Heart attack story in NYT

[fiamme red]

http://www.nytimes.com/2008/07/08/health/views/08case.html?scp=1&sq=heart+attack&st=nyt

Most Saturday mornings, I bicycle with a group of men, mostly in their 50s, whom I affectionately call the Cheat Death group. We are all in pretty good shape, competitive but supportive, and convinced that hard-core exercise is our ticket to postponing the inevitable.

The ride a few Saturdays back was a tough one. At 6:30 a.m., the pack took off fast and immediately headed for the hills near Durham, N.H. The first few climbs felt pretty good, but by the third hill I started to feel nauseated.

Figuring that was probably a result of the four beers and large Chinese dinner the night before, I kept going. Twenty-five miles into the ride, I had fallen to the back of the pack. I was short of breath and wondering how I was going to make it much farther...

[Bill Bove]

Sounds like me on most Saturday mornings :eek: Seriuosly, a guy I know who rides tons of miles just had a quad bypass and another from that same guys group died a short time later of a heart attack. Kinda scary.

[Ozz]

Renton man dies during triathlon in Oregon (http://seattletimes.nwsource.com/html/localnews/2008025398_webtriathlete30m.html)
"A Renton man participating in a triathlon in central Oregon died of a heart attack Sunday during the swim portion of the event, his family said today.

Patrick Findlay, 45, was in the Wickiup Reservoir around 9:40 a.m., starting the first leg of the Pacific Crest Triathlon...."


sad....

[Fixed]

no one knows when their ticket gets punched
enjoy today
cheers

[learlove]

You never know - I had a friend, he was 43 years old an airline pilot and fighter pilot (A-10's) in the Air National Guard. I add the part about the airline/guard because at his age that means he gets 3 physicals per year (one for the military and 2 for the airline, one of which includes an EKG). He was a marathon runner and triathlete. And this isn't something he had just picked up. He was an all round athlete in high school, ran cross country at the Air Force Academy then never stopped running and picked up triathlons in his mid 20's.

He went out for a run after doing some flying in the guard one day and just had a massive heart attack. They said he was dead before he hit the pavement it happened so fast. This guy was the spitting image of a marathon runner - 6 foot 3 inches and not an ounce of fat. His call sign was "flash" because he could move so fast.

[bostondrunk]

We had the same sort of thing happen on a club ride about 3 years ago. Guy in his mid 30's, young, in OK shape, not great, but had been riding casually for a few years, pulled over all of a sudden and fell over sideways. Gone right away, despite efforts to revive him.
His father, who was a marathon runner, came to a memorial ride we had two weeks after, and then he died of a heart attack two weeks after that......scary...

[Dino]

Well, I admit. I have now officially been scared into getting a check up. I am fit. Have been an athlete all my life. But my dad has heart disease. Has been under the knife more than once. So I want to get the "right" tests done. I'm not sure what that means yet. But I want to ask the right questions to a doc who understands sports. I realize that many of these guys had regular check ups, but I gotta at least give the tests a shot that it will give me some peace of mind.

If anyone has any experience with this - please share. Other than cholesterol and stress tests - what can be done? How do you find out if there is a hidden glitch in your heart?

[gdw]

I'm about to head out the door for an evening of hill repeats and you guys start two posts on friggin fatal heart attacks. That's just what you want to be thinking about when maxing out the old ticker. That's almost as bad as watching that Celine Dion AC/DC link before a 6 hour solo training ride.

[bostondrunk]

Well, I admit. I have now officially been scared into getting a check up. I am fit. Have been an athlete all my life. But my dad has heart disease. Has been under the knife more than once. So I want to get the "right" tests done. I'm not sure what that means yet. But I want to ask the right questions to a doc who understands sports. I realize that many of these guys had regular check ups, but I gotta at least give the tests a shot that it will give me some peace of mind.

If anyone has any experience with this - please share. Other than cholesterol and stress tests - what can be done? How do you find out if there is a hidden glitch in your heart?

