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Old 06-12-2009, 03:11 PM   #21
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Why I developed the blockage will always be a mystery. Start with the proposition that half the people who have heart attacks have normal cholesterol. In recent years, mine was better than normal (high hdl, low triglycerides). Inflammation within the arterial walls seems to be the culprit. The development of plaques is not, I don't think, from ingesting cholesterol and the proper types of fats but from factors associated with inflammatory conditions like diabetes, periodontal disease, certain types of foods and other lesser known causes. Eskimoes who traditionally lived on much fat (but the right kind) didn't develop heart disease. For the past five years or so, I have eaten predominatly animal protein and generous amounts of vegetables (I don't count potatoes as a vegetable) and fruits. On the other hand, perhaps a quarter of the time, I defaulted back to sandwiches, pizza, pasta and the like. However, this damage was probably done over decades. I used to run a lot and thought that gave me license to chow down on pasta, pizza, cookies and the like superimposed on a rather typical diet. I was in a very high stress occupation and too often carried some excess lard around my waist. I was probably border-line pre-diabetic for some of those years. Like I said in my first post, I have had reassuring lipid and inflammatory marker test results for the past several years. If I hadn't interpreted the recent onset of throat pain and shortness of breath on my bike rides as exercise induced asthma and went in for a cardiac workup, I would still have needed surgery but not on an emergent basis. Now my primary mission will be to keep the new plumbing patent. Again, thank all of you for your kind thoughts and encouragement.
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Old 06-12-2009, 04:39 PM   #22
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Nuclear stress tests are more sensitive and specific, but also much more expensive and involve radiation exposure. And they are not perfect, almost always leading to catheterization if any abnormality is found, some of which are erroneous.

The choice of what flavor stress test is best involves numerous factors: the baseline EKG, reason for testing, pre-test likelihood of coronary disease, etc. Nuclear studies are not the screening test of choice for many. Similar comments would apply to stress echocardiography.

The main thing is to take symptoms of this nature similarly.
Thanks -I thought I was covered - If I have a hart attach while hiking alone in the wilderness; I'll be thinking of you.
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Old 06-12-2009, 05:01 PM   #23
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Thanks -I thought I was covered - If I have a hart attach while hiking alone in the wilderness; I'll be thinking of you.
God forbid.

Sorry for the full disclosure. I'll try to be more misleading in the future .

If it makes you feel better, the ability to reach 10 METS during a stress test or exercise in general, is associated with a very low likelihood of a heart attack in the subsequent years. 10 METs is running at a 10 minute mile pace. Ask you cardiologist what maximal MET level you reached.
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Old 06-12-2009, 05:12 PM   #24
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Sorry about your heart problems but luckily it all worked out okay !
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Old 06-12-2009, 06:31 PM   #25
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Windsurf,

Glad that you survived! Best wishes on a continued good recovery and staying out of the hospital.
Certainly this post is a great benefit to many people including myself. Thank you for making the effort even though you are ill.
I suspected that medicine is making less progress than people think on the predicting heart attacks. This post confirms it. It is better to have the straight facts than a lot of BS IMHO.
The 10 METs thing is interesting. I want to find more info on it.
I am surprised that the cholesterol screening has so little a correlation to the event.
My father was having problems and seeing a cardiologist. He had a attack right after visiting him and passed away. Once you understand that there are many things that are not within the doctor's control, it is hard to be angry about it.

Hard to make predictions, especially about the future. This is why I am glad I am ERed and trying to make the most of my life (whatever that means).

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Old 06-12-2009, 06:58 PM   #26
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Windsurf--congrats on your "second chance." You certainly did have angels on your shoulder that day. I wish you a speedy and full recovery.
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Old 06-12-2009, 07:18 PM   #27
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If it makes you feel better, the ability to reach 10 METS during a stress test or exercise in general, is associated with a very low likelihood of a heart attack in the subsequent years. 10 METs is running at a 10 minute mile pace. Ask you cardiologist what maximal MET level you reached.
Rich,

A few weeks ago I started running on treadmill (SHOCK). I am now running twice a week for 30 mins at a time and doing 3 miles. Does running 10 minute miles for 3 miles equate to the equivalent of 10 METS?

