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Re: Can someone provide help for mild Aortic dilation? Values in Echo ...
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Re: Can someone provide help for mild Aortic dilation? Values in Echo seems to decrease and then increase

Hi everyone-

I'm 37, Male, and my health is fine, active while playing and exercising and my family's genes are good.  I've been treated for Panic Attacks
using the following:

1) Antidepressants/anti-anxiety (Cipralex or Lexapro) since Aug 2009 (2 years so far)
2) BetaBlocker (Propanaol) -> Time release 40 mg

3) BP is under control

Liver, Kidneys, heart are fine.

I'm also on multi vitamins for the past 1 year

1) Following Paulig's therapy: VItamin C and Lysine (1000 mg every 3 hours for 5 times per day)
2) Taking Arjuna and Ashwagandha for the past 1 year
3) Some other muti vitamins like Vit D3 (only for a time so that value of Vitamin D3 cholicalciferol test
reveals values under optimum levels)


Cardiologist i met recently told me that there are 3 ways they measure values for AO in Echo and
there are other sources of error as well:  Mean, left of that (this would reveal higher value), right of that (this would
reveal lower value).  I don't know the deviation between mean and left and mean and right.


Here are the results of the echo and i'm interested in your opinion and help on the AO parameter:

1) In Mar 2003 -> Everything was normal and AO - 26 mm (not sure how they measured it, mean, left of that etc.,)
2) In Sep 1, 2009 ->  Everything was normal and AO - 31 mm (not sure how they measured it, mean, left of that etc.,);   Mild COncentric Left Ventricle Hypertrophy was present and all this regressed nicely in subsequent echos
Note: No BP medicine between those 6 years and hence it's possible that it increased due to hypertension
3) In Sep 15, 2009 (2 weeks later and 2 weeks after antidepressnt LExapro and betablocker) - Ao - 34 mm
4) in Feb 14, 2010 ( around 6 months after antidepressant Lexapro and betablocker) -> AO - 31 mm
5)  in Sep 9, 2011 (around 2 years after antidepressant Lexapro and betablocker) -. AO - 37 mm (This the cardiologist told me was the mean value)

I've few questionas:


1) What's the gold standard in measuring Ao Dilation value?  Is it MRI?  Is this risky?  Does Echo underestimate or overestimate?  Why's there so much variation in my values?  what should i do to find out the exact value?
2) Has anyone who has tried Pauling's therapy or additions to it atleast to keep the AO value fairly stable and if not non-progressive or reversible or keep them stable?
3)  Does COQ10 help + good diet in reversing it by even 3-4 mm?
4)  I've read a report that anitdepressant like SSRI class (similar to lexapro) caused aortic valve problems in newborns.  Does anyone know whether antidepressant can cause/increase AO dilation (however mild it may be)?  I'm thinking off coming off this drug in 2 months time
5)  I'm really confused and worried as to what i should do
6)  Also, what are the possible causes of AO dilation so that i can rule out this one by one and find out possible
narrowed causes?

I'd some cold, fatigue, sore throat in the last 3 months and it went away.  Does this indicate endocarditis?  if so, can this trigger this AO dilation?  Please help

Please help


This discussion is related to Enlarged Aorta.
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Hey Nick-

From what i'd seen in the few days i've been on this forum, you were one of the few people who has been on top of this and passed on suggestions.   Could you help me as well please?
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I'd like to mention the following so that it might be benefit to others;

Medication:
-------------------------
1)Anti-anxiety :  Since Sep 2009, Lexapro (10-12.5 mg per day)
2) Betablocker (Propanaol):  40 mg Time release
3)  Ativan (1 mg) at night - on demand (i don't take this anymore)


Since Feb 2010, following is something i've added:

