I had my latest angiogram on Friday 5 mar, the result of which was that no additional stents were fitted and that no physical improvement actions were implemented. Although I was aware of the possibility that no improvements would be possible during this process I really was not mentally prepared for that outcome. I suppose I had been assuming, rather optimistically as it turns out, that the dodgy artery would be located, an additional stent would be fitted, and then it would be back on the bike after a few weeks and looking forward to the summer. Well NO!
The cardiologists who carried out the angiogram said that the risks were too great in trying to repair the troublesome artery with a stent and that the only physical fix would be a bypass. However, given the scale of the issue ‘that would be like using a sledgehammer to crack a nut’. I will be referred back to my local cardiologist to review further medication remedies. In the meantime I would just like to sound out views within this community.
In summary I would dearly love to be able to continue cycling. I have no expectations to be Tour de France type roadster but to be able to ride 20 to 30 miles, on country roads around where I live, two or three times a week is my aerobic exercise. I have ridden these distances for many years and greatly appreciate this time in the outdoors, especially in the summer. Indeed, this goes way further than aerobic exercise, I would say my mental wellbeing relies on these rides, so I want to investigate all possibilities with the exception of the bypass.
A little background – I had a Heart Attack back in 2007 at age 50, one stent fitted in LAD at that time. In 2019 after experiencing Angina type discomfort whilst cycling and following investigation a second stent was fitted in LAD overlapping the first which was then showing significant blockage. This improved the Angina discomfort during exercise but it never really went away completely. The discomfort is fairly minor and could be mistaken initially for a dry throat. Unfortunately, it is definitely not a dry throat though. So throughout 2020 there has been attempts to control the Angina symptoms via adjustments to my meds but nothing has managed to prevent it at present. I did have a treadmill stress test and that did confirm an ECG change during exercise that pointed to a fault with one of the small arteries in my heart.
I have also tried the GTN spray before exercise and GTN spray during exercise when symptoms are present. The affects of the GTN spray only last around 20 to 30 minutes and the Angina returns.
I don’t discount the possibility that my cardiologist will come up with combination of meds that will work and all will be well but then again what if that is not possible. One possibility that has occurred to me and I wonder if anybody has any experience of this is to use an accurate heart rate monitor device during exercise and learn to keep within a set of limits. Has anyone used this type of live data as a way of controlling/preventing Angina symptoms? A combination of modified meds and heart monitor could be the way ahead. Any views?
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Compas
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Very interesting . Are your Isosorbide slow release ??
I have a 100% blocked RCA with a bypassed and stented LAD.
After a Perfusion scan the cardiologist told me that currently the Heart Muscle not receiving a blood supply was about 20 % and was non viable !!! So it is still possible for your Cardiologist to investigate further to see if more work is viable or not.
Do you have a Turbo that you could set up in a Garage or such like space to see how hard you need to go to kick the Angina in.
I know a Turbo can be hard work but at least you would be safer doing it that way rather than out on the open road.
I use an Apple watch to monitor my heart rate during walks and exercise, I've been surprised at how much seemingly random variation can occur. I'll see my heart rate varying anywhere between 95-125bpm at a specific point in a specific exercise regime. Maybe the device isn't particularly accurate, maybe ambient temperature makes a difference, maybe my pace or technique varies more than I'm aware of? Whatever the explanation, it's left me a little sceptical about using heart rate monitoring as the key metric for managing exercise, I now tend to interpret the information in the context of how I'm feeling.
Regarding the main part of your post. If I were you I'd be really reluctant to abandon cycling. None of us can cure our heart disease, all we can do is try and manage its progress down to a crawl. But removing exercise is surely a blue print for accelerating the disease rather than arresting it. And if you're forced to reduce your cycling then are there other life style changes you can introduce to try and compensate, such as better diet or different exercise?
Some further information I should have included in the original post:-
I haven't been cycling since September 2020 hence my disappointment at the result of the angiogram - the advice I received from my GP at that time was that I should not continue to exercise when the Angina symptoms appear - which is every time I cycle - I should wait till they subside. Even before the point I was advised to stop until reviewed by cardiologists my cycling was biased towards checking the latest tweak to medication dosages advised by my GP.
This information was repeated by the cardiologists carrying out the angiogram - I should not continue to ride through an Angina episode. So, as I say it occurs every time I cycle therefore either I dont ride or I find some way to mange the condition that would allow me to cycle.
Also, the Angina symptoms occur when walking briskly uphill so it is consistent with significant aerobic exercise.
Very interesting post, but could I pick up on what chappy has said? You obviously have a history of CVD here, going back to 2007 as you say with the HA. What was your diet like before this, and what steps, diet wise, have you taken since? Please don't take this as any sort of criticism, I am just interested in this aspect. I always exercised but still fell victim to CHD and have fairly drastically modified my diet (vegetarian and very little dairy intake) to try and ward of any future events. I would be very interested in your honest comments regarding your diet, and also, you have not stated you are on any Statin, is this an omission or a conscious decision? You seem to be in the position now that I dread in the future, so am very interested in your reply!
Thanks for the reply, could I ask - did you cycle before the HA or other exercise? Also, what sort of intensity are the 20 - 30 mile rides you have been doing? I don't understand the attitude that seems to be coming through from the consultant, if