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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Had Heart Attack. ECG Showed Delayed Ventricular Response. CT Revealed 4cm Ascending Aortic Aneurism. What Should Be My Next Step?

Hi, I am an otherwise healthy 53 y.o. female who had s/s of a heart attack this weekend and went to ER. Borderline ecg, (delayed ventricular response) 171/123 b/p (normal for me is 106/63) - this did trend down to normal after 24 hours. CT revealed a 4 cm ascending aortic aneurism. Otherwise unremarkable. Have been told on various Dr. visits I have a heart murmur. Released from hospital after overnight observation with appt. to get a stress echo in 2 days. Upon researching this I realize I probably have aortic bicuspid valve. Further research shows this to be commonly related to connective tissue syndromes, such as Marfan's or LDS. Wondering what questions I should ask when I get my stress echo, and what I should think about doing next. No family hx other than mom's supraventricular tachy, and dad's a-fib. I am vegetarian, normal weight, exercise regularly, positive thinking, take supplements, eat organic, no junk food. Being so healthy, this was a total shocker. I live in Seattle, I'm an RN at UWMC. Any rec's for local care?
Sat, 31 Aug 2013
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Cardiologist 's  Response
Respected Ma'm
Thanks for your query to us.
1. I hope your work-up at hospital does not reveal heart attack else you would have mentioned this.
2. The significance of this ascending aorta aneurysm depends upon size, your body surface area, presence or absence of bicuspid aortic valve, disease like marfan's or EDS, presence of concomitant high blood pressure and aortic regurgitation. Some of this information is not there in your query.
3. You must ask about the status of your aortic valve, the degree of stenosis/ regurgitation (if any) across it, involvement of mitral valve, your overall exercise capacity and the final result of stress ECHO.
4. If your stress ECHO turns out to be normal and there are no significant abnormalities on your baseline ECHO, your goal will be to control your blood pressure very well.
Hope this helps . Feel free to discuss further.
Sincerely
Sukhvinder Singh
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Had Heart Attack. ECG Showed Delayed Ventricular Response. CT Revealed 4cm Ascending Aortic Aneurism. What Should Be My Next Step?

Respected Ma m Thanks for your query to us. 1. I hope your work-up at hospital does not reveal heart attack else you would have mentioned this. 2. The significance of this ascending aorta aneurysm depends upon size, your body surface area, presence or absence of bicuspid aortic valve, disease like marfan s or EDS, presence of concomitant high blood pressure and aortic regurgitation. Some of this information is not there in your query. 3. You must ask about the status of your aortic valve, the degree of stenosis/ regurgitation (if any) across it, involvement of mitral valve, your overall exercise capacity and the final result of stress ECHO. 4. If your stress ECHO turns out to be normal and there are no significant abnormalities on your baseline ECHO, your goal will be to control your blood pressure very well. Hope this helps . Feel free to discuss further. Sincerely Sukhvinder Singh