Heart Of A Cyclist

Courtesy of American Heart Association You're The Cure

Today I celebrate my third birthday.

Yes, you read that right. T-h-i-r-d.  I didn’t mean to type thirty (but it sure would be nice to return to those days of relative youth).  Nor is it a typo for forty third.  February 8th marks the third birthday I will celebrate since suffering a near-fatal heart attack on August 8, 2009.

It’s a hard day to forget.

Each day I’m reminded of it when I swallow one aspirin, three prescription meds,  and four different supplements after I eat my bowl of oat cereal topped with fresh strawberries and blueberries chased down with a glass of pomegranate Kefir.  I can barely remember the days when the fruit I ingested for breakfast came in the form of loops and was spelled with double-o’s.

I guess it’s fitting that my birthday falls at the beginning of American Heart Month.  It’s a gentle reminder to not only remember those who saved my life exactly two and a half years ago today*, but to also remember to share my story with others that might benefit from it.

Failure to see the warning signs

I woke up early that fateful morning in a hotel room near Oakland, California.  I had a strange ache in my left arm and some discomfort in my chest.  For a brief moment I thought “these seem like heart attack symptoms.”

Then I remembered that I was only forty three.  I wasn’t overweight, although I was getting close to that next BMI demarcation.  I was fit.  I didn’t smoke.  I didn’t drink (not even coffee).  I had never had high blood pressure or high cholesterol (still don’t).  I thought I did a pretty good job of denying myself the usual artery cloggers – red meat, cheese, bacon, mayo, and fried foods.

I quickly dismissed my symptoms – two very key symptoms – as sleeping on my arm the wrong way and indigestion from a large meal the night before.

I popped four aspirin, two Tums, and went about preparing for my 2pm flight back to Chicago.  The intensity of the chest pressure ebbed and flowed as the aspirin surged and wore off.  About every four hours, I popped another four aspirin, took a couple more Tums, and continued on with my journey home.

Rental car.  Shuttle bus.  Airplane.  Shuttle bus.  Minivan.  Sometime after 9pm I arrived home and crawled into my bed to finally sleep this thing off.  If it was still bothering me in the morning, I would go to the urgent care.

My daughter, Erin, did not agree with my decision to sleep it off and insisted on taking me to the emergency room.  I reluctantly agreed, if only to dismiss this annoyance, pick up a prescription, and finally get some sleep.

Me and Erin before her college graduation, May 2009

Erin dropped me off at the entrance to the ER and I quietly walked up to the desk.  The moment I described my symptoms and offered my “it’s probably just bad indigestion” diagnosis, I was quickly whisked into a side room to check my blood pressure.  Within a few short minutes I was lying on my back in a triage bay with no less than five technicians hovering about me.

I had never experienced anything more surreal than that moment when the ER doctor told me, almost nonchalantly, “you are having a heart attack.”

Heart attack?  This couldn’t be happening to me.  Fit 43 year-old cyclists don’t have heart attacks!  A person can’t just carry on a 14-hour day of traveling while suffering from a heart attack…

Even though I never uttered any of that aloud, the members of the triage team were more than quick to refute that flawed line of reasoning with an “oh yes you can and you bet your ass you are, buddy.”

My new cardiologist was even more blunt.  “You should have gone to the emergency room in California.”

It was at that moment that I learned some very hard truths about heart attacks.  Every minute that you delay seeking treatment, heart muscle dies, that’s right dies from a lack of oxygen.  At any moment, the synapses that control the pumping of blood can short circuit causing cardiac arrest or sudden death.

Not only was I a walking time bomb on my sojourn home, I was causing permanent damage to heart muscle every step of the way.

After rebuking me, the cardiologist could only hope that I hadn’t arrived too late for him to save my life.

The Emergency Angioplasty

So there I was, lying flat on my back on a gurney in the triage bay of the emergency room, my life completely in the hands of a group of complete strangers.  While the catheter lab was being prepped, I continued to be peppered with questions.

Are you a smoker?  No.  Do you drink?  No.  Use drugs?  No.  Is there a family history of heart disease?  Well, now that you mention it…

As I lay there, still stunned by the ER doctor’s rather matter-of-fact diagnosis, it began to come into focus.  Despite just barely missing “preferred plus” status on a life insurance policy eight years earlier due to elevated triglycerides, I was certain that I’d beaten the family curse.  Could the cause of my heart attack simply be fate?

Before I even realized it, I began rattling off statistics like a 10 year-old Cubs fan.  First there was my maternal grandfather who died of heart failure a few years after suffering a heart attack (back in the days when bloodletting was still a treatment).  Next was my mother’s oldest brother who died of a heart attack at 47.  Then her next oldest brother who died from complications while undergoing his second bypass surgery at the age of 51.  My mother’s sister, thirteen years her junior, lives with diabetes and has suffered a pair of heart attacks and undergone numerous angioplasties.  Then of course there’s my mom – diabetic, two heart attacks, a stroke, living with congestive heart failure (and surgically implanted, state-of-the-art defibrillator) but still going strong at 77, bless her barely functioning heart.

As preoccupied as I was with amazing the crew with family cardiac trivia and regaling them with every small detail of my 14-hour journey to the ER, the gravity of the situation had yet to sink in.

It became “as serious as a heart attack” the moment they sent for my daughter.

When they told her the news, she remained remarkably composed.  She immediately called her brother and informed him that he’d better get his butt to the hospital ASAP.  I wanted to let her know how proud I was of her.  Instead, I remained speechless.  Fighting back tears, lips quivering, my voice trembling, all I could manage to mutter was “I’m sorry.”

