So it wasn't exercise-induced asthma...

[scottyjames]

Back in Sept I posted a query here looking for thoughts/advice on some weird chest pains I was having while riding, which were most acute in the morning. A nuclear stress test had been normal, and I was wondering if my problem might've been exercise-induced asthma. A number of you weighed in, and a few of you asked that I let you know what the outcome was. Short answer: a solid case of heart disease, and a couple of spots in the LAD that were about 70% or more blocked. So much for the asthma theory -- I'd been experiencing classic signs of stable angina. I was finally able to get in to a cardiologist shortly after I posted my note here, and it didn't take her long to order an MRI and an angiogram, which confirmed what was going on. Began a beta-blocker and statin regimen. Stable angina remained so until mid December, when it decided to go all unstable, and a week before Christmas I was forced to check myself into the emergency room at MGH because I suddenly couldn't walk more than a block before my chest would light up. Two days later I had two stents placed in the LAD. One week after that I was taking the dogs for hard walks in the woods. Started a cardiac rehab program of monitored exercise, and about a month ago I skate-skied for the first time this season. Shortly after that I got back on the bike for the first time since Sept. No problems at all. I'd say I got off easy, all things considered. Bottom line: get to a cardiologist asap at even the slightest hint of chest discomfort. Don't pretend it's not happening, and don't pretend it can't happen to you, no matter how fit you are or how much you just paid for those new carbon wheels. Ok, end of lecture. Hope there's something useful in all this. Scott

[bikerboy337]

Thanks for the update. Glad to hear things seemed to have turned out for the better!

[FlashUNC]

Great news.

[Cat3roadracer]

Excellent news, thanks for posting. My primary care doc sends me to the cardio doc every three years to make sure everything is good to go. Excersizing as hard as we do, in my opinion it's a good idea.

[MattTuck]

wow, great to hear that you're doing better.

what kind of stents did you get? I hear the titanium ones are great!

[AngryScientist]

great news scott.

if you dont mind sharing:

why did they wait until essentially you got acutely worse to do the stent job?

how old are you?

just curious, no pressure to answer either of those questions if you dont want to.

getting back to exercise is a wonderful thing, cheers!

[Black Dog]

wow, great to hear that you're doing better.

what kind of stents did you get? I hear the titanium ones are great!

Come on! Everyone knows it is not the material that the stent is made of it is the way they are designed! ;)

P.S. Great news about the OP's outcome and even better advice.

[merlinmurph]

To be honest, I wasn't sure how your post was going to end up - glad it ended on a great note.

Sounds like you're in the Boston area - MGH? Mass General?

Murph

[scottyjames]

Good questions, Angry. The doc wanted to manage my situation with an aggressive drug therapy, with mechanical intervention as a last resort. I agreed completely with this approach, even if it made exertion/exercise tricky. But afternoons were still much better than mornings for me, so I had that. Plus, the beta-blocker/statin combo has been shown to actually reduce arterial plaque in some cases over time, so that was my long-term hope. My body had other plans, obviously. When the angina went from predictable to unpredictable, stenting became our only option.

Me: 51, never smoked, never overweight, lean, athletic, former xc ski racer, etc. Good diet. Not so good about regular checkups and staying on top of my cholesterol, though. I knew it was on the high side, but turned out it was sky-high. So that was a big mistake on my part. Diet and exercise alone can't always match some dodgy genetics. I'll add that to my earlier lecture.

[Jaq]

All things considered, that's wonderful news on your diagnoses, treatment, and now recovery. Much continued success!

[thwart]

if you dont mind sharing:

why did they wait until essentially you got acutely worse to do the stent job?Recent studies suggest that the blockages we're talking about here do as well or better with medical therapy (drugs), rather than doing procedures to open up the blockages. Turns out coronary arteries aren't the same as the pipes in your kitchen---where if there's a blockage causing an issue, then clearly the best answer is to just go in there and clean it out.

Good to remember that angioplasties and such can sometimes go wrong, although the complication rate is fairly low in most places.

But... some on medical therapy will go on to develop a more critical stenosis (as it sounds like you did), and wind up with angioplasty or bypass surgery.

Glad to hear that you're doing better and back to cycling, skiing and such!

[scottyjames]

Thwart, it was immensely disappointing when it became clear that drugs alone couldn't manage it. And in a weird way, sort of a relief -- the beast was fully out in the open, finally, and it required a big, definitive response. Believe me, I'd have rather skipped that step and not needed the stents -- plenty can go wrong with them in the long term, too -- but psychologically I'm finding some benefit on being on the other side of all that. Glass half full, I suppose.

Murph: Yeh, Charlestown. Looking forward to resuming my Ctown-Quincy bike commute. Nothing taxes the heart like riding Dot Ave during rush hour.

[slidey]

Glad to know you're doing fine. Here's wishing you a speedy, and complete recovery!

