was 112/65. During the actual testing, his BP dropped to 80/46. They also found he had an enlarged aorta with an echo. They tried to get blood work but my son has a phobia in regard to needles and he screamed and ran out of the room.

We were told to come back in a year for follow up and he was told to eat more salt and get plenty of fluids. The enlargement was small apparently. His ADD med (concerta) was put on hold the week between the silly spell/pediatrician appt and cardiology who said he could take his ADD meds again and restart his Tae Kwon Do as well.

I have since been told by some friends (all in health care) that when there is aortic enlargement, strain and lifting weights should be avoided as well as contact sports to avoid blows to the chest. I think they said that the enlarged area can become bigger with the stress or something. They also think that even though he does not want blood drawn because he is terrified that we need to find a way to get around that and get some labs done to look at electrolytes and check for anemia. My son has not eaten meat in over a year. Eats only fruit and some yogurt and cheese. Pediatrician says he is growing and nothing to worry about, but he is very thin and I do worry about anemia.

I am left wondering if we should seek a second opinion or not. Does more testing or more frequent monitoring need to be done? Is this the same as an aneurysm? I don't want to take a chance with his health and possibly life. But I don't want to worry too much or worse, make him anxious about dying (he already was crying about that because he thought he might). Yet he admires his older brother who wrestles and lifts weights and I am afraid that at age 13, interest in lifting weights is next.

Any help appreciated.

Thanks!





This discussion is related to leaky aortic valve and enlarged aortic root.

[nickppatel]

I can't comment on your son's mental/emotional development issues, but as far as the aortic enlargement goes, I would keep an eye on it with regular echocardiograms (they are non-invasive).  If it continues to grow more than it should for a boy his age (be sure you visit an expert on this issue, as many cardiologists are not very knowledgeable), you should try to find out the root cause - what is causing the problem in the first place.  It may be a connective tissue disorder like Marfan syndrome or something else.  In any case, aortic root enlargement can often be controlled using angiotensin receptor blockers (ARB) drugs.  These drugs, when taken at sufficiently high doses (high dosage is very important), can halt or reverse aortic enlargement.  Again, most cardiologists are unaware of this treatment, so you need to find an expert (send me a personal note if you need help).  You should also know that ARBs have been shown to have a slightly increased risk of cancer (6% in general population vs. 7.5% among ARB users), but that risk should be balanced with the risk of aortic dissection or rupture.

Let me know if you have any questions (send me a note).

[kenkeith]

QUOTE:  I have since been told by some friends (all in health care) that when there is aortic enlargement, strain and lifting weights should be avoided as well as contact sports to avoid blows to the chest. I think they said that the enlarged area can become bigger with the stress or something.

>>>>>>An enlarged aorta for an adult is 2.0-3.7 cm, and if the size is 4.0 cm it is considered an aneursym and closely watched for any rapid growth (0.5 cm/year) to 5.0 cm and at that time intervention is considered.  Blood pressure should be managed as that can further exacerbate the condition....heavy lifting, etc. can cause a spike in blood pressure and that should be a voided.

The danger is the enlarged aorta can rupture, but when carefully watched and monitored the risk of any serious complication is avoided.  

Sorry to hear of son's medical health, but it may not be a problem.  Actually, before any medical diagnoses can be made requires subsequent testing to see if there is a rapid growth factor involved.  Also, your son's aortic size may be normal for him.  

An abnormal EKG requires further testing and is not ever considered a diagnoses for any health condition. It is a tool and requiries further testing and related symptoms to validate.

If the doctor says there isn't anything to worry about, that would indicate the aorta root, ascending aorta size is not an issue.  But you may want to get confirmation that heavy lifting, etc. should ba avoided.  

Hope this helps give you a perspective, and if you have any followup questions you are welcome to respond.  Thanks for sharing, and I wish your son well going forward.  Take care.