"Mildly dilated aorta"...

[CAD_007]

Hi,
I am a 46 year old male, 230 lbs.
My brother was diagnosed and is currently recovering from Hypertrophic cardiomyopathy (HCM). His cardiologist recommended that his siblings get an evaluation for the same. Fortunately, I don't have HCM. However, I've got slightly elevated BP, am currently on Benazepril and back on my hypothyroid meds.

My ECHO came back with these readings:
"Normal LV systolic and diastolic function.
No evidence of LVH or Holcomb.
Normal valve function.
Other than a mildly dilated aorta, this is a normal study."

The measurements of concern:
"Aortic root/End-diastole: 3.8, distal = 4.1"

So, my cardiologist recommended a CT scan.

My questions are as follows...
1) What is "mildly dilated"? Is it something to be concerned with?
2) Is a CT scan necessary? Being that the CT scan will cost me over $1,000, aren't there alternative scanning methods?

I'm seeing another cardiologist today - my brother's.

I have no family history of anything like this.

Thanks in advance for you response to my questions.

[kenkeith]

Thank you for your comments, but what I said in the opening is true and non specific!  When one ages often the vessels have calcified in varying degrees and may present a problem, that has nothing to do with Marfins, etc. just another factor that may be an issue.  Now, do you understand!?

You are welcome to state your opinion at any time, but please do your homework on what I have said on other threads, etc. before you make wild accusations....with thousands of heart related posts there is undoubtly some mistakes...but this thread is not one of them!

I have subscriptions to many on-line medical publications, and to say I have a limited resource to just misinformed GPs is an example of your uninformed and misleading characterization of me and many other members on this forum who contribute worthy information.    

[angioscientist]

Re read your opening paragraph to this person in THIS very thread...you mention both high blood pressure and atherosclerosis....

I have no time to argue with you

Good Luck

[kenkeith]

You may want to go back and review the numerous threads on the subject I have input.  I have never said nor implied that the named conditions are related to arthersclorosis. We know Marfin's disease is a vascular tissue disorder.  We know bicuspid aorta disease is congenital and often medical problems begins with an individual's third decade of life.  We know coarction of the aorta is not an arthersclorotic condition.  Where have I ever stated any arthersclorotic under pinnings for AAA?  I have answered about 7 thousand medical related posts and about 5 years of general heart related research...I certainly don't recall associating calcification. etc. of vessels to be related or a cause for disorders discussed...posible but I don't believe that is so because that is not what I believe!.

I don't recall ever taking a position you have stated as a common mistake made by doctors'.  For instance the only medication I have acknowledge as appropriate is an ACE inhibitor to prevent high blood pressure, also it is recommended not to do any heavy lifting...never have suggested or believe a beta blocker is appropriate...I believe  even a GP knows better, but you may be correct...I don't care, and I don't know what dp/dp but impressive.  Also, it has been stated that I believe all doctors are correct and there shouldn't be any doubt about their opinion...whatever....not true!  But as a general statement what is your evidence that many in the medical profession lack knowledge of their chosen field of endeavor?  Do you believe everything you read?

How do you know whether I read medical journals or not!  I can tell you I have numerous prescriptions to a number of on-line medical information publications.  Have I read them all?  No, I wish I had more time because I find it interesting....Wrong again, I'm not regurgitating something a doctor has said!

You may be preaching to the choir, because I don't fit the pattern you are attempting to put on me!  Probably says more about you than me....its called projection :)

[angioscientist]

Kenkeith

I am a scientist who specializes in angiotensin and aortic disease.  I have to say I wholeheartedly agree whith Nick Patel on this issue.

There has been studies fo several years (almost a decade) describing reduction in aortic root diameter with high doses of angiotensin receptor blockade.  ACE inhibitors also look like they do the same in very high doses.

I respecfully disagree with your notion regarding doctors.  The general practitioner is little to no knowledge regarding aortic disease.  To illustrate you have yourself repeated several common misconceptions.

1.  Acending aortic aneurysm has NOT been shown to be related to atherosclerosis.  The disease process of cystic medial necrosis is not an atherosclerotic process.  I can provide you with the research papers confirming this if you like.  In fact those with aortic root aneurysms have been shown to have REDUCED atherosclerotic disease in the coronary arteries !!!!!

2.  Aortic root diameter has been found to NOT correlate well with blood pressure....thus it appears that acending aortic aneurysm is most likely not a result of hypertensive heart disease as is commonly repeated by physicians.

