Lifting with a dilated ascending aorta

[TravisG]

First time poster here. I did already search and read several threads related to those with aortic aneurysms. On a short list of reasons to not train

I'm a 43 year old male, 6'2", 190-195lbs, thinner frame (graduated high school at 155lbs). Started working out in my early 20s, lifting at a gym, never too heavy, almost exclusively upper body. All the stereotypical bull crap lifts one may do for vanity. Weighed about 180-195 during those years. Then during COVID, discovered Starting Strength from a friend and fell in love with heavy lifting. I never got that strong, 1 rep squat of 330, DL of 350, bench 250ish.. got up to 204lbs at one point. Past 2 years or so, was more in a maintain mode with slightly less weight. But always consistently worked out 3x a week. Never been a cardio/aerobic guy.

I proactively got a Coronary CT Scan in September of 2023 to see if I had any calcium... thankfully that came up 0. It did show that my ascending aorta was 4.0cm and labeled as ectasia (dilated). In June of '24, I proactively did a Prenuvo full body MRI, and it measured at 4.4. That rate of growth in 9 months would be very alarming. I went to an Aortic clinic at Stanford, and they looked at my MRI and said it was measured wrong and was really about 4cm. A follow up echocardiogram showed 3.9. So thankfully it has not grown in 9 months which is great news. I was freaked out for a bit.

I have a 10ish year history of slightly elevated blood pressure, 130-135 range, as well as slightly elevated LDL in the 110-120 range. I'm now on a low dose BP med as well as Lipitor (different doctors had differing opinions on whether this was necessary). General medical guidance for this is to prevent it from growing, and therefore keep your BP low. That also came with new guidance for how I work out. Their recommendation is anything that I can do 20 reps of is okay. As is aerobic/cardio (running) as those have more gradual BP increases. For weightlifting, they say no straining/grunting, and specifically said no Valsalva! Make sure I can breathe fine the whole time.

Quite often these things are genetic. I'm awaiting test results, but the doctors don't suspect I have any of the tissue disorders. My doctors are legit, and they say there is no way to know for sure what caused this outside of a potential genetic component. Maybe the elevated BP and lifting could have contributed. I've been down the rabbit hole researching this topic. There are studies that show a higher % of NFL players have larger ascending aortas compared to similarly sized control groups. Similar studies with endurance athletes. An aortic doctor at Yale measured BP during heavy lifting, and it can get up to 380. The immediate pressure during the Valsalva is tremendous, so if someone has a weakened aorta for whatever reason, it makes sense to avoid that BP spike... because no one wants to die with a barbell on their back when their aorta dissects!

Thankfully mine is not labeled an "aneurysm." That happens if it grows fast or gets 1.5x the normal size... and being a bit taller, I have a bit more leeway. My plan is to adapt my life to keep it from growing, but also hope to find the right balance to weightlift. I've started doing 3x20 sets of much lighter weight and measuring my BP right after. Obviously can't get the reading right at the bottom of a squat, but with only 65lbs on my back, I'm not coming close to straining. Just a bit of the high rep burn.

Curious if anyone has experience lifting in this capacity. In theory, could I add weight and get stronger with a 3x20 routine similar to a 3x5? But not allowing myself to strain/grunt/hold my breath? Anyone work with any cardiovascular athletic trainers in this area? I recognize this is a forum and not medical advice... just curious if anyone is in a similar situation as I am.

[Mark Rippetoe]

Sounds like things have already been decided. Good luck with your training.

[Will Morris]

First time poster here. I did already search and read several threads related to those with aortic aneurysms. On a short list of reasons to not train

I'm a 43 year old male, 6'2", 190-195lbs, thinner frame (graduated high school at 155lbs). Started working out in my early 20s, lifting at a gym, never too heavy, almost exclusively upper body. All the stereotypical bull crap lifts one may do for vanity. Weighed about 180-195 during those years. Then during COVID, discovered Starting Strength from a friend and fell in love with heavy lifting. I never got that strong, 1 rep squat of 330, DL of 350, bench 250ish.. got up to 204lbs at one point. Past 2 years or so, was more in a maintain mode with slightly less weight. But always consistently worked out 3x a week. Never been a cardio/aerobic guy.

I proactively got a Coronary CT Scan in September of 2023 to see if I had any calcium... thankfully that came up 0. It did show that my ascending aorta was 4.0cm and labeled as ectasia (dilated). In June of '24, I proactively did a Prenuvo full body MRI, and it measured at 4.4. That rate of growth in 9 months would be very alarming. I went to an Aortic clinic at Stanford, and they looked at my MRI and said it was measured wrong and was really about 4cm. A follow up echocardiogram showed 3.9. So thankfully it has not grown in 9 months which is great news. I was freaked out for a bit.

I have a 10ish year history of slightly elevated blood pressure, 130-135 range, as well as slightly elevated LDL in the 110-120 range. I'm now on a low dose BP med as well as Lipitor (different doctors had differing opinions on whether this was necessary). General medical guidance for this is to prevent it from growing, and therefore keep your BP low. That also came with new guidance for how I work out. Their recommendation is anything that I can do 20 reps of is okay. As is aerobic/cardio (running) as those have more gradual BP increases. For weightlifting, they say no straining/grunting, and specifically said no Valsalva! Make sure I can breathe fine the whole time.

