Q. CT scan taken for recurrent pain and tightness in my left chest shows aortic dilation. Please explain.

Answered by
Dr. Sagar Ramesh Makode
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jul 26, 2020

Hello doctor,

I just received the report from a cardiac calcium scoring CT scan, and while my calcium score is zero, the report notes that my aortic root is dilated up to 3.7cm.

I am a 42-year-old male. I had the CT scan performed because of recurring pain and tightness in my left arm, left side of my neck, jaw, chest that particularly follows any kind of exercise (this issue has occurred for at least five years, and so I figured it was not likely a heart attack but I wanted to be certain), and also because my family has a lot of cardiovascular problems. (My father has had a triple-bypass surgery for severely blocked arteries, and he has an abdominal aortic aneurysm that so far has responded well to two non-open surgeries).

When I first went in for the CT scan, the technician told me that I had an arrhythmia, with my heart rate jumping from the 70s to the 120s, and she recommended that my doctor prescribe a beta-blocker. After taking Propranolol, my heart rate calmed down and I was able to have the scan.

I have mast cell activation syndrome (MCAS), which causes a lot of mostly bothersome, but sometimes fairly severe inflammatory symptoms. I assume that this may be related to that. I had Lyme disease for a number of years that presented with MS-like symptoms. However, I was eventually diagnosed and I believe I have been successfully treated for the Lyme infection. (I mention this only because I am aware that Lyme disease can cause cardiac problems in rare cases).

I understand that my next step will be to speak with my doctor and likely to follow up with a specialist. The most immediate question I have is whether the heart CT scan I just had shows anything below the aortic root. If it does not, then I am very curious what the likelihood may be that the aorta could be more widely dilated farther down, and whether the bulging of the aortic root makes it more likely that the thoracic and abdominal aorta could be likewise further dilated and potentially aneurysmal.

I am currently on Famotidine and Cetirizine to treat mast cell activation syndrome, and I occasionally take a small dose of Clonazepam.



Welcome to icliniq.com.

If you have classical symptoms of angina, like chest pain occurring every time or most of the time you exert (rather than occasional symptoms), then you will also need to undergo stress test as well. Because calcium scoring is not a reliable test to rule out the possibility of blockages. So, if symptomatic then should undergo stress test like treadmill test or stress echo. I guess you must have already undergone echo, if not then it is an essential investigation.

Coming to aortic dilatation, they can also see the arch of aorta and thoracic aorta. So probably other parts of aorta within the chest are not involved. Now 3.7 cm is mild elevation and you should monitor it with 1-2 yearly echo, especially if your current echo shows dilatation. Nearly 20-25 percent individuals with thoracic aortic aneurysms also have abdominal aortic aneurysm. So abdominal ultrasound should be done, specifically focused to look for aorta.

Now I guess, they meant aortic root means ascending aorta, but not the aortic sinus. Because aortic sinus can be dilated this much normally. So just confirm it. LDL (low density lipoprotein) is a bit high so healthy lifestyle and regular activities should be practiced.

So overall, if symptomatic then should undergo stress test, needs regular follow up echo for aortic aneurysm and screening abdominal ultrasound.

I hope this helps.

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