3. Research has found that beta blockade has little to no effect on reducing the expansion of aortic aneurysm...thus calling into question the very concept that presure (dP/dP) has anything whatsoever to do with it.

Doctors are not on top of their game more than you would ever even wish to know.  If you have an illness I STRONGLY suggest that you read the research AS IT IS PUBLISHED IN JOURNALS and not wait for it to be regurgitated to you by a doctor...esp a GP.

Congressional studies have shown that it takes a average of 17 years for clinical findings to translate into practice....I know I am on the edge of that myself.

Thanks for caring enough to offer your time to help others....but in regard to research on ACENDING (not abdominal) you have repeated common untruths that only serve to further confuse and muddle the issue.

[nickppatel]

The cardiologists to whom I refer gave blank stares and followed up their blank stares with questions about the research.  They hadn't heard about it.  They found me to be well-informed and asked if they could keep the printouts of the studies I'd brought with me.  But if you want to continue believing that doctors know everything under the sun, well, to each his own.

I have no financial interest or personal gain.  My only goal is to help people with aortic troubles know about the latest research since, chances are, their doctors aren't telling them (I know mine didn't - I had to bring the latest studies to his attention before he prescribed the ARBs).  

What you need to understand is that there are pros and cons to anything.  ARBs have pros and cons.  The pros are that they may very well keep an aneurysm patient's aorta from bursting, causing them a quick but agonizingly painful death.  The cons are a risk in chance of cancer (the average incidence is 6% among the general population; among ARB users, it is 7.5% - a difference of 1.5%).  That means that the person with an aneurysm needs to make a choice - does he/she want to take the 7.5% risk of cancer (compared to 6% in the normal population) while making the aneurysm go away, or does he/she want to keep his cancer risk at 6% while letting their aneurysm continue to grow and possibly burst.  That's each patient's choice.

I don't present the cancer data with all my posts because, as even Dr Sipahi admits, it's all still very much up in the air.  As Dr Sipahi repeatedly states, more studies are needed.

And I've answered you this many times, but the reason I tell people to contact me by screenname/email is because I don't spend all day, every day on this website, and I have no way of tracking who's asking me questions on all the different threads.  The only possible way I can keep track of it is to have people contact me directly.  

[kenkeith]

Hey, I don't have any personal issue with ARB's so it doesn't matter what position is taken on the subject. You call it arguing, but I am presenting another "documented" side. The interested reader can decide for themselves.  I don't disagree with your position, nor do I agree!

Sorry, blank stares from a few cardiologists is not sufficient evidence that you know more than an educated specialist, and it is not very persuasive.  You asked me?... the doctors' blank stare to you and your questions may be to due to how you presented your opinion, the info as you know or believe it, your demeanor, your medical history, etc. and not based on your doctor being ignorant, and it is not evidence to base a guarantee of your wisdom v. doctors as you seem to believe.

I find your information on the subject interesting and cerainly worthy of consideration and discussion. But do you have a financial interest or some personal gain by virtually crusading on the subject of aorta aneursyms and ARB's? You ask interested posters on the subject to contact you by e-mail,  and it appears you don't want any open discussion.  Why don't you present both sides, and you seemingly object to another side being made? This has been a pattern on the subject for you, and it seems to me you would welcome different views...I know I would, and I believe an interested poster would also.

[nickppatel]

" With so much data on the internet and published medical reports it is highly unlikely a doctor would not know the issues involved and have an opinion."

Prove this.

You don't seem to understand the challenges of a medical practice.  Doctors do not have the time to read every medical report that is published.  Do you have any idea how many reports are published every year?

"What law prevents or worries a doctor from using his/her judgement on a medical issue.  Off-label use is entirely legal:"

Yeah, I know.  That was my point.  Some doctors are hesitant nonetheless.

"Sometimes with a little knowledge of a subject the patient believes to have better knowledge than the doctor....it is wishful thinking, subjectivity and denial...hopefully a doctor views the issue objectively"

Sometimes that's true.  But not in this case.  I guarantee you I know more on this subject than many doctors.  I've spent years researching the topic.  I've mentioned it to 3 cardiologists and I get completely blank stares.  Why do you think that is?  After all, with so much information on the internet these days, doctors surely know everything under the sun.  We should put them on pedestals!

