Aortic Dilation and preload

[kmmcgea]

I am a 56 year old male, 5' 9"  182 lbs.  (BP 120/80  pulse 64)  Mother and father still alive at 81, father has had chronic Atrial Fib over 10 years and pacemaker.  
I have been dedicated to eating healthy and swim 1.5 miles/day at a competitive pace. My cholesterol is elevated, but with a high percentage of "good" cholesterol I am told.  I feel terrific except for sporadic heart palpitations that I do not worry about.  Annual company physical  (MARCH 2007) EKG revealed T-wave depression in leads II, III and VF. I took this EKG to a cardiologist where he ran further tests including an ECHO. His diagnosis was PAC's and ECHO aortic root = 3.8 cm.  No restrictions.
On August 27 2008 my company EKG revealed PVCs  (I can feel the minor"thumps" too), and company doctor recommended another visit to my cardiologist who did another EKG and did not have the PVCs during that visit.  My cardiologist did want to do anothe ECHO to measure Aortic root and ejection fraction = (4.4cm  and 55-60%).  Because of increased Aortic root dilation, a CTA is scheduled for Sept 17.    Question:  If  my CTA confirms ECHO Aortic root dialation, may this related to PVCs and PACs in any way?  Does the Aorta dilation irritate the heart causing arrhythmia?  Does the PVCs cause a stress on the Aorta from the extra pressure pulse after pre-load (assoc. compensatory pause)?  Can I continue to swim hard when I feel those thumps?   What are good questions to ask my cardiologist after the CTA is completed?

[Michael J. McWilliams, M.D.]

PVCs and PACs are not related to your aorta.  There is no causative relationship in either direction that I have ever read about ---pac/pvc causing aortic dilation or vice versa.

I can't really advise you about about exercise.  In general, exercise is ok for people with structurally normal hearts.

I would ask your doctor what the size of the root is?
Is the dilation only in the aortic root?
Is the aortic valve normal -- aortic aneurysm are sometimes related to bicuspid aortic valves.
Your doctor will likely want to repeat an echo/Ct in 3-6 months depending on the rate of progression.  It is also worth asking if they think you need surgery and if so, when.

I hope this helps.  

[kmmcgea]

Thanks for answering, it was very helpful.   I especially appreciate the appropriate questions to ask after my Ct.