I was wondering if, as I improve, it would be better cardio-wise to maintain the 10 minute mile pace for longer or try to increase the distance in 30 mins (faster pace).
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Old 06-12-2009, 07:40 PM   #28
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Wow! You are one lucky Windsurfer! Congratulations and welcome back!
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Old 06-12-2009, 07:42 PM   #29
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That is one of the reasons I had that test where they inject you with radioactive solution to see the condition of your arteries. I did this just before quitting.

I would recommend the procedure to anyone before retiring.

You are very fortunate such qualified medical help was nearby.
Uhhh.....there is a worldwide shortage of medical isotopes because an aging nuclear plant in Ontario has gone kaput. Unfortunately there are only 2 or 3 plants in the world that manufacture the raw materials for MIBI scans. So don't count on getting this test quickly in the near future. Sorry!
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Old 06-12-2009, 10:10 PM   #30
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A few weeks ago I started running on treadmill (SHOCK). I am now running twice a week for 30 mins at a time and doing 3 miles. Does running 10 minute miles for 3 miles equate to the equivalent of 10 METS?

I was wondering if, as I improve, it would be better cardio-wise to maintain the 10 minute mile pace for longer or try to increase the distance in 30 mins (faster pace).
If your treadmill is accurate and you reach a 10 minute mile, you qualify as low risk assuming your EKG is within normal limits. Depending on your age and risk, I prefer 10 to 11.5 MPH (maybe 9 METS) for 45-55 minutes for general fitness since it causes fewer orthopedic problems with the same health benefits. This kind of stuff is best discussed with your internist or cardiologist since the final recommendation relates to the specific results on he stress test and/or your general risk profile.

Personally (just my preference) I run 55 to 60 minutes at a heart rate in the 130s (I'm sixty and fit). I don't track distance, just time and heart rate. If I focus on my speed or distance, all that testosterone toxicity/competitiveness starts to emerge and I push myself a bit too hard.

Pick the program that works for you and your health care provider.
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Old 06-12-2009, 11:21 PM   #31
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Wow windsurf! Best wishes for a speedy recovery.

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Rich,

A few weeks ago I started running on treadmill (SHOCK). I am now running twice a week for 30 mins at a time and doing 3 miles. Does running 10 minute miles for 3 miles equate to the equivalent of 10 METS?

I was wondering if, as I improve, it would be better cardio-wise to maintain the 10 minute mile pace for longer or try to increase the distance in 30 mins (faster pace).
I'm a runner not a MD but my advice is to mix up the distance and the pace.

IMHO the worst thing that you can do (except for not doing anything) is to do the same run at the same pace all the time.

I think that would also be the recommendation of most "running experts."

For example, if you are running two days a week, on one day you could keep the distance constant and gradually increase the pace and on the other day maintain the pace and gradually increase the distance.

The most important thing is to make changes (i.e. increases in speed and distance) very slowly to allow your body to adjust and minimize the chance of injury.

My "perfect" three day a week running schedule is:

- one day of track or hill intervals, say 6-10 400 meter repeats well into the anaerobic zone
- one "threshold" run of 3-5 miles at just below the anaerobic threshold
- one long run of 10-12 miles at a very easy aerobic pace

For a two day a week schedule for someone that is not interested in running competitively I would drop the interval day and adjust the mileage and pace on the other days to your own fitness level.

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Old 06-13-2009, 08:49 AM   #32
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In response to my "what happened," a rescue squad guy bellowed down, "Your heart stopped!"
And what a calming thing for the EMT to say to someone who has just had a heart attack.
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Old 06-13-2009, 09:55 AM   #33
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Rich and mb,

Thanks very much for the feedback, very informative indeed. DW and I were just sitting having a drink and "2nd breakfast" after 90 minutes of tennis this morning and discussing this. She had exactly the same questions as myself as she is also now running on a treadmill so I have just been showing her the responses.