Good question....
Through my work, I was speaking to a GP about another rider that he and I both know quite well. The rider is about 50 years old, and in very good shape, been bike racing for several years, very strong. He had a heart attack all of a sudden. He did survive and is doing well now. It was a blockage and they managed to open in up..
So I asked the doc what he could have done to see it coming? Was it a case of not getting his cholesterol checked, etc..
He said that outside of having an angio done (or whatever that test is where they send the line up through your vein to see if there is a blockage...), there was no way he could have seen it coming..

[gasman]

Good question....

He said that outside of having an angio done (or whatever that test is where they send the line up through your vein to see if there is a blockage...), there was no way he could have seen it coming..


This is often the case. The only really definitive way you can tell if you have heart disease is to do an angiogram.A catheter (small tube) is placed in your femoral artery (the big artery to your leg) and the catheter is run retrograde up your aorta to your heart. Contrast (dye) is injected into your coronary arteries and they can tell if and how much blockage you have.

But, it is expensive and has potential complications-hematoma, bleeding, coronary dissection, etc. The risk any one complication is low but it is a pretty darn hard way to figure out what is going on. A stress test would be a better screening tool. A resting EKG is easy but pretty worthless most of the time.
Sometimes stuff happens that you could never see coming.

[1centaur]

www.bewellbodyscan.com

Imaging keeps getting better.

[Louis]

Just live your life as best you can. Eat right, and exercise. Don't worry about it.

If your number's up it's up. Might be a dump truck around the corner, or heart blockage. You don't let the dump truck ruin your riding, why let some other highly unlikely event that you have very little control over ruin your life?

Just ride and enjoy your good health and your life.

Louis

[sailorboy]

didn't the reader have an article in the last issue about how a one-time uber-endurance athlete is now preaching moderation in all things endurance-related? Citing plenty of examples of individuals who take it to the limit all the time, and in the end pay for it with serious damage to their systems.

worth another read for sure after this story.

[Flat Out]

Just live your life as best you can. Eat right, and exercise. Don't worry about it.

If your number's up it's up. Might be a dump truck around the corner, or heart blockage. You don't let the dump truck ruin your riding, why let some other highly unlikely event that you have very little control over ruin your life?

Just ride and enjoy your good health and your life.

Louis

+1,000

Thank you.

[3chordwonder]

'shortness of breath'
'discomfort'
'lightheaded'

- I must have been having heart attacks for the last twenty years every time I get out for exercise.

[Dekonick]

This is often the case. The only really definitive way you can tell if you have heart disease is to do an angiogram.A catheter (small tube) is placed in your femoral artery (the big artery to your leg) and the catheter is run retrograde up your aorta to your heart. Contrast (dye) is injected into your coronary arteries and they can tell if and how much blockage you have.

But, it is expensive and has potential complications-hematoma, bleeding, coronary dissection, etc. The risk any one complication is low but it is a pretty darn hard way to figure out what is going on. A stress test would be a better screening tool. A resting EKG is easy but pretty worthless most of the time.
Sometimes stuff happens that you could never see coming.

+1

As usual, Gasman nails it.

The thing about heart disease is that you can't see it. You can take a baby asprin daily (ask your MD first... not for everyone.) to help protect you. You can take a statin (I do) - you can get a stress test (I do - every year) but no matter what, you can die from a MI at any time. The key thing is to know your body and listen to it - denial is a common 'symptom'

Dyspnea, heart racing, tight chest, tingling in extremeties, - sheesh - thats what I experience when I do hills.... :no: :eek:

Be safe out there!

[gasman]

www.bewellbodyscan.com
Imaging keeps getting better.


Using fear to increase the bottom line and expose you to unnecessary radiation and increase your risk of cancer. Worthless.
Ultrasound imagining is not dangerous but there is no guarantee of lack of disease.

Like someone said-moderation.