[soulspinner]

Glad you are O.K. My first question would be family history, second one Angry asked. It seems a lot of people that take good care of themselves could have picked better parents:rolleyes:

[shovelhd]

Nothing taxes the heart like riding Dot Ave during rush hour.

You crazy. :)

Seriously, good luck with your recovery. I suffer from EIA, and it sucks.

[redir]

Glad to hear you are ok and your wise advice should absolutely be taken serious by anyone who has such symptoms.

[Wayne77]

This post is pretty timely for me...Scott thanks for posting

I don't think what I experienced over the weekend is the same thing but I'm still in investigative mode: Last Sat AM woke up with some mild pain in my upper-left chest area. I had a short crit that day, but ignored the pain. I did the race and honestly didn't notice any pain during the race (short 30 min crit). Later that day, my left chest really started to flare up - shooting pain directly relating to exhaling, but not so much with inhaling. Sunday morning it felt worse - the pain would only go away if I was laying on my right side.

So I went to see our family doctor that afternoon. He immediately hooked me up to an EKG and everything looked good there. Blood pressure measurements came through excellent. My lungs sounded fine. Next we did a chest x-ray. He explained that he thought it was either something called "pleuritis" or a partially collapsed lung (maybe it got worse during the race?). He also said he wanted to make sure there wasn't a blood clot in the lung waiting to break free (scary!) and mentioned that should show up in the x-ray.

Anyway the x-ray came back negative for any signs of blood clot or collapsed lung, but I do have some scar tissue in the lower right lung from an early chilhood case of pnuemonia - but that isn't in the location of the pain...

so the Dr thinks it's plueritis, gave me a prescription for an anti-inflamatory and sent the x-ray to a radiologist for confirmation. He said he'd call me back if the radiologist disagrees, otherwise assume his diagnosis is correct.

The pain (is mostly) gone, the Dr insists I can still ride hard, and I have a crit scheduled for tonight...hmmm..based on this thread, sounds like I should get an appt with a cardiologist or pulmonologist soon.

If anyone else here has had plueritis or a collapsed lung, I'd love to hear what your symptoms are like - feel free to PM so as not to detract from the OP.

[scottyjames]

Wayne, the main thing is that you checked in with your doc asap. If he says keep riding, then do it, especially if the pain is subsiding. It's also good news if the pain isn't triggered by exertion, and it doesn't sound like it is. If that changes and exertion brings it on, and/or if you experience pain in your left arm or sudden fatigue, then definitely get back to the doc. I hope that's not necessary. Enjoy those crits.

[Wayne77]

Wayne, the main thing is that you checked in with your doc asap. If he says keep riding, then do it, especially if the pain is subsiding. It's also good news if the pain isn't triggered by exertion, and it doesn't sound like it is. If that changes and exertion brings it on, and/or if you experience pain in your left arm or sudden fatigue, then definitely get back to the doc. I hope that's not necessary. Enjoy those crits.

Thanks - heading out for the race in a bit! :-)

[biker72]

Scotty monitor your cholesterol closely. The arterial plaque is reversible. Exercise is great and helps elevate your HDL but your diet is equally important.

Unfortunately we can't do anything about heredity.

[Johnny P]

I also thought I had exercised induced asthma, but it was a heart condition. Be careful when you can't go harder on a bike, it may be your heart more than your lungs holding you back.

[scottyjames]

Biker72, I'm all over it -- and man, do I miss those three-egg swiss + mushroom omelets. Hello, oatmeal dosed with flax seed. But a nice benefit of my new no-fun diet is that I'm seriously lean/mean, and the season's hardly begun. I'll be a monster by the time D2R2 rolls around this summer.

[spaced_ghost]

timely post for me, too. I actually just got blood test results back today and found out I have extremely high cholesterol. not good, considering I have a family history of heart disease. I'm a bit freaked out, going to have to change things immediately.

[shovelhd]

Hey, at least you found out. I was on a statin for 1.5 years to bring it down, and have been off of it for over a year now with a ton of exercise and sensible diet changes.

[spaced_ghost]

yeah, i'm not doing Statin. my gramps takes that and has had seriously problems with it. I'm going to do everything I can through diet and exercise.

[palincss]

yeah, i'm not doing Statin. my gramps takes that and has had seriously problems with it. I'm going to do everything I can through diet and exercise.

You know, there are more than one statins, and because you have bad side effects with one doesn't mean you'll have bad side effects with others. It's the same thing with blood pressure drugs. You'd be foolish to rule out all statins just because a relative of yours had problems with one of them. You'd even be foolish to rule out all of them because you yourself had a problem with one of them.

[thwart]

I actually just got blood test results back today and found out I have extremely high cholesterol. not good, considering I have a family history of heart disease.

yeah, i'm not doing Statin. my gramps takes that and has had seriously problems with it. I'm going to do everything I can through diet and exercise.I'm all for pushing diet and exercise as far as you possibly can and avoiding pills, but if you have two major risk factors for heart disease (high cholesterol, genetic predisposition) you may want to reconsider your stance here.