1) ONe should Check out Pauling THerapy as this has been proven to reverse artherosclerosis for many who had lot of plaque etc., Got to vitamincfoundation.org.    This is also used for prevention.  Started myself on Vitamin C/Lysine (around 5 gms per day of vitamin C with 1000 mg per 3 hours as Vitamin C has a short half-life)
2) Started using Fish oil for omega 3  on and off
3) Started using for 2-3 months Coq10 (around 50 mg per day).
4) Alpha Lipoic acid (100 mg per day) used it for around 14 months.
5) b-vitamins
6) lot of whole grain diet

CUrrent medications since Sep 2011
----------------------------------
1) COQ10 (60 mg per day )_
2) Fishoil Triple strength with Neptune Krill Oil(around 1500 mg per day of omega 3 (adding EPA and DHA of entire capsule)
3) Bilberry (2 capsules per day - around 500 mg per capsule)
4) Pauling Therapy (around 5 gms - 7.5 gms per day of VItamin C taken together with food that has Lysine or Lysine supplement)
5) CLA through milk or curd and raw ginger (proven to be antiinflamattory)
6) Still on Lexapro and Betablocker (will be looking to come off LExapro in 1-2 months time as i believe SSRI drugs like Lexapro can cause inflammation and there was an article linking it (SSRI's) to aortic in new borns after pregnant women took it) problems

Strategy to be followed;
---------------------------------------

7) TODO -  looking to add Bromelain in a month or two and alpha lipoic acid.  ALso, planning to meet a doctor in Bangalore, India for getting a MRA done to get a baseline of the AO value and get on the ARB as well.

Question
----------------

Would request anyone to let me know if someone has been using anti-depressants and has seen any increase in AO value using MRA or CT instead of Echo.  I'll keep everyone posted about my thing.

Note;
--------------

I believe this anti-depressant causes lot of inflammation and i can personally attest to it as i'd few problems with the tummy (H-Pylori, Burps, UTI, acidosis etc.,)

Profile
------------------

Current Age in 2011: 37, Male, from India, 170 cms, 67 kg

No smoking (used to smoke 5-10 cigarettes per day)
Alcohol; 6-7 bottles of beer per week

Active in sports

Date /AO Value/MEthod used
-----------------------------------------------------
1) Apr 2003 /26 mm/Echocardiography (not sure how it was measured) Age 29 years
2) Sep 1, 2009/31mm/Echo (had a panic/anxiety attack 2 days before this measurement)  -.  No BP medication up until this point.  High BP at 160/110 resulted in 'current in both hands and legs', 'little sweat' and this led me to Emergency before the diagnosis was made after few days as there was fear and this led me to visit the hospital few time during subsequent nights.  Doctors gave me Thiamine injection and put me on Clonotril (0.5 mg) and i again had fear and this led me to get admitted to hospital as this was the first time i encountered this thing.  Diagnosis;  Panic
3) was put on Lexapro (10 mg) and Betablocker (initially inderol normal release and later TR 40 mg after 10 days)
4) Sep 14, 2009 ->  34 mm -> Echo (measured at a different center)
5) Feb 2010 -> 31 mm ->  Echo (measured at the same center as before but possibly by a different technician)
6) Sep 10, 2011 -> 37 mm -> Echo (measured at the same center as was on Sep 1, 2009)
6) b) added Triple STrength Fishoil plus COq10 *60 mg per day plus Bilberry (around 1000 mg per day) for 3 days before measuring again
7) Sep 13, 2011 -> 36 mm /Echo (measure at a different center altogether)

Met around 3 cardiologits and one did nod in agreement that ARB can and does arrest growth of AO but did say that i don't need it and other one told me that my Aorta is normal and asked me to stop doing Echos

based on Nick Patel's suggestions and others's viewpoint, going to get a MRA done in few weeks time and taper off Lexapro and find some doctor to get started on ARB.  If i live for another 20-25 years without surgery and if this one remains stable, i'm happy and i want the same for everyone.