[gasman]

+1

As usual, Gasman nails it.
The thing about heart disease is that you can't see it. You can take a baby asprin daily (ask your MD first... not for everyone.) to help protect you. You can take a statin (I do) - you can get a stress test (I do - every year) but no matter what, you can die from a MI at any time. The key thing is to know your body and listen to it - denial is a common 'symptom'

Dyspnea, heart racing, tight chest, tingling in extremeties, - sheesh - thats what I experience when I do hills.... :no: :eek:

Be safe out there!

Well said Dek-except the part about me nailing it. I always wish I knew more.

[KeithS]

Like others I am paying for the sins of my past. Ironically I will be at the Dr. this afternoon. I am 52. 10 years ago I weighed 125 lbs more than I do today. I had some really bad habits. Today, I ride a lot - for a guy with a full time job, two young kids and a wife with an even more hectic calendar. My cholesteral is creeping back up, I will hear this afternoon "back on the statin" from my Doc.

Enough whining about me. One of my college roomies who is a year older than me was flying back from a golf outing with a wealthy friend on said friends private jet. His heart stopped, friends wife was a nurse for a cardiology practice. She sees and understands symptoms, renders aid, gets heart going and they quickly get to the nearest airport and get him to ER. Doc tells him it wasn't a blockage. His heart just stopped, Doc says he probably had a virus that stored a corrupted message to stop heart now. He said he had been feeling just fine, Doc says could have been last week, could just as easliy have been when he was 15. He has an implanted device to restart if it ever happens again. He was told no diagnostic efforts would have detected his bad wiring. No event since the episode.

He still gets to drink, eat poorly and avoids exercise. But I think I like my course better.

I think I am going to ask my Dr. today what diagnostic he recomends.

[Bernie]

I hope this person recovers fully. The part I really have trouble with is there were no warning signs. I don't buy it. Your body tells you a lot, unfortunately most of us don't listen. What did he think the failure to be able to handle the ride he normally does with the group was? Why did he think that shortness of breath (significantly more than usual, not just from overexertion) was? He says he was carrying more around the middle than he should and that he had a high stress job. There are at least two key risk factors contributing to heart disease. Was there any family history? If so, that's not a warning sign? Again, hope he recovers fully and leads a wonderful life as he has my sympathy. However, don't justify your past behavior by denying what was in front of you and somehow rationalize that you were caught off guard when in reality you just chose not to pay attention.

[Dino]

I too subscribe to "just get out and live", etc. etc.
But the reason I ask about testing is simply due to the fact that my dad, grandfather, great granfather and grandmother all had heart disease. However, I am the first in the family to have adopted an athletes lifestyle. I've got years of running the pump at big sustained loads. From pre-heart rate monitors, to present.

I'd simply want to know if there any "new" questions that can be asked. Or "new" tests that can be administered. I see no sense in skipping out if there was indeed something that could have been done about it. I eat right. Drink red wine. Train with a program. Fit. Etc. But if there is some sneaking crud building up that I don't know about - well heck - I'd rather take the steps to eliminate it now.

Thanks for the feedback thus far.
Are there any cardio docs that hang out on this message board who could offer some insight?

[Dekonick]

Well said Dek-except the part about me nailing it. I always wish I knew more.

Well heck, I seem to remember you talking about the physiology involved in the mitochondria on the other - ahem - place... the electron chain... deep - really deep understanding there bro...

One day I will glean as much as you know, but it will take a lifetime. Pass the gas BTW... :beer:

[Dekonick]

Well, to answer the bit about tests -
A stress test with EKG will tell you about the health of your heart's arteries and whether or not you have blood shortages to parts (ie - angina) but it can't peer inside to see if you have unstable plaques etc. A statin seems to help mostly by stabilizing plaques - what is not commonly known is that alot of heart attacks occur because of an inflamatory process - and often a hard coating over a soft fat capsule is the danger you can't see. Think of it like a blister inside your blood vessel, only the top layer of the blister is hard (plaque) - eventually part of the blister breaks open. This doesn't interfere with blood flow, but what it does is start the inflamation response - your body senses injury and wants to heal it - it sends helpers to stop and seal the break - and this is what can kill. A clot forms. This clot can get big enough to completely block the blood flow, or can break off and block smaller vessels. At the same time, your body will try to tear down the clot to keep blood flowing - its a tug of war. This is where a baby asprin can save your life - even if it is taken after you start to have heart injury and experience symptoms (hard to breathe, pain, pressure, numbness, just not feeling well, nausea, - there are a plethera of symptoms and not all are the AHA typical things we were all taught - especially for diabetics, and women)

A statin may reduce your cholesterol, but the true benefit is to stablilize these weak parts in your blood vessels. There is also a link to bacteria and heart disease, it isn't all about eating doughnuts.