Most folks actually do well on statin drugs.

Doesn't have to be one or the other...

[spaced_ghost]

well, I have two family members that work in medicine and they both told me not to take statin. my gramps got his down without the statin and I think I can, too. wouldn't mind if you didn't call me foolish for choosing my own path back to health.

[shovelhd]

You can certainly do what you please. I wish you the best of luck. My deal with the doc was to take the statin and make lifestyle changes. Once my cholesterol was down for 6 months straight I would be taken off of it. It was a means to an end. I figure the less time I'm alive with high cholesterol the better.

[biker72]

well, I have two family members that work in medicine and they both told me not to take statin. my gramps got his down without the statin and I think I can, too. wouldn't mind if you didn't call me foolish for choosing my own path back to health.

Exercise and diet modifications do work for some people. I lowered my overall cholesterol from 284 to 228 with diet and exercise. Not near enough.

A newer drug on the market is Zetia. This is used with a low dose statin and has worked wonders for me. All of these drugs have side effects. Not everyone can tolerate them.

Bottom line is that if diet and exercise will get the cholesterol low enough...go for it.

[Britishbane]

This post is pretty timely for me...Scott thanks for posting



Timely for me as well. I've gone about 2 months with tightness in my left chest. It has never been what I'd consider painful, but rather dull enough that I'd notice it. The sensation lingered long enough that I went to my GP who diagnosed me with a limited left bundle branch block through an EKG. I followed up with an exercise stress test (not nuclear) and everything came back normal, except of course for the LBBB. The doctors seem to think my heart is healthy and tell me the LBBB isn't necessarily a big deal (its an electrical delay - not a blockage of any valves or arteries).

I'm 28, with a blood pressure well within the nominal range and my cholesterol is normal as well. I've no history of heart disease in the family that I know of - perhaps my paternal grandfather had some, though I'm not sure. Anyways, at my age and given my test results the doctors have ruled out a heart issue, though I'm not entirely convinced. We're now going through tests to see if its a skeletal/muscular issue as bike riding and yoga seem to increase my symptoms more so than running. This has really messed up my Spring riding form, darn it.

[oldpotatoe]

Back in Sept I posted a query here looking for thoughts/advice on some weird chest pains I was having while riding, which were most acute in the morning. A nuclear stress test had been normal, and I was wondering if my problem might've been exercise-induced asthma. A number of you weighed in, and a few of you asked that I let you know what the outcome was. Short answer: a solid case of heart disease, and a couple of spots in the LAD that were about 70% or more blocked. So much for the asthma theory -- I'd been experiencing classic signs of stable angina. I was finally able to get in to a cardiologist shortly after I posted my note here, and it didn't take her long to order an MRI and an angiogram, which confirmed what was going on. Began a beta-blocker and statin regimen. Stable angina remained so until mid December, when it decided to go all unstable, and a week before Christmas I was forced to check myself into the emergency room at MGH because I suddenly couldn't walk more than a block before my chest would light up. Two days later I had two stents placed in the LAD. One week after that I was taking the dogs for hard walks in the woods. Started a cardiac rehab program of monitored exercise, and about a month ago I skate-skied for the first time this season. Shortly after that I got back on the bike for the first time since Sept. No problems at all. I'd say I got off easy, all things considered. Bottom line: get to a cardiologist asap at even the slightest hint of chest discomfort. Don't pretend it's not happening, and don't pretend it can't happen to you, no matter how fit you are or how much you just paid for those new carbon wheels. Ok, end of lecture. Hope there's something useful in all this. Scott

VERY useful, glad you are OK. Curious as to why the Nuke stress test didn't find anything..I had one for A-Fib, looking for structural issues with ticker.

For the Dr. BCS below--my question..Nuke stress test and blockage. I don't have chest pain, never had, just 4-5 episodes of A-Fib, short duration(24 hours was the longest one). Had a heart scan with very low numbers(less than 10) and nuke stress test...monitor for 24 hours-no electrical or structural problems. Went on Lipitor..220 to 145 total numbers...works for me!!

[BCS]

Exercise and diet modifications do work for some people. I lowered my overall cholesterol from 284 to 228 with diet and exercise. Not near enough.

A newer drug on the market is Zetia. This is used with a low dose statin and has worked wonders for me. All of these drugs have side effects. Not everyone can tolerate them.

Bottom line is that if diet and exercise will get the cholesterol low enough...go for it.

Zetia lacks outcomes data. It is a poor choice. As a physician, reading these anecdotes amuse me but they can be counterproductive. I don't ask my dentist about bike repair. Soliciting med advice on a bike forum, especially from non-physicians is unwise.

[spaced_ghost]

I wasn't soliciting medical advice. quite the contrary, I'm trying to fend it off. .