Thanks and best wishes
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Avatar_m_tn
COrrection;  Cigarettes (5 cigarettes per year and not DAY)
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Avatar_m_tn
Also following is something i've added for the past 1 year:

ARjuna
Ashwagandha
Liv 52
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Avatar_m_tn
By the way:

HSV 1 (Herpes SImplex ) positive since the last 2.5 years
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Avatar_m_tn
Posting questions answered by NIck so that i can be of benefit to others:

Sent by nickppatel Sep 11, 2011
1) What's the gold standard in measuring Ao Dilation value?  Is it MRI?  Is this risky?  Does Echo underestimate or overestimate?  Why's there so much variation in my values?  what should i do to find out the exact value?

>>MRI, yes.  It is not risky.  Echo comes within 2mm error in most cases.  If anything, I would think it tends to overestimate, but I'm no expert on echocardiography.  No idea why your values are varying so much.  You should visit a top university hospital or top cardiology hospital and have them definitively measure it by MRI.  Alternatively you can be followed with serial echocardiograms every 6 months to 1 year done by the same technician on the same machine in the same doctor's office.

2) Has anyone who has tried Pauling's therapy or additions to it atleast to keep the AO value fairly stable and if not non-progressive or reversible or keep them stable?
>>Never heard of Pauling's therapy.  To keep stable, take angiotensin receptor blockers (ARBs).  Good ones are candesartan, telmisartan, valsartan.  Depending on your body size you may need to take a maximal dose or even more than a maximal dose if you are a big person.  (When I say maximal dose I refer to the maximum dose approved by the United States Food & Drug Administration; this info is available on the internet for each type of ARB.)  High-dose ARBs can stop or even reverse aortic root dilatation.

3)  Does COQ10 help + good diet in reversing it by even 3-4 mm?
>>Not that I know of.  The only thing I know of that can stop/reduce dilatation is ARBs, taken in maximal or ultramaximal (higher than FDA-approved max) doses.

4)  I've read a report that anitdepressant like SSRI class (similar to lexapro) caused aortic valve problems in newborns.  Does anyone know whether antidepressant can cause/increase AO dilation (however mild it may be)?  I'm thinking off coming off this drug in 2 months time
>>I doubt it, but I'm no pharmacist.  The effect of a drug in utero is very different than on an adult male.

5)  I'm really confused and worried as to what i should do
>>Get consistent monitoring of your aortic root with the same technology.  Echo is the cheapest and will give you a good idea, over time, of your aortic size.  And if your aorta is indeed dilated/growing, research and take high-dose ARBs.

6)  Also, what are the possible causes of AO dilation so that i can rule out this one by one and find out possible
narrowed causes?
>>There are many.  In someone your age, probably some kind of connective tissue disease, but I believe atherosclerosis is another possibility, as are bicuspid valves, and very poor blood lipids.  

Hope this helps.
Sent by sai16 Sep 13, 2011
thanks for the reply. few more questions- out of anxiety, yesterday i did an echo after taking krill oil(1000 mg), co q 10 (60 mg per day), bilberry supplement, AO value was 36 mm.  since i'm already on beta blocker, i have to find a doctor, who will work with me to prescribe ARB in bangalore, India.  is there a formula that one uses to find the maximum dose? i am 170 cm, 37, 65 kg,  also does ARB keep (AO value) at  same value atleast for all who are on ARB as far as u know assuming one good diet?  thanks
Sent by nickppatel 22 hours ago
For someone your size, you should talk to your doctor about starting at the maximum United States FDA recommendation.  For telmisartan, for instance, it would be 80mg/day.  Valsartan would be 320mg/day.  And so forth.  You can get this information on Google.

ARBs seem to work for most people, but not everyone.  
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Avatar_m_tn
As Echo can result in an error of 2-4 mm, i'm thinking it was 34 mm for the past 2 years all along.  Will anyway work with a doctor who's understanding and get a MRA done to get at the baseline and get started on ARB to be on the safer side (hoping this would either arrest it/better reverse it by few mm even).

Thanks
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Avatar_m_tn
Questions:



Has anyone seen reversal in Aortic root value without using ARB?   If so, waht's that you've used as supplements/diet.  If so, what was before and after value and time period?
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