We find tennis about as aerobic as it gets as it involves heart rate at an aerobic rate for long periods with bursts of anaerobic rates during rallies involving lots of short sprints.
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Old 06-13-2009, 10:06 AM   #34
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MB makes good points about running, especially for the more serious and disciplined runners.

I find that quite a few people just want to "stay in shape." Happily, most of the risk reduction benefits can be achieved at a surprisingly low exertion level, like a fast walk 3 or 4 times a week for half an hour or so. You won't reach a high level of conditioning or performance, but you will achieve lower lipids, weight loss effect, and other beneficial effects. Health-wise, it's diminishing returns as ypu go above that - some gain for more pain.
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Old 06-13-2009, 10:22 AM   #35
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MB makes good points about running, especially for the more serious and disciplined runners.

I find that quite a few people just want to "stay in shape." Happily, most of the risk reduction benefits can be achieved at a surprisingly low exertion level, like a fast walk 3 or 4 times a week for half an hour or so. You won't reach a high level of conditioning or performance, but you will achieve lower lipids, weight loss effect, and other beneficial effects. Health-wise, it's diminishing returns as ypu go above that - some gain for more pain.
Great info - DW says "thank you very much ". Her heart rate has always been on the high side so that staying in the aerobic range does not mean nearly as much effort as myself. (She has had a couple of treadmill tests over the last 10 years and no problem, plus regular blood tests are always well within limits).
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Old 06-13-2009, 10:31 AM   #36
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Windsurf, you are indeed blessed. Best of luck in your recovery.

I had some very minute and intermittent chest discomfort a few years back. It felt like someone was tapping very lightly on the inside of my upper left chest, near the collarbone. It happened rarely, maybe 3 times a year, usually at w*rk during some intense meetings. I do not have high blood pressure or cholesterol problems.
I mentioned it to my doc, who ordered a battery of screening tests. Everything checked out fine.
It didn't happen again until I was under extreme stress (w*rk and life). This time the doc got really serious and sent me to a cardiologist. More detailed cardio type tests, all passed with flying colors.
The cardiologist concluded it was stress induced and told me to learn to relax.
I FIREd about 1 year later. Tapping sensation never happened again.

Sound like much ado about nothing? I now know my heart valve is OK, no arrythmia, no blockages, and my docs have baseline tests to use for later comparison if symptoms return.
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Old 06-13-2009, 10:55 AM   #37
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I FIREd about 1 year later. Tapping sensation never happened again.
Sounds like your body was tapping and saying "hellooo, anyone in there? Time to retire .... are you listening to me?"
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Old 06-13-2009, 11:08 AM   #38
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Sounds like your body was tapping and saying "hellooo, anyone in there? Time to retire .... are you listening to me?"
Exactly what went through my mind. And I listened...I would probably be able to safely say that is when I seriously starting looking at my exit options.

UPDATED: I forgot to mention my maternal grandfather succumbed to a fatal heart attack sometime in his late 40s or early 50s. I think that is why my doc did not mess around and got me tested, screened, poked and prodded. It was wonderful to know that there was nothing really bad going on.
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Old 06-13-2009, 12:26 PM   #39
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And what a calming thing for the EMT to say to someone who has just had a heart attack.

I'm not complaining!!
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Old 07-05-2009, 06:05 PM   #40
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Well, I am a little better than one month out from my "event." I am scheduled to start formal phase II rehab this week and that starts with a monitored treadmill test to establish a baseline. My wife, pooch, and I hiked for an hour and a half today. I feel like I could walk indefinitely but running will be a different story for awhile. Also, I am on a beta blocker for the time being. I am feeling pretty normal but am restricted from lifting heaviy weights until the sternum grows fully back together (8-12 weeks). It's a wonderful life!
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