How do I build muscle with an enlarged aorta?
January 11, 2022 2:12 PM   Subscribe

My cardiologist just told me she recommends avoiding "extreme weightlifting" (which she has defined as lifting any more than 40lbs) to avoid risk of damaging my already enlarged aorta. My father died suddenly of an aortic dissection at 59 so I'm at risk. I want to follow medical guidance, but I also care so much about being physically strong!

Are there cardiologists that cater to athletes? Personal trainers who can create safe, muscle building programs for young strong people who don't want to damage their aorta? Is there a life I can lead where I get to be strong and keep my heart safe?

For many reasons, the advice from my doctor is devastating to me. I'm so frightened by the news, she's not being super specific, it brings up a lot of grief about my dad, and finally, I am really proud of being a physically fit and muscular person and I don't want to lose that.

The doctor has been really confusing about what exactly is safe wrt lifting things--40lbs sounds sort of arbitrary. Squatting 40lbs is very different than pressing it. Would swinging a 38lb kettlebell be safe? She said she won't be able to give me specifics of that nature, which is really frustrating. Does anyone have knowledge about that? Why the doctor recommends 40lbs?

Powerlifting is extremely important to me. I'm female, 32, 5'10", ~185lbs, and basically define myself by how strong I am. I only feel good about my body when I am muscular. Is there any more research/guidance on achieving progressive overload without using the Valsalva maneuver (that I'm supposed to avoid)?

I feel a little stuck because I really don't like a lot what I think are the other exercise options she's expecting me to do. I don't feel good when I exclusively do cardio--I really need muscle building to feel mentally ok. Absolutely no offense to those who enjoy it, but I have never taken to classes like HIIT, pilates, or yoga because the progress is so scattershot, I get bored, or the focus isn't on building muscle. I like being bulky 🤷 Anyone have leads on things that are fun and focused like powerlifting?

(More medical specifics: I have a dialated aorta, not yet an aneurysm. There doesn't seem to be signs of connective tissue disorder, but their recommendations are based on my family history.)
posted by mwahlalala to Health & Fitness (20 answers total) 7 users marked this as a favorite
 
I am sorry you're going through this. I have an insatiable appatite for hard physical labor and I also have a bad back which means I shouldn't lift weights.

So my buddy is married to a firefighter and she and I were allowed to use the gym at the firehouse for working out for a while. They had this totally amazing ladder thing that I was (and still am) obsessed with. Looks like it's incredibly stupidly expensive but you didn't mention a budget and I can't express how much I miss climbing that ladder forever. Super fun and focused. Best workout equipment ever and if I had the space for one I'd be climbing that ladder every morning.
posted by RobinofFrocksley at 2:34 PM on January 11, 2022 [2 favorites]


1) You can maintain or build muscle with lighter weights and higher reps, as long as you approach or reach failure. However, it will probably be a different type of strength - more endurance but lower one-rep max.
2) The worry about weightlifting seems to be is that it induces a sudden sharp increase in blood pressure. Logically, then, you could limit the risk by doing isolation exercises with smaller weights with high reps, where the total cardiovascular demands are smaller because they are more distributed. For example, instead of squatting 100 lbs for 5 reps, do 20 reps of single-leg extensions with 25 pounds. That might limit the spike in blood pressure. However, because the total work done will still be very high, it still induces large cardiovascular demands - that is, your heart will be beating very fast.

This really is not medical advice. I'm a internet stranger with no medical training. Rather, run this plan or similar scenarios by your cardiologist or other trusted medical professional.
posted by Mr.Know-it-some at 2:36 PM on January 11, 2022 [3 favorites]


There doesn't seem to be signs of connective tissue disorder, but their recommendations are based on my family history.

There are a large number of non-syndromic genetic aortic disorders that are distinct from connective tissue disorders that have been (relatively) recently identified like TAAD and FTAAD. A lot of these things used to get lumped under a Loeys-Dietz/Ehlers-Danlos/Marfan diagnosis, even in the absence of other symptoms that comprise those syndromes.

Are there cardiologists that cater to athletes?

