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Intense weight training can rip major artery, doctor says

Monday, January 5, 2004

WASHINGTON -- Bill Linski was lying down watching television when he felt as if something in his chest was being ripped apart.

It was.

The largest artery in Linski's body, the aorta, was splitting. It took a major operation to keep him together, and his surgeon thinks Linski's weight training triggered his brush with death.

The pain began in the middle of Linski's chest, went away for a half second, then returned, racing up through his neck and into his jaw, leaving him wheezing.

Linski was only 21. He had worked out that morning to prepare for competitive bodybuilding, and at first tried to pass it off as muscle pain or heartburn. But his father had died of a massive heart attack at age 38, and "in the back of my mind, I pretty well knew something was going on," he said.

It turned out that Linski had an aneurysm, an abnormal swelling of the blood vessel. Next to his heart, his aorta had stretched to twice its normal size. And it had begun to dissect -- bleeding through the blood vessel wall into the chest.

The Quaker Hill, Conn., man was treated at Yale-New Haven Hospital, where Dr. John A. Elefteriades, professor and chief of cardiothoracic surgery at Yale University School of Medicine, operated on him. The damaged part of his aorta was removed and replaced with Dacron tubing. He also has a metal heart valve to replace a valve that had to be removed during the surgery.

But Elefteriades, himself a weight trainer, had noticed something: Linski's case was part of a pattern. Over two years, the doctor collected five cases -- three at his hospital, who survived, and two elsewhere, who did not. Two patients had been weight training, two had been doing push-ups and one had been trying to move a heavy piece of granite.

A report of five cases does not constitute proof, but Elefteriades believes the aortas in all five were unable to withstand spikes in blood pressure resulting from the strain of the patients' activity.

A normal blood pressure measurement gives a reading of 120 millimeters of mercury as the heart is beating. "Powerlifters get up to 370 to 390," Elefteriades said. While most powerlifters can do it with no harm done, he considers it risky.

Elefteriades and his colleagues wrote a warning letter, published in the Dec. 3 issue of the Journal of the American Medical Association. "The risk of weightlifting as a cause of aortic dissection has generally been underappreciated," it said.

One reason is that cases can be misdiagnosed as heart attack, Elefteriades said.

Another is that the reasons why the aorta weakens are not well understood. Elefteriades is working with a research company, Celera Genomics, to seek new genetic links. However, it is known that aneurysms can develop in people with Marfan syndrome, a genetic disorder of the connective tissue that can affect the blood vessels. High blood pressure also can be a factor, especially as people age.

With the exception of one person with a family history, none of the five cases noted in the letter had those problems, he said.

The cases should teach some weight trainers to be cautious, the JAMA letter said. These include patients with known aneurysms or connective tissue disease, a family history of aneurysm or dissection, underlying high blood pressure or being middle aged or older, it said.

Elefteriades recommended lifts that don't send blood pressure into giant spikes. "If you limit your lift to 50 percent of body weight, you don't exceed 200 millimeters of mercury," he said.

Just the same, lifters like to lift at least their own body weight, Elefteriades said. "I bench press 120 and I weigh 175, and I do my body weight once a month, just to prove I can do it," he said. "But do your own body weight and the pressure gets very high."

People who intend to do high-intensity lifts should get their aortas imaged to make sure they don't have aneurysms, Elefteriades said.

However, the costs of those screens would be high compared with the small number of cases they could be expected to pick up, said Dr. Gerald Fletcher, a cardiologist at the Mayo Clinic in Jacksonville, Fla., and a spokesman for the American Heart Association. The letter in JAMA is reason to consider scans but not to require them, he said.

Lifters also can modify their techniques while still getting solid results, said Tom Cross, strength conditioning coach at MidAmerica Nazarene University in Olathe, Kan. A case in point is the squat, in which the lifter builds leg muscles by moving down into a sitting position and then back up. "We are going to squat very heavy, but we are not going to squat to push our brains out," he said.

As for Linski, after a lengthy recovery from his trauma in 1999, the 25-year-old is a graduate student at Sacred Heart University, studying to be a teacher, and he is back weight training.

Linski had entered the hospital at 205 pounds; today he weighs 184 pounds, which he considers healthier. And he has modified his regimen. While he used to bench press 250 to 300 pounds, he limits those chest, shoulder and arm workouts to no more than 225 pounds. And he keeps an eye on his blood pressure.

"I'm able to customize my workouts," Linski said. "One thing I don't want to do is strain. With age grows wisdom."


On the Net:

National Institutes of Health aortic aneurysm information: http://www.nlm.nih.gov/medlineplus/ency/...

Aortic aneurysm illustrations: http://everest.radiology.uiowa.edu/nlm/a...


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