I am rambling but hopefully this is helpful information in plain english.

Oh yeah - one more thing that can save your life - no joke!

Floss your teeth!

[kgreene10]

Okay, I'll bite -- how can flossing save your life?

[gasman]

Okay, I'll bite --how can flossing save your life?

Flossing decreases the inflammatory process in the body and is correlated with lower heart disease risk. Really.

[Dekonick]

Flossing decreases the inflammatory process in the body and is correlated with lower heart disease risk. Really.

:beer:

And it helps you have nice breath!

[stackie]

Dekonick gets it.

The fallacy in cardiology is that everyone focuses on the plaques that cause significant blockage in the coronary arteries. No one thinks about the little 10-30% lesions. Sure, it's the 70-90% lesions that cause you to have exercise/stress related symptoms. However, these lesions have probably been with you since your teens, growing with you. They're like old friends, nice and stable. The little 10-30% lesions are new, fresh little punks. Not so stable. When one of them ruptures because you're pissed off at your boss and exposes the vascular endothelium to your blood, the clotting process starts, progresses very rapidly, blocks the artery and you infarct a segment of your heart.

In fact, for many years cardiologists were unable to prove reductions in mortality from angioplasty, only reductions in morbidity (symptoms).

In my feeble mind, this is the explanation for the apparently very healthy people who drop dead from a "heart attack", if, in fact, it was due to myocardial ischemia.

Dekonick is also spot on about the statin class of drugs. Not only do they reduce LDL (bad) cholesterol, raise HDL (good) cholesterol, but they stabilize atherosclerotic plaques. Probably the single best class of meds to be on.

See your doctor. But, remember medicine is much an art as it is a science. We don't know it all yet.

Jon

[johnnymossville]

hmm, This thread is getting a bit depressing. I guess you just never know when your time is up. Enjoy the ride!

[kgreene10]

If it's just correlated then isn't it like thousands of other inconclusive medical studies? It might just as well be that those who floss generally take better care of themselves and thus have lower incidence of heart disease. You need a randomized experiment or at least a panel study to really figure these things out.

BTW, I hate to floss.

Flossing decreases the inflammatory process in the body and is correlated with lower heart disease risk. Really.

[1centaur]

Given much evidence that cholesterol levels are not highly correlated with heart attacks (50/50 on heart attacks for high cholesterol; many foundational studies biased by extreme examples of super high cholesterol; many cultural examples of high cholesterol diets with low heart disease, etc. - no time in this thread for a full list), are statins worth more than anti-inflammatories in preventing death? Seems like evidence is increasing that level of inflammation is much more related to heart attacks than cholesterol levels, so perhaps a variety of anti-inflammatories can be just as effective as statins in reducing mortality.

[Dekonick]

Or better yet - a combination of meds to target multiple factors - at present it seems that a statin, baby saprin, diet high in fiber and antioxidant rich (blueberries!) and good oral hygene and exercise will provide you a long healthy life compared to your bretheren who dont follow the same regemine.

My2cents :beer:

[KeithS]

I had a conversation with my Dr. yesterday afternoon in a general sense about the anecdote in the NYT article. I asked about diagnostic tests, he used to not so much believe in them. He's come around. I am scheduled at 8:00am tomorrow for a CT Cardiac Calcium Scoring test. Bad cholesteral creeping up over time, back on the statin, good news is good cholesteral is very good.

I guess I will learn something new tomorrow. I am asymptomatic, but then I have been asymptomatic on my diabetes for 12 years too...