Obviously, this depends on where you are, access to health care, insurance, etc., but have you asked for a referral to a cardiologist and/or vascular specialist who specializes in genetic aortic disorders? Exercise needs aside, this is an important clinical follow to have (and apologies in advance if this is already table stakes for you since this is a health issue you're well aware of, just thought I'd throw it out there).

For many reasons, the advice from my doctor is devastating to me. I'm so frightened by the news, she's not being super specific, it brings up a lot of grief about my dad, and finally, I am really proud of being a physically fit and muscular person and I don't want to lose that.

As a friend with Marfan's put it (she's undergone dacron graft surgery to repair her ascending aorta and aortic root to prevent an impending dissection, among other vascular whatnots), you really want someone who knows what you have to get more specific answers. In her experience, she's said that's hard to get with some GPs since their knowledge of what's the latest in diagnosis and management of aortic disorders really tends to lag owing to the relative specialty of the area (plus the relatively recent improvements in the understanding of non-syndromic aortic disorders).

Where I am, the Genetic Disorders Association of Canada has a fair bit of info and resources on this, and the in the U.S., the Ritter Foundation has been doing the same work, on a larger scale and might provide some starting points for pushing things further referral-wise.
posted by mandolin conspiracy at 2:45 PM on January 11, 2022 [14 favorites]


I wonder if a cardiac rehab center could help you? I know when my dad was recovering from various heart-related stuff he would go to a specific gym staffed by physical therapists and nurses who specialized in creating exercise programs for cardiac patients.
posted by corey flood at 3:14 PM on January 11, 2022 [5 favorites]


Ah. Found it. I did some behind-the-scenes volunteer work for the Canadian side of this Aortic Dissection Awareness Week symposium in 2020, and this was one of the talks by Siddarth Prakash, who's a vascular and aortic diseases expert. It deals alot with post-dissection exercise, but it also includes some discussion of exercise and overall dissection risk (which, he says, varies depending on the genetic cause, along with other factors).

Exercise and activities after an aortic dissection | ADAW2020
posted by mandolin conspiracy at 3:23 PM on January 11, 2022 [6 favorites]


As the daughter of a mom who died of a sudden rupture of the ascending aortic root (just leaving the heart) I sympathize. I very much agree with mandolin conspiracy who suggests you seek a referral to a cardiologist who specializes in your risk population. Although you obviously have this family history, your personal risk can be greatly mitigated by such things as maintaining a normal/low blood pressure. Do you have high blood pressure? How about your dad? If he did, did he take his meds or blow off medical advice? Did he smoke? My mom did, for sixty years, and it contributed to her rupture risk.

I suspect this is why lifting heavy weights is concerning to your doctor, and I suspect she is evasive because this is not her specialty so she can only advise you generally. I think this is something you should discuss in depth with an appropriate cardiac specialist. Like most things in life, the answer to your exercise and weights questions are not simple, and your risks need to be evaluated by a specialist. You may need to seek out a specialist at an academic medical center rather than a community cardiologist to find a truly qualified physician. Good luck.
posted by citygirl at 3:33 PM on January 11, 2022 [3 favorites]


Yeah, I think you need to get a second opinion from another cardiologist, and yes, I agree to finding one that works with athletes. I have no idea if she's right or wrong, but it seems worth a second opinion.
posted by bluedaisy at 3:35 PM on January 11, 2022


This is outside the scope of the question, perhaps, but I wanted to add that you are in the process of adjusting to some big news about how a chronic illness will change your life. You describe this diagnosis as "devastating". This is a very normal reaction to news of a chronic illness, which is what you have. Coming to terms with the reality of having a disease is a PROCESS. I wish that I could tell you the proper exercise substitute and then everything could go back to normal for you, but in reality your life has just changed in ways large and small. You need to grieve the ways that it has changed (a therapist, if it's an option, can really help with this).

I'm not saying you won't be able to find the right power-lifting plan that scratches all your workout itches. But you may also have to find ways to adjust to not being as bulky as you like, or open your mind (and body) to becoming another sort of active person.

