Weight Lifting and Aortic Dissection: More Evidence for a Connection

Abstract

Background/Aims: In 2003, we reported on a small number of patients in whom acute aortic dissection appeared to be causally related to intense weight lifting. If additional cases could be identified, the phenomenon of weight lifting induced aortic dissection would be further substantiated. We now report a substantially larger number of cases in which aortic dissection is associated with intense physical exertion. Methods: Additional cases of acute aortic dissection occurring at the time of intense physical exertion were accumulated and analyzed. Cases were culled from retrospective review of a large university data base and from reports forwarded to our attention from around the country. We determined type of activity bringing on symptoms, age and sex of the patients, location of the dissection (ascending or descending aorta), aortic size, therapy, and survival. Results: We identified 31 patients in whom acute aortic dissection occurred in the context of severe physical exertion, predominantly weight lifting or similar activities. All patients except one were males. Mean age was 47.3 (range = 19–76). All except four dissections were in the ascending aorta. Only three patients (9.7%) had a family history of aortic disease. Mean aortic diameter on the initial imaging study was 4.63 cm. Twenty-six of the 31 cases were diagnosed ante-mortem and 5 post-mortem. Overall, 10 of the 31 patients (32.2%) died. Of 24 patients reaching surgical therapy, 20 (83.3%) survived. Conclusion: Weight lifting related acute aortic dissection appears to be a real phenomenon, with increasing evidence for the association of extreme exertion with this catastrophic aortic event. 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. Routine echocardiographic screening of individuals engaging in heavy strength training should be considered, in order to prevent this tragic loss of life.

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

“…117) Hatzaras et al pointed out the relationship between aortic dissection and weight lifting, in which systolic blood pressure is markedly elevated. 118) An abrupt elevation of blood pressure may lead to a tear of intima, although there has been no literature which clearly demonstrated a direct relationship of blood pressure variation and incidence of aortic dissection. Hatzaras reported that 65 of 90 patients with aortic dissection (72%) could recall specific inciting events, exertional or emotional, immediately prior to the onset of dissection.…”

Acute Aortic Dissection Occurring “Behind The Wheel”, Report of 11 Cases

“…Some specific sports activities, including weight lifting, can trigger the onset of AAD due to a rapid increase in hemodynamic stress. 11) In these cases, the underlying cause is a sportsinduced mechanism. Driving a vehicle is probably not directly related to the pathogenesis of AAD.…”

Attenuated Increases in Blood Pressure by Dynamic Resistance Exercise in Middle-Aged Men

“…However, BP rises rapidly and remarkably during high-intensity leg press exercise (10). Indeed, it has been reported the accidents, such as artery dissociation and subarachnoid hemorrhage, occur during resistance exercise (39)(40)(41)(42). Therefore, care should be taken regarding the rapid and marked increases in BP response to resistance exercise, particularly in middle-aged and older men.…”