| Dr
DIMITRIOS – JAMES MANOS
1
June 2011
REVIEW: STRENUOUS
WEIGHT LIFTING/ EXERCISE MAY INCREASE THE RISK FOR FATAL AORTIC
OR BRAIN ANEURYSM RUPTURE OR AORTIC DISSECTION
There are many concerns that strenuous
weight lifting may cause aortic dissection or aortic
or brain aneurysm rupture, and these may be fatal.
Current studies in the pathophysiology and predisposing conditions of acute aortic dissection in young
population (children, adolescents, and young adults)
include congenital cardiovascular anomalies, certain
heritable disorders of the connective
tissue (such as Marfan’s
syndrome), cocaine abuse
and weight lifting (5).
Aortic dissection (AD) is an uncommon condition
that occurs mainly in population aged more than 40 years old.
It is rare in younger people and is usually associated
with trauma, Marfan’s syndrome, or pregnancy. A
case of a young weightlifter who died
from an AD was reported in a study. The autopsy diagnosed
a non-Marfan’s fibrillinopathy.
The authors of the study recommend that aortic dissection (AD) should be considered in symptomatic
patients with any family history of early cardiac deaths, a
history suggestive of a connective tissue disorder (that is,
multiple joint surgeries) or to people who practise weightlifting
(6).
Weight training, contrary to aerobic
exercises, routinely produces acute
rises in blood pressure to over 300 mmHg! This is a danger
for individuals with an unknown aortic aneurysm to whom
the deteriorated mechanical properties of the aortic wall resulting
from aneurysmal enlargement increase the susceptibility to aortic
rupture, when the high wall coincident with exertion exceeds
the tensile strength of the aortic wall. A study demonstrated
a causal link between extreme exertion,
severe emotional stress, and acute type A
aortic dissection. Aortic enlargement is often unknown
to persons participating in weight training, especially in the
youth population. Thus, an iSnapShot Echocardiogram screening
program has been proposed on
persons participationg in weight training.
The pre-participation
cardiac screening is important for early detection and prevention
of aneurysms. Without aneurysm, wall tension does
not reach dangerous levels, even at extremes of exertion. However,
in individuals with known aortic dilatation, the authors recommend
a program that limits their lifting to 50% of body weight in
the bench press or equivalent level of perceived exertion for
other specific strength exercises (2).
Another study mentioned a case of a 23-year-old male
professional body builder who developed squeezing
retrosternal chest pain following weight lifting. On the ER examination
his heart rate (HR) was 42 bpm and his blood pressure (BP) 70/50
mm Hg. The electrocardiogram (ECG) showed inferior and right
ventricular ST elevation myocardial infarction. An emergency
coronary angiography was done and showed normal left coronaries,
however the right coronary artery angiogram revealed a dissection
in the mid-part of the right coronary artery which was
extended to the right ventricular branch (3).
Interesting is also the case of a 28-year-old previously
healthy male with a 13-year history of weight lifting. The patient
presented to the emergency department (ER) complaining of severe anterior chest pain beginning during a workout. Transthoracic echocardiogram
and computerized tomogram gave the diagnosis of an ascending aortic dissection. The patient was taken
emergently for surgical repair of an incompetent
aortic valve and type II aortic dissection. Histopathologic
examination of the aorta showed cystic
medial degeneration (4).
Studies have demonstrated that repetitive upper- and lower extremity weight training incorporating
a Valsalva maneuver can increase arterial pressure to values
as high as 480/350 mm Hg. This marked increase in
arterial pressure is transmitted to the cerebral vasculature
and increases cerebral arterial transmural pressure and may
have the potential to initiate the rupture of a previously innocuous
intracranial aneurysm. Three cases of subarachnoid
hemorrhage (SAH) associated with arm (bicep) curls and
leg press weight training were reported in a study, raising the
possible link between weight training and aneurysmal subarachnoid
hemorrhage (SAH) (1).
Weight lifting related acute aortic dissection
is associated with extreme exertion. Moderate aortic dilatation
confers vulnerability to exertion-related aortic dissection.
Individuals with known aortic dilatation should be cautioned
to refrain from weight lifting or strenuous exertion.
Also, routine echocardiographic
screening of individuals engaging in heavy strength training
should be considered
(7).
REFERENCE:
1. http://www.ncbi.nlm.nih.gov/pubmed/8925367
2. http://www.ncbi.nlm.nih.gov/pubmed/20924328
3. http://www.ncbi.nlm.nih.gov/pubmed/17913271
4. http://www.ncbi.nlm.nih.gov/pubmed/15758856
5. http://www.ncbi.nlm.nih.gov/pubmed/10696543
6. http://www.ncbi.nlm.nih.gov/pubmed/15788848
7. http://www.ncbi.nlm.nih.gov/pubmed/16847387
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