If you had told me when I got my chronic illness diagnosis that in a few years, following a bout of mono, that I was going to get really into CrossFit, I would have laughed you out of the room. Life, and your body, will take you to some really weird places sometimes.

Good luck. And find a doctor that you think understands your life. It helps a lot.
posted by you'rerightyou'rerightiknowyou'reright at 3:39 PM on January 11, 2022 [13 favorites]


Response by poster: Thank you for these thoughtful answers I means a lot to me. As you'rerightyou'rerightiknowyou'reright pointed out, I have to adjust to the new paradigm of having a chronic illness and I'm really resisting it. I will look into a more specific cardiologist and some of the conditions mandolin conspiracy mentioned.

Do you have high blood pressure? How about your dad? If he did, did he take his meds or blow off medical advice? Did he smoke?

I'm really sorry to hear about your mom, citygirl. It's awful. To answer your question, I have low blood pressure, my dad had high blood pressure, and he was conscientious about taking medication. He quit smoking long ago. He had Parkinson's too so everything was... Bad. Unlucky.
posted by mwahlalala at 4:59 PM on January 11, 2022 [1 favorite]


This may sound a bit harsh and I don't mean it to, but in essence this question is asking: my doctor said it might be life threatening for me to do X, and that I need to stop, so, strangers on the internet, how do I do X anyway, because I can't live without the effects of X on my body?

When you put it that way it almost sounds like an addiction, doesn't it?

Right now, you've been told you can't safely lift > 40 pounds. A limitation like that was bound to show up in your life (as in all our lives) eventually, and now it's here. Maybe you can and maybe you can't have the exercise regimen and/or physique and/or physical ability and vitality you expect of yourself despite this somehow anyway, but if you find a way, know that it's temporary. At some point in your life if not now, if you're lucky and live long, you will not be able to be a powerlifter, not be able to have that physique, not be "strong," whatever that means to you.

And what then? Can you still have a worthwhile life anyway? Now might be a good time to answer that question, perhaps with therapy, instead of trying to claw back a way to lift weights despite your doctor.
posted by shadygrove at 7:19 PM on January 11, 2022 [3 favorites]


My first knee-jerk reaction was, "I wonder if this doctor would give the same advice to a man with the same condition." Maybe, maybe not, but absolutely worth a second opinion from a cardiologist who works with athletes to be sure. There are a lot of people out there with very outdated ideas of what women's bodies should be used for, and some of those people are doctors. Best of luck to you and I hope you get some answers that satisfy you.
posted by potrzebie at 7:51 PM on January 11, 2022 [6 favorites]


When people tell me lifting x amount of lbs isn't safe I ask them how I will get up off the floor if I sit, or fall down. How will I stand up if I sit down on a chair? I am around 200lbs, so standing up from the ground requires me to move much much more weight than squatting 40lbs would. (And yes "lifting" are we talking deadlifting - does this person think you can never pick up a 40lbs object from the floor again? Or are we talking snatch or a bottom up kb press?)

Yes weightlifting can = spike in p
Blood pressure, so more information is needed, but if your doctor is suggesting that "lifting 40lbs is dangerous", I would be concerned that they are not really thinking about the fact that we frequently move our bodyweight and objects in life in ways that are much more sudden, uncontrolled and heavy than so called "extreme weightlifting". I'm sure that your doctor means well but yes find a specialist with an understanding of sports exercise and your condition for a more detailed opinion.

(Massive amounts of bias here, I'm an incredibly inclusive weightlifting coach who believes weightlifting is for EVERY body, in some format which may involve adaptation).
posted by eastboundanddown at 11:40 PM on January 11, 2022 [5 favorites]


You could try searching for 'sports cardiologist' specifically to find someone less clueless than your current cardiologist.
posted by aussie_powerlifter at 12:53 AM on January 12, 2022


I'd also suggest searching for "adult congenital heart disease cardiologist" and "cardiovascular genetics."
posted by kuanes at 3:21 AM on January 12, 2022


I only feel good about my body when I am muscular.

That would be the key to the thing, for me. If I were in your shoes I'd be focusing less on what I could do to maintain my existing bag of tricks for feeling good about my body, and more on what I could do to add more tricks to that bag.

