Monitoring Cardiac Health

[EMSC]

My update is a very unfortunate one. With some great plans and fun times expected I may or may not ski another day by late this season.

Despite all the right foods, exercise, no big sin habits, health measuring (calcium scores), pills, etc... my short term world came apart last Wednesday at about 4:30am. Heart attack... and still in the hospital as my body just wants to argue the details of fully stable, though I'm told that will happen and I'll be able slowly start some sort of recovery which is currently predicted to be above the average person due to the good shape the rest of my body was/is in. In the plus column is that I recognized something was very wrong literally immediately and had my wife rush me to the closest hospital.

Anyone want to ski Mustang Powder in January or Feb?? I'm asking others as well, but not easy to fill with such short notice to Jan esp.

I will be living vicariously through TR's for a while so post'em often!

 

[jamesdeluxe]

Jesus, that sucks but glad you're here!

At some point, if you wouldn't mind letting us know how you recognized that something was wrong?

 

[ChrisC]

Oh wow! Glad you are OK and recovering.

 

[Tony Crocker]

At some point, if you wouldn't mind letting us know how you recognized that something was wrong?

Yes, the most dangerous cases are asymptomatic until something major happens. Any stent or bypass needed?

health measuring (calcium scores), pills

Those were already being monitored? Were you on statins or blood pressure meds already? Following the example of a friend who had almost no symptoms but ended up with 3 stents, I demanded every cardio test in the book when I had to start taking breaks on strenuous ski runs over 10,000 feet. But that was just as I turned 70. Nobody fit and active like EMSC thinks about this stuff in their 40's or 50's unless an annual check up reveals high blood pressure or bad cholesterol numbers.

Anyone want to ski Mustang Powder in January or Feb??

Paging ChrisC!

 

[Sbooker]

@EMSC sorry to hear but I’m glad your episode wasn’t the big one. This hits close to home as I’m waiting for the inevitable due to severe hypercholesterolemia. I’ve been on statins for 39 years but they’ll only do so much.
All the best with the recovery.

 

[jasoncapecod]

@EMSC sorry to hear but I’m glad your episode wasn’t the big one. This hits close to home as I’m waiting for the inevitable due to severe hypercholesterolemia. I’ve been on statins for 39 years but they’ll only do so much.
All the best with the recovery.

Get a calcium score
Very good indicator of future problems
That said , I guess emsc didn’t show anything.

 

[EMSC]

how you recognized that something was wrong?

For me it was nearly instant upper chest pain (7 of 10 at start, 9 of 10 by hospital), plus both hands and lower arms tingling very significantly.

Yes, the most dangerous cases are asymptomatic until something major happens. Any stent or bypass needed?

2 stents, one on the 'widowmaker' artery.

Those were already being monitored? Were you on statins or blood pressure meds already?

I was on blood pressure med. Not sure the proper artery order of the calcium scores, but mine were 0, 0, 0, 12. Basically as small as you are likely to see.

Every doctor and nurse asked all the standard questions about lifestyle (smoker? Heavy drinker? Drug user? etc...). Basic gist is I seem to be one of a small percent slipping though and have unusually unlucky genetic component for non-calcium plaque somehow. No real good answers. I thought I was doing all the things as good as I could.

 

[Sbooker]

Get a calcium score
Very good indicator of future problems
That said , I guess emsc didn’t show anything.

I’ve had two. One at age 50 to get a baseline. It showed “about as much build up as the average 65 year old” and one at 52 that showed little change.
My maternal grandfather dropped dead of a coronary while refereeing a rugby league game at age 36.
It appears the statins have been doing their job.

 

[Sbooker]

Incidentally we in Oz measure blood cholesterol in millimoles per litre while in the US you measure it in milligrams per decilitre I believe. Multiply the Australian measure by 18 to get the US measure apparently. Without statins my cholesterol level is near in 200 in your measure.

 

[jasoncapecod]

For me it was nearly instant upper chest pain (7 of 10 at start, 9 of 10 by hospital), plus both hands and lower arms tingling very significantly.


2 stents, one on the 'widowmaker' artery.


I was on blood pressure med. Not sure the proper artery order of the calcium scores, but mine were 0, 0, 0, 12. Basically as small as you are likely to see.

Every doctor and nurse asked all the standard questions about lifestyle (smoker? Heavy drinker? Drug user? etc...). Basic gist is I seem to be one of a small percent slipping though and have unusually unlucky genetic component for non-calcium plaque somehow. No real good answers. I thought I was doing all the things as good as I could.

Wow wow
I had a 12 too. Scary stuff glad you caught it. I guess ya never know.

 

[Tony Crocker]

The tests:

The one they start with is EKG treadmill, rarely finds out anything aside from what kind of fitness you have. It lasts 12 minutes with speed or incline ramped up every 3 minutes. They kick you off before 12 minutes if your heart rate is high for your age. Post age 70 they remove me a little after 10 minutes even though I am not yet as out of breath as exercising above 10K at Mammoth.

The calcium test is some kind of scan. I had zero when first done in my early 60's but was around average for age 70.

There are two tests that directly measure cardiac problems.

The nuclear stress test measures blood flow. You get scanned with an IV injected with radioactive fluid injected. This is done twice, once at rest and once while you are on the treadmill exercising. Comparing the two results is informative and they found nothing unusual with me.

Most people know about angiograms where they run a microcamera via a leg artery up into your aorta, then into each coronary artery to measure actual blockage. As an invasive procedure this is generally done only if there are clear symptoms of a serious problem.

