Cardiac clinic today

[Degrassi]

I'm finally going for my "yearly"(tho its been almost 3 years) checkup at the cardiac clinic today. I'm meeting my new cardiologist and getting a EKG and Echo. Since its been so long since my last echo I"m a little nervous. I hope my aorta hasn't changed or that its stayed shrunk down.

I"m going to ask for the echo report and maybe a copy of my last few visits to track the progress, so I'll let you guys know the results.

Wish me luck!

[Degrassi]

Well just got back from the clinic and its good news. My aorta has stayed at 3.7!!! So thats about 5 or so years now that its shrunk down from 4.2 and been stable at 3.7ish!

My new cardio is really nice. She seems fairly knowledgeable about marfans, knew about ARBs and the studies and has a couple marfans patients. I liked her.

So i'm happy One less thing I have to worry about.

[pacifica]

Hi Degrassi,
I am really happy to hear that you are stable. I think you and I are on the same medication (Avapro).

That is great news! Thanks for letting us know. Have a good weekend everyone.

[Degrassi]

Yes I've been on 300mg of avapro since about 2005.

Have you noticed any changes in your aorta from taking it?

[pacifica]

I have been on 300 mg Avapro for about a year and a half. Prior to that I was on Losartan. My aneurysm is stable at 4.4 cm. The physician who read my MR hinted that it may be the slightest bit smaller but not enough to call as a definite change. I also take a small dose of atenolol. Of course I would like the aneurysm to shrink but even stabilizing my aneurysm is great, as I think it has been slowly growing over time. My aneurysm is in the mid ascending aorta, rather than the aortic root. I apparently don't meet criteria for Marfan's although I and some family members do have some of the physical characteristics of Marfan's.

[npp33]

Excellent news, Degrassi!

Pacifica - it's not clear whether ARB therapy will help aneurysms outside the aortic root. The root is TGF-b sensitive, I believe, and so TGF-b blockade using ARBs is very effective. Outside the root, I think the aorta is not so TGF-b sensitive, and aneurysms outside of the root may represent a different pathology/cause. That's why a significant percentage of MFS patients have aneurysms confined to the root.

Glad to hear that it's stable, though!

[Degrassi]

Ok just recieved my Echo results in the mail, along with some other history.

The letters say at the age of 10 my aorta was 3.1cm and I was placed on a beta blocker(atenolol). Then at age 15(1998) I was placed on a ACEi(I think it was Lisinopril) and my aorta was about 3.6-3.7ish. In 1999 I was taken off the ACEi because of headaches and put on a ARB(Irbesartan, started at 75mg). From about 1999-2003, at each yearly visit I had my Irbesartan amount raised. It wasn't lowering my blood pressure like my cardio wanted, so she kept increasing it. In 2003 my aorta had reached its biggest size of 4.2cm. Around 2003 I was taking 300mg of Irbesartan, or at that appointment is when she upped it to 300mg, I can't remember. But then by 2005 my aorta had shrunk down and was measuring 3.7 to 3.8. Its been about 5 years at 3.7ish now.

I guess the Irbesartan really helped. Your aorta can't just shrink down by itself can it? I"m just lucky my cardio decided to try Irbesartan back then

Here is just a simpler time line

1993- no meds - 3.1cm- put on atenolol (marfans diagnosis made official as my aorta was involved)
1998- 3.6-3.7cm - switched to Lisinopril
1999- Switched to Irbesartan(75mg)
1999-2003- Increased Irbesartan each year. Aorta also increasing each year
2003 - 4.2cm, highest aorta measurment. Started 300mg of irbesartan
2005- aorta had shrunk down to 3.7
2005-2010- aorta staying at 3.7cm

[tesla77]

Very important information. Thank you for sharing....more evidence in the dose dependency of this whole thing. I fear so much for the losartan clinical trial because its the wrong drug and way too low of a dose....

God Bless

Tim

[akm3]

Yes, thank you very much for this information!!
May I ask for your weight?

[Degrassi]

Ha, my weight. Its fluctuated a LOT due to other medications I've been on and my inability to exercise(bed bound from DE and headaches). In 1999 I was 135lbs(super skinny considering i'm 6'4"), then by 2003 I was around 190-200lbs, and my highest weight was 250-260lbs. But now i'm 230lbs and loosing weight. I haven't noticed my weight affect Irbesartan's effectiveness.

[npp33]

Degrassi brings up a very good point. My weight has increased lately, from a stable 190lbs to about 202 lbs. My aorta in February measured 3.74 up from 3.7, but I am pretty sure this is just variation between the echos (esp. because it was a different tech measuring). Still, I wonder if I need to hurry up and lose weight so that the ARB is at maximal effectiveness (by minimizing BSA).

[tesla77]

Nick

You know full well the echo cant read 0.04 cm LOL !!!

Its possible that there is a small reduced effectiveness with MAJOR weight gain but I wouldnt worry too much about it...you aorta did not change at all !!!!