I know you get upset whenever someone disagrees with you on these forums, so I'm not going to argue with you any further on this topic.

[kenkeith]

QUOTE: "To answer the second question:  both. Usually they don't know, but sometimes their misunderstanding of the law keeps them from prescribing even if they do know".

>>>>>So you are suggesting some doctors don't know/understand the law!  What law prevents or worries a doctor from using his/her judgement on a medical issue.  Off-label use is entirely legal: The FDA doesn't regulate the practice of medicine, so physicians can use drugs or devices for any appropriate purpose, approved by the FDA or not....is that the law you are referring?

Could it be the doctor has the best interest for his/her patients?  With so much data on the internet and published medical reports it is highly unlikely a doctor would not know the issues involved and have an opinion. Sometimes with a little knowledge of a subject the patient believes to have better knowledge than the doctor....it is wishful thinking, subjectivity and denial...hopefully a doctor views the issue objectively.  There exceptions!

Dr Ilke Sipahi, from Case Western Reserve University School of Medicine in Cleveland, Ohio, said: 'We have found the risk of new cancers was increased with these medications (ARBs) by 8 to 11 per cent.
Dr. Ilke Sipahi, associate director of heart failure and transplantation and assistant professor at Case Western Reserve University School of Medicine, noted that among the malignancies examined--breast, prostate, and lung—only new lung cancer was significantly higher in the patients who took the ARBs. While the risk of lung cancer was increased by 25 percent, there was no increased risk seen for breast cancer and only a “weak trend” for prostate cancer, according to an article in heartwire.

"FDA recommends that healthcare professionals continue to use ARBs as recommended in their product labels (high blood pressure). Patients should not stop taking their medication unless told to do so by their healthcare professional".  

>>>>>There is no proclamation for off-label AAA treatment.
I believe that ARBs are approved by FDA for high blood pressure but are off-label for aneurysms.  Also, ARBs are recommended for patients that can't tolerate ACE inbibitor medication for their high bp.  I take an ACE inhibitor for blood pressure, and it works well for me.

Just an alternative view, but a good doctor should know and keep updated on his/her medical knowledge.  If ARBs are effective treatment, that would be great and worthy of total  recognition.

[nickppatel]

I answered this in another thread, but the cancer risk increases 1.5% in that study. Compare that with the prospects of aortic surgery or death.

To answer the second question:  both. Usually they don't know, but sometimes their misunderstanding of the law keeps them from prescribing even if they do know. Which is silly, because virtually all aneurysm patients benefit from reduced bp.

[kenkeith]

What is the status of the cancer implications?  When you suggest someone should do their investigation what does that say about the treating doctors'?  They don't know about the treatment or don't approve?

[nickppatel]

As I tell everyone with dilated aortic roots, you need to investigate ARB therapy.  ARBs (like telmisartan and losartan) and ACE inhibitors (perindopril in particular) have been shown to reduce aortic diameters in humans when taken in sufficiently high doses (at least the FDA-approved max).  Research "losartan and Marfan" (even if you don't have Marfan syndrome) to learn more, or click my screenname to read previous posts on the topic.

[kenkeith]

QUOTE: "Aortic root/End-diastole: 3.8, distal = 4.1"

>>>>>An aortic root dimension >4.0 cm and is most likely an expression of a pathological condition, requiring close clinical monitoring.

For some insight, the wall of the aorta is normally very elastic. It can stretch and then shrink back as needed to adapt to blood flow. But some medical problems, such as high blood pressure and atherosclerosis (hardening of the arteries), weaken the artery walls. These problems, along with the wear and tear that naturally occurs with aging, can result in a weak aortic wall that bulges outward. Also, there can be congenital tissue vulnerable to rupture.

When an aorta root is > 4.0 the condition is considered an aneurism,  and if the size rapidly increases to 5.0 cm the condition becomes a concern for rupture and may require intervention.  If there is a generic predisposition to tissue abnormality the intervention may be sooner.

If your doctor thinks you have an aneurysm, you may have tests such as an ultrasound, a CT scan, or an MRI to find out where it is and how big it is.

Even if your aneurysm does not grow or rupture, treatment be to controll high blood pressure and asked not to any heavy lifting that can cause a soike in your blood pressure. Your doctor may suggest that you exercise more, eat a heart-healthy diet, and stop smoking.
Hope this helps, and if you have any followup questions you are welcome to respond.  Thanks for sharing.