Now there is a CT angiogram which can see the plaque in the coronary arteries. In 2023 the CT showed I had <50% blockage in the less important left artery and none in the other three. The catch is that if you have too much calcium, the CT can't get a picture though it and you must have the invasive procedure to check for blockage.

Recall Stuart's cardiac story which MarzNC referenced last month. The nuclear stress test was what diagnosed him over a month after he first had discomfort for which the source was not obvious. My friend was in the same situation as Stuart with the blocked Widowmaker where tributary arteries had grown to prevent the drop dead scenario. He had fewer symptoms than Stuart.

Stuart was out skiing again about 3 weeks after the stent procedure. EMSC's situation must be different or he wouldn't be giving up a Mustang seat over two months from now.

I am diligent on this subject because my dad was diagnosed with heart disease at age 61. He was diligent in following doctor's orders after that and had two bypass surgeries but his activity level was constrained until he finally died at age 78. The damage was probably done from smoking 2 1/2 packs a day for 45 years.

 

[jimk]

I've had high cholesterol between 240-290 since about age 40. I was active and my good cholesterol numbers were good. Overall ratio was considered fine and no meds until about about 7 years ago. Since then been taking atorvastatin, which knocked number back to 200-220. Now at 40mg daily. Doc trying to get me under 200. He says I have arterial plaque that showed up in a cat scan for a kidney stone three years ago.

I think we all sympathize with EMSC because...there but for the grace of God go I. Wishing him the best!

My wife's grandmother lived until age 103. We attended her 100th birthday party, where she played Old Maid with her great grandchildren. At the party the story was shared that when her son took her for a routine medical check-up at age 100 the doc's first question was, "what meds is your mother taking?" The answer was - none.

 

[Tony Crocker]

"what meds is your mother taking?" The answer was - none.

Liz and I have the mindset that is an admirable attitude and need to be convinced when long term rest-of-your-life meds are necessary.

In the early 2010's my cholesterol was just over 200 with ratio around 5.0 and my primary doc suggested statins. I did a little research which said not necessary at that level with no other cardiac risk factors and recommended baby aspirin. By 2020 (cholesterol was 227 and ratio 5.7) cardiologists didn't like baby aspirin any more and recommended I go on statins. I asked for the minimum dose, which is 5mg and that took the cholesterol down to 147 and ratio to 3.3. In 2022 my blood pressure went up, so I went on a 5mg dose for that too. In 2024 the statin was bumped up to 10mg.

FYI the baby aspirin I was taking 2013-2020 probably caused the massive black-and-blue spreading down my legs after two ski falls in 2014 and 2017. This is surely a side effect for those who get coronary stents too, because my friend said you are on blood thinner for the rest of your life if you have a stent.

 

[EMSC]

my friend said you are on blood thinner for the rest of your life if you have a stent.

Skieric can confirm, but my understanding of the past few days is that nearly everyone who gets stents has a lifelong likelihood of arrhythmia occurring. Arrhythmia has very high likelihood of generating blood clots and therefore strokes. And that is why lifelong blood thinners: to prevent strokes.

 

[Tony Crocker]

What is the reason for the gradual recovery time from stent procedure vs. Stuart in 2024? Was heart muscle damaged? If so how long does it take to heal? Cursory Google search on "heart attack" suggests up to 3 months, but of course varies by individual.

 

[Skieric]

Skieric can confirm, but my understanding of the past few days is that nearly everyone who gets stents has a lifelong likelihood of arrhythmia occurring. Arrhythmia has very high likelihood of generating blood clots and therefore strokes. And that is why lifelong blood thinners: to prevent strokes.

Primary indication for blood thinners after stents is to prevent a blood clot from forming in the stents and creating another heart attack. Once the stents become coated by endothelium (lining of blood vessels), the potent blood thinners are generally stopped and changed to a medication such as aspirin which is not as potent of a blood thinner. (3-6 months) A heart attack is a myocardial infarction. (loss of blood flow to heart muscle and muscle death). Depending on the extend of heart muscle injury this could leave someone with reduced cardiac function and exercise tolerance. The heart has some ability to remodel and improve some of this function; however, this will take time and cardiac rehab. I dont know the extent of EMSC heart function after the MI, hopefully it is on the minor side.

 

[Tony Crocker]

Depending on the extend of heart muscle injury this could leave someone with reduced cardiac function

Presumably that was my dad's situation. I heard he had "heart attack symptoms" in the doctor's office on an early visit. I was away at boarding school when all of this happened at his age 61. My mom told me I was lucky not to be around over the next few months when he was quitting smoking.

When I took up skiing my dad considered going along to observe sometime, but his cardiologist said absolutely not to go to high altitude.

 

[ChrisC]

My attack was severe enough that I won't be seeing snow till at least next season sometime. Glad to still be posting to these boards, but also a very long road to hoe for me unfortunately.

Do you need to build up aerobic exercise gradually over months?

Glad you are still with us.

 

[EMSC]

Do you need to build up aerobic exercise gradually over months?

Understatement. I get the sense (reading between lines) that the first couple months is simply doc's seeing if I truly fully stabilize or if I show signs either direction of slight better or even possibility of worse.

Glad you are still with us.

Thanks. At one point I was even told that even being at the hospital within 10 minutes like I was, my type of attack was at best 50/50 survivability. With apparently a large % of the survivors of my type of attack needing mechanical heart stimulation and breathing tubes (which I did not need). The guess by everyone being my solidly good fitness was a key reason I survived at all (I had just spent the prior 6 months ramping up to ~1.5+ hrs most days of biking, lifting, workouts, etc...).