An obvious place to start would be with work on learning to value improvements in endurance as much as you presently value explosive strength. How would it be, do you think, to be able a year from now to look back and reflect that the year's work has got you to a point where you can now walk or run or cycle maybe five times as far without feeling any need to take a break?

Getting older is always going to put some kind of limit on how explosively strong a human body can get without taking damage; if it wasn't your aorta then at some point it would probably be your spine or your knees or some damn thing. But getting older is in and of itself an endurance event, when it comes right down to it. Think about Cliffy showing the strong young whippersnappers how it's done. He'd been building endurance for his whole life before entering that race.

You already know how to get strong. Might be time to learn how to get tough as well.
posted by flabdablet at 4:26 AM on January 12, 2022 [3 favorites]


I am not a doctor and I am not giving medical advice. Rather, I am a 70-year old male living many years with an enlarged aorta as one of the symptoms of biscupid aortic valve. I would say two things:

Like you, I think 40 lbs seems arbitrary. My cardiologist gave me a rule of thumb that has served me well in the gym: effort is good, strain is bad. I don't limit my lifting beyond that. My trainer also introduced a rule I use: steady breathing always; no holding your breath during effort.

How close is your enlarged aorta to needing surgical intervention? When I first learned of my condition, I was, like you, alarmed. But it's hard to stay alarmed for 10-15 years, and in my case I am still at least several years away from needing surgery. Intervention for me will be indicated when the diameter of the ascending aorta is between 5.0 and 5.5 cm; I am at 4.6 as measured with annual MRIs. If I were you, I would ask my cardiologist for a monitoring plan going forward.

Good luck and best wishes to you.
posted by Short Attention Sp at 5:30 AM on January 12, 2022 [6 favorites]


Absolutely no offense to those who enjoy it, but I have never taken to classes like HIIT, pilates, or yoga because the progress is so scattershot, I get bored, or the focus isn't on building muscle. I like being bulky 🤷

Is there a rock climbing or bouldering gym near you? Because solving puzzles with your body is way more focused than any cardio and definitely helps keep you muscley, but if you get really into it you can also perhaps make peace with being slightly leaner if you drop the power lifting because excess bulk can eventually, at high performance levels, impair your progress getting up a wall.
posted by deludingmyself at 7:31 AM on January 12, 2022 [3 favorites]


And that's a clue to more attributes of one's own physicality that could well be worth cultivating an internal appreciation for: not only strength, not only endurance, but capability and efficiency too.
posted by flabdablet at 7:49 AM on January 12, 2022


I was diagnosed with this last summer. Mine's 4.3. I also got an autoimmune diagnosis last summer, and just last month, a clotting disorder. So I don't know whether I should expect to drop from an aortic dissection or a stroke first. Maybe both. Seriously, it's a lot, and then on a day/day basis, not any different from yesterday? I'm still trying to wrap my brain around it. I'm also a pretty active person -- mostly a climber and mountain biker, and I lift in support of those activities. Both of those activities can get pretty intense in terms of instantaneous effort.

My cardiologist's advice was along the lines of Short Attention Sp above (and yeah, hard to stay alarmed for years!). In terms of weights, I think of this as something where I can do 10+ reps while breathing in control, and not going to where I fail at 5 reps and/or hold my breath. I'm still learning to do this in practice, habits are hard. I think the 40 lb thing seems nonsensical, obvs someone who doesn't lift.

I'm assuming you'll be monitored at least yearly. It's probably worth trying to find a 2nd opinion from a cardiologist who is active themself, or specializes in athletes.

Mandolin, thank you for those links and videos.
posted by Dashy at 8:54 AM on January 12, 2022 [2 favorites]


I have a heart condition. I do not have your heart condition. I also never did cardiac rehab because 'merca. However, I would suggest looking into cardiac rehab, which it doesn't sound like you need exactly, but they may be able to help you do the exercises you want to do safely.
posted by misanthropicsarah at 10:56 AM on January 12, 2022 [1 favorite]


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