The next thing I know I was hurtling feet first down whitewashed corridors like an Olympic bobsledder atop a luge.  I was slid onto an ice cold stainless steel table with a black boom looming ominously overhead.  And then I was out.

When I awoke I was back on the gurney rolling slowly toward an elevator.  There were many voices behind me.  Inside the crowded elevator I caught a glimpse of my daughter, my son, my fiancee, and my ex-father-in-law.  None of my departed relatives were anywhere in sight, so apparently I was still alive.

Picture all of us, two nurses, and a gurney inside an elevator...

Inside the ICU, I was told repeatedly that I was a lucky man.

I didn’t find out just how lucky I had been until I saw a diagram of my blockages the following day.  Two at ninety percent.  One at one hundred percent.  One was in the circumflex artery.  The other two were in the LMCA – the widow maker artery.  One of those two was the hundred percenter.

Two stents were installed in the LMCA during the emergency catheter procedure.  The 90% blockage in the circumflex would have to wait another four or five weeks to be opened and stented.  I was far from out of the woods.

I was given a photocopied diagram of a heart with my blockages crudely sketched in pen.  Any questions I might have could be answered in an illustrated guidebook that appeared to be written for a fifth-grader.  Meanwhile, I was scheduled for more EKG’s, more blood work, and an echocardiogram.  There was no telling how long I would remain connected to the monitoring equipment surrounding me in my private room in the ICU.

The extent of the damage to my heart – caused in large part by my delay in seeking treatment – would not be revealed immediately.  I would have to wait for the doctor’s analysis of all the monitoring equipment, the series of EKG’s, the continual blood work, and the echocardiogram.

I could only hope that the same, strong, bicycling heart that allowed me to endure a 14-hour myocardial infarction would become strong enough to propel me on many more two-wheeled adventures.

As I peered out my hospital room window, I could see the familiar Poplar Creek Trail that I had ridden close to a hundred times before.  It was either a sign of hope or a cruel reminder of what my delay in seeking treatment had truly cost me…

Courtesy of Mayo Clinic

To see the key for the above illustration, click here.  

How did this happen?

When I woke up lying flat on my back in a twin size bed on the morning of August 9, 2009, it took a moment or two for me to adjust to my surroundings.  Ordinarily, I’m not surprised to awaken in an unfamiliar room as I travel frequently for work.  But even the cheapest hotels I stay in don’t have guardrails on the beds.

Slowly, it all came back to me.  My loved ones hovering over my bed, looking as if they had seen a ghost.  The phlebotomist who drew samples continually throughout the night.  The EKG tech who attached color-coded wires to the matching post-it patches that stretched from my neck to my feet.  The night nurse who woke me up to ask how I’d been sleeping.    Everywhere I turned there was evidence that I had, in fact, suffered a heart attack.

The only thing that didn’t make sense was how and why this had happened to me.

The “how” part is actually pretty straightforward.  At some point in time, inflammation developed in an artery.  Cholesterol sped to the scene and applied itself as a band-aid to the wound.  More cholesterol piled on, causing a buildup of plaque and a narrowing of the artery.  While the plaque continued to build, blood vessels continued to grow within the plaque.  The plaque ruptured and a blood clot was formed.

The clot formed a blockage that prevented blood from flowing to the myocardium (heart muscle).  Deprived of oxygen where the blood flow had been cut off, heart muscle began to die.  While my heart continued to pump blood through a narrower opening, it also routed blood through smaller blood vessels, even forming new vessels to nourish the affected area.  This was when I began to experience chest and angina pain.

Had an electrical impulse (synapse) been interrupted by the disruption of blood flow to the heart muscle, I would have suffered cardiac arrest.  Until blood flow was restored through the reopening of the blocked artery during the emergency angioplasty, my heart muscle continued to die.

There is no question that the fourteen aspirin helped keep the blood flowing – although the cardiologist stated that one would have been sufficient.  He also concurred with me that had my heart muscle not been conditioned through nine years of bicycling, I may not have survived as long as I did.

So how long had there been plaque buildup in my arteries?  What caused the inflammation to begin with?  How could I have known that I was at risk?

When I arrived in the ER, a lipid profile was derived from a blood sample.  My HDL – the good cholesterol  – was low at 37 (should be greater than 40).  But my LDL – the bad cholesterol – was very low at 78 (well less than the <200 recommended).  The problem was with my triglycerides.  At 279, this level was nearly double the high end of the recommended range.

High triglycerides and low HDL is a deadly combination for heart disease.

Had I routinely taken advantage of discreet screenings offered by organizations like Life Line Screening, I may have become alerted to my risk factors.  I would have then had the opportunity to change my diet which likely would have prevented my heart attack.  My own health scare prompted my fiance, Nancy, to do just that.

Life Line offers a range of services from a basic lipid profile to C-Reactive Protein screening.  Nancy’s experience with them was wonderful and she found out that she was in far better health than I had been even at my peak eight years earlier (she did receive preferred plus life insurance status).  It gave her peace of mind in planning our future together.

At this point, I understood how my heart attack occurred.  I also learned what I could have done to determine my risk factors and likely prevent it.  I still didn’t know the answer to the all important question – why?  

It would take quite awhile into my recovery to begin to find the answer to this question.  It would also take a little more time to understand the full extent of the damage done to my heart muscle.

More to come…

*Thanks to my daughter, Erin, my cardiologist, Dr. Arthur Nazarian, the ER doc, the ER triage team, the catheter lab crew, the ICU staff, and everyone in the cardiac care unit at St. Alexius Hospital in Hoffman Estates.  More thanks to my internist Dr. Robert Dick and the nursing staff at Alexian Brothers’ cardiac rehabilitation program in Schaumburg.