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I am 66 years old, 5'4", 167. I was diagnosed

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I am 66 years old, 5'4", 167. I was diagnosed with a thoracic ascending aortic aneurysm in 2008 which was 4.2 CM. monitoring yearly. This past week, aneurysm was 4.7 up from 4.5 in December of 2016. Am experiencing some dizzy spells and weakness upon exertion. No trouble breathing.
My cardiologist indicated operating when around 5.0 CM. Is that still true. Could my dizziness be attributed to the increase in size of the aneurysm. No other symptoms other than dizzy on occasion.
Don't see my doctor again until Nov 17th. BP is usually pretty well controlled, except the past few days, as I'm currently very stressed.
Posted Sun, 26 Nov 2017 in Hypertension and Heart Disease
 
 
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome on HCM!

I passed carefully through your concern and would like to explain as follows:

- it is true that a cut off value of around 5 cm could be considered for surgical treatment especially if there is a presence of a connective tissue disorder (Marfan syndrome), or bicuspid aortic valve, aortic stenosis, or a growth rate ≥1 cm/year.

- your actual aortic growth rate is only 0.2 cm/year, so it could not be considered a rapid aortic enlargement; so this is not criteria for anticipating surgery.

- Furthermore, you should know that aorta surgery is associated with with intra-operative mortality of around 1.6- 4.8% and with age the risk increases (the upper range for age> 55.

- the best estimate for the clinical significance of aortic aneurysm severity would be aortic size index (ASI) that is provided when aortic diameter is divided by body surface area (BSA, which is calculated by body high and weight).

By calculating ASI we can predict the level of risk complications (including the risk of rupture) and consequently the indication for a near surgery.

If you could provide me with your body weight value, I could assist in calculating ASI.

In conclusion, I would add that it is necessary to adequately measure the aortic diameter, preferably with the same imagine modality (CT or MRI) and evaluated by an experienced specialist.

Meanwhile, I recommend to review your recent aorta exam (by the radiologist) to carefully exclude any aorta wall disruption, check frequently your blood pressure values and optimize your anti-hypertensive therapy (if any) as high BP values may trigger dizziness and weakness.

If no tendency of aortic wall disruption is suspected, there is no need for anticipating surgery; just control your BP values and follow a healthy life.

That's my professional opinion.

Hope to have been helpful to you!

If you have any further questions, feel free to ask me again.

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by
 
Follow-up: I am 66 years old, 5'4", 167. I was diagnosed 8 minutes later
My current height is 5'4" and my current weight is 167 (trying to get that down).

I do not have marfan syndrome, nor a biscuspid disorder. The radiologist report did not indicate any kind of disruption. When I am dizzy, I checked my BP and it was neither too low or too high.

Is flying dangerous at this point? Plan on flying home for Christmas.
 
 
Answered by Dr. Ilir Sharka 3 hours later
Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

Considering your body weight and height, your ASI is around 2.6 cm/m2, so you are considered at low risk group for rupture (4%/year) as your ASI <2.75 cm/m2.

Your symptoms seem more likely to be related to blood pressure fluctuation; so you need to look after that.

Regarding your travel, I would explain that flying is safe and you could take a flight without worrying about it.

Wishing you good health!

Regards,

Dr. Iliri
Above answer was peer-reviewed by
 
Follow-up: I am 66 years old, 5'4", 167. I was diagnosed 3 days later
What exactly is an ASI, my normal aortic measurement? It appears I'm just barely under the ASI of 2.75. I thank you for your advice.
 
 
Answered by Dr. Ilir Sharka 3 hours later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again!

Regarding ASI, also called aortic size index, it is calculated by dividing the aortic diameter by body surface area (BSA, which is calculated by body high and weight).

This is done, because different aortic diameters have different clinical significance based on the weight and height of the individual.

The limit of ASI is 2.75. Your ASI is 2.6, so this means that you are at the minimal annual risk of rupture, which is 4% per year. Higher ASI are associated to high annual risk for rupture.

Coming to this point, all you have to do is a periodical follow up with cardiac ultrasound to monitor your aortic diameter and its possible progression.

Hope to have clarified some of your uncertainties!

Wishing all the best,

Dr. Iliri

Above answer was peer-reviewed by
 
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