Quite often these things are genetic. I'm awaiting test results, but the doctors don't suspect I have any of the tissue disorders. My doctors are legit, and they say there is no way to know for sure what caused this outside of a potential genetic component. Maybe the elevated BP and lifting could have contributed. I've been down the rabbit hole researching this topic. There are studies that show a higher % of NFL players have larger ascending aortas compared to similarly sized control groups. Similar studies with endurance athletes. An aortic doctor at Yale measured BP during heavy lifting, and it can get up to 380. The immediate pressure during the Valsalva is tremendous, so if someone has a weakened aorta for whatever reason, it makes sense to avoid that BP spike... because no one wants to die with a barbell on their back when their aorta dissects!

Thankfully mine is not labeled an "aneurysm." That happens if it grows fast or gets 1.5x the normal size... and being a bit taller, I have a bit more leeway. My plan is to adapt my life to keep it from growing, but also hope to find the right balance to weightlift. I've started doing 3x20 sets of much lighter weight and measuring my BP right after. Obviously can't get the reading right at the bottom of a squat, but with only 65lbs on my back, I'm not coming close to straining. Just a bit of the high rep burn.

Curious if anyone has experience lifting in this capacity. In theory, could I add weight and get stronger with a 3x20 routine similar to a 3x5? But not allowing myself to strain/grunt/hold my breath? Anyone work with any cardiovascular athletic trainers in this area? I recognize this is a forum and not medical advice... just curious if anyone is in a similar situation as I am.

Seen this more than a few times, as I spent many years working with military individuals and this finding does pop up occasionally.

Have you ever taken your blood pressure immediately after walking briskly? If not, take a brisk walk for 5-10 minutes and immediately take you BP.

[TravisG]

Sounds like things have already been decided. Good luck with your training.

This is still very recent, so I wouldn't say anything is firmly decided. However, I'm reluctant to lift anything too heavy based on everything I've learned. Safe to assume you don't believe much that 3x20 seats are enough of a stress for the body to adapt well enough to get stronger?

Seen this more than a few times, as I spent many years working with military individuals and this finding does pop up occasionally.

Have you ever taken your blood pressure immediately after walking briskly? If not, take a brisk walk for 5-10 minutes and immediately take you BP.

I have not yet tested after a brisk walk, but I have started running now. First 2 mile run, I came back and it was 132. Second time it was 157, and immediate next reading was 144. Second time was a bit closer to my morning coffee and very hot outside.

[Alexander Dargatz]

no one wants to die with a barbell on their back when their aorta dissects!

No?

How do you want to die?


I think that would be one of the better ways to go, especially at a high age, with a decent load on your back.
My alternative choice would involve swinging axe and sword and taking a few down with me, but that is unlikely in this day and age.

[TravisG]

No?

How do you want to die?


I think that would be one of the better ways to go, especially at a high age, with a decent load on your back.
My alternative choice would involve swinging axe and sword and taking a few down with me, but that is unlikely in this day and age.

Fair point

[Alexander Dargatz]

I have not yet tested after a brisk walk, but I have started running now. First 2 mile run, I came back and it was 132. Second time it was 157, and immediate next reading was 144. Second time was a bit closer to my morning coffee and very hot outside.

Is that your blood pressure or your heart rate?
Blood pressure has two values, systolic and diastolic.

[TravisG]

Is that your blood pressure or your heart rate?
Blood pressure has two values, systolic and diastolic.

I could have made that more clear... It's my systolic blood pressure. Doctors don't really care too much about the diastolic, as it's the sudden spikes of systolic pressure that can stretch out your aorta.

[Jdcuth]

Did you pay for those scans? Because they may well end up of no discernible benefit and could instead make you too worried to do anything. As long as they get paid they could tell you never to move off the sofa and what does it matter to them?

[TravisG]

Did you pay for those scans? Because they may well end up of no discernible benefit and could instead make you too worried to do anything. As long as they get paid they could tell you never to move off the sofa and what does it matter to them?

I did pay for them. A coronary CT scan is about $150, and used to measure if you have calcium in your vessels. I heard about it from a podcast, advocating that anyone over 40 should get one done.

I'm thankful I proactively did this because it showed a slightly dilated aorta and not yet a full blown aneurysm. So therefore, I can hopefully make lifestyle adjustments to stop it from growing. Once a dilation turns to an aneurysm you need open heart surgery to replace that part of the aorta with a man made tube. If it's in your descending aorta, you may be eligible for a stent. They call aortic aneurysms the silent killer or ticking time bombs, because quite often you have zero symptoms until it dissects or ruptures.

My doctors are not telling me to "stay on the couch" and are encouraging exercise, just modifying the way I do it. They even described a study involving mice with aneurysms. The ones that were allowed to go on the wheel had better outcomes than the sedentary ones.