30 replies to this topic

[Tom Hampton]

I posted this in another forum that I frequent. Surgery date was last wednedsay. I was released from the hospital yesterday. Note: I did not have a heart attack, my heart tissue is 100% healthy.

I'm currently sitting in a chair at home.

Link because it's fudging long:

https://forum.slowtw...e=unread#unread

[-P-]

Glad you made it and see you soon at the track!

[Tom Hampton]

Roger that! Someone over there asked, "what kind of racing did you used to do?"

Wtf? Right.

[Steve Scheifler]

Quite a story Tom, it’s great to know you are on the mend!

These types of stories about otherwise healthy and sometimes exceptionally fit people suddenly hit by an unseen condition leave me wondering. Given all the technology available and the obscene amounts of money spent on healthcare after stuff happens, when are we going to start routine screenings for stuff like this the way we do some cancers?

Do you have a sense of what tests, at a minimum, would have been necessary to catch this long before the blockages got that bad? Do you know of a reason that anyone active in sustained stressful activities such as running wouldn’t want to be screened for blockages every x many years?

Anyway, glad you took the hint and got checked before the big one!

[MPR22]

Tom, great write up, sorry it’s not post race. Does it make you wonder if you had full use of your heart would you have made your 10k goal?

[FTodaro]

Tom you got lucky that can be a silent killer.

Heredity can be a killer too. I have been on lipitor for about 15 years.

[Tom Hampton]

Hi Steve -

As I understand (simply as a patient) is that the trick with much of this testing is balancing cost, risk, invasivness, effectness. I don't know all the tests because I sorta cut to the front of the line.
Cardiologists have a process they call risk stratification that they use to determine the application of these (and probably other) tests.

The most basic screening is a simple blood lipid panel. This should be part of everyone's annual physical. It measures HDL, LDL, total cholesterol and triglycerides. Risk measures are TOTAL/HDL ratio less than 5.0 lower is better. Absolute LDL Below 100, again lower is better. Some docs are driving ldl below 50 and some lower than that. It's not clear where/if the lower bound is.

Next up would probably be a cardiac CT calcium score. The measures the overall calcification around the heart. This is a pretty blind tool as I gather and has a large margin of error. I also understand that it is somewhat relative, such that it is better at tracking change over time rather than an absolute go/no-go assessment.

There is the resting ekg. That's the test we all do periodically for our racing licenses. Pretty hard to fail. I passed mine last August.

Then comes a battery of stress tests. These are all exercise tests monitored by different types of equipment. The idea is always to look for change in heart function as more and more load is applied. This gets tricky with fit athletes. And may also be tricky with very unfit people. I've been told these catch about 85% of candidates. Passing the test just means your heart is stronger than you are---not that your arteries are clear.

Next would be an echocardiogram. Actually I don't know where this falls in the strata. It's an ultrasound of the heart. Can be 3d. It allows to doc to see a video of the heart beating. The echo can be used in a stree test.
The gold standard is the angiogram. This is a 3d photograph of the blood flowing through your vessels. It involves sedating the patient, inserting catheters into the heart, injecting die into the blood and eventually taking the photos (videos) using a fluroscope. This is done in a hospital OR setting. So, obviously cost and risk are at the top of the chart here. Accuracy isn't free.

So... I've had 3.5 of these:

Lipid panel every year since 2004. In 2004 my results showed sky-high cholesterol with an total/HDL ratio of ~5.5 and an ldl around 220. I started 20mg daily crestor at that time. Most recent test shows total/hdl =2.1, ldl=69.

I've had an angiogram. This took about 30min for the actual procedure... But, involved most of a day in the hospital. Then again I was already a guest at that point. Outpatient might be less time consuming. There were about 5-7 staff in the OR to aid in the test conduct. Can't imaging this test is cost effective without other pre-screening. Also, interventions can be administered during the test based on the results. So, if they find a blockage, they can clear it with one of several options.

I had an echo in prep for surgery. If you've participated in your wife's sonogram, it's the same thing just looking in a different spot.

Lastly, I Sorta had a half of a stress test. As noted in the original posting, I initially had an unusual ekg in the ER. then later I had a normal one. Then again, after my anxiety started to kick in and my heart went nuts, I had an ekg showing classic signs of strain. So, I didn't run on a treadmill, but the results were the same.

I would have passed every single one of these tests 3 weeks before surgery, except the angiogram and possibly the calcium score test (though as noted it's not pass/fail). I passed the echo in the hospital.

[Tom Hampton]

Tom, great write up, sorry it’s not post race. Does it make you wonder if you had full use of your heart would you have made your 10k goal?

Yes. I have several informed cardiologist athlete friends say exactly that.

Looking back there were several hard workouts that didn't go as planned. Particularly the 400s and 800s which can be cardiac output limited. But, late in the program I had some issues with 1-2 mile repeats. Also, I bailed on some hard hill workouts because I just felt "off".

I know you do (or did) train also. So you know what I mean. You develop an expected progression in a program based on prior experience. And we know with a high degree of precision what we "should" be capable of. When it doesn't work, we look at recent training history for answers. Most of the time you look back three days and you can see it clear as day. But in the absense of a smoking gun, we are left scratching our heads.

I had enough of those week/week where I plateaued in my speed over the last 5 weeks.

[Jim Drago]

Quite a story. Im sure it is hard to feel fortunate, but this likely turns out really bad 9 out of 10 times.  You will be back to new before you know it!

[Bench Racer]

So very happy you woke your wife. 

[Tom Hampton]

Quite a story. Im sure it is hard to feel fortunate, but this likely turns out really bad 9 out of 10 times. You will be back to new before you know it!

It is not hard AT ALL to feel fortunate. Based on the severity of my blockages, this thread should have been started by you or Chris reporting my untimely demise: "Tom Hampton found dead on fm 546, where he was out for his normal training run, of an apparent hear attack."

Probably followed by a bunch of comments about how much of an asshole I was. :=)

When the surgeon draws a picture of your heart in the white board showing all the major vessels and the filling it in with dots and %s where all the blockages are, you get a sense real quick how close to death you are. Especially, when there isn't a single one the has better than 10% flow.

Yeah, it sucks right now. But, that's just pain from wounds that will heal. Time will fix all that.

I'm still dealing with a lot of atrial flutter... Which is caused by an alternate conduction path through the heart. So, I can't do much of my exercises until that's under control. Then its just "a process."

[MPR22]

Yes. I have several informed cardiologist athlete friends say exactly that.

Looking back there were several hard workouts that didn't go as planned. Particularly the 400s and 800s which can be cardiac output limited. But, late in the program I had some issues with 1-2 mile repeats. Also, I bailed on some hard hill workouts because I just felt "off".

I know you do (or did) train also. So you know what I mean. You develop an expected progression in a program based on prior experience. And we know with a high degree of precision what we "should" be capable of. When it doesn't work, we look at recent training history for answers. Most of the time you look back three days and you can see it clear as day. But in the absense of a smoking gun, we are left scratching our heads.

I had enough of those week/week where I plateaued in my speed over the last 5 weeks.

You are correct on knowing what you are capable of, but like you said you had the flu, I did too and you start using those as the "reason" you are off.  Also, when you are doing your progressive overload training, you just don't quite know when you reached the threshold and went at it too soon.  But those are almost always muscle fatigue or as you know just a lack of go when you hit the gas, the shortness of breath is only at the top end of your exertion.  So glad you didn't just put it off.  Hate EKG's because for the most part they only tell you whats going on "now" unless you have damaged your heart.

[trimless]

Thanks for sharing. Happy to hear you caught this in time!

[mdavis]

Glad Tom is doing well.   The flutter will get better.

 

Timely article that I read today as the hard copy showed up in my mailbox.  

 

https://www.amjmed.c...0567-4/fulltext

 

To summarize.... if you are 45 or older and have an intermediate risk of cardiac disease based on a cardiac risk calculator you might want to ask your primary care physician about doing a coronary artery calcium scan.

[Tom Hampton]

Glad Tom is doing well. The flutter will get better.

Tomorrow I go in to get shocked back into rhythm. If that doesn't fix it, they will ablate it.

[Tom Hampton]

Follow up to Steve's query regarding screening. Dtoce is a well known cardiologist from Connecticut. You can read his thoughts on screening tests.

https://forum.slowtw...152166#p7152166

[Steve Scheifler]

Thanks Tom, that was somewhat informative.

[Alberto]

Wow.  Scary stuff.  Happy to hear that you caught it and are recovering.

 

I guess the lesson learned is that running is bad for you and will cause a heart condition.  Go racing instead.

[BlueJay73]

Wow, Tom, glad you're OK.

The same thing (mostly) happened to a friend of mine. Ex-military guy, always in great shape, distance runner his whole life, lean, mean machine, etc.

Went out for a run, came home, didn't feel right; his wife, a nurse, took him to the hospital. Widow maker coronary event (differing from you, he actually did have a heart attack). His wife recognized the EKG as a widow maker, and didn't think she was going to bring him home. He's ok now. I don't know what the lesson is. Stay in great shape, so that when a cardiac event hits you, you have a better chance to survive? Weird how some people are overweight, in terrible shape, eat bad, and don't have any problems. Others, in great shape, do. Enjoy every day from here on as a gift.

Jim

[Tom Hampton]

I think the lesson is:

1. Know your own risk.
2. Know the symptoms of angina and heart attack.
3. Don't wait. If you experience tighness/burning in your chest/throat that gets worse with activity and better with rest GO!
4. Yes, being otherwise fit improves your odds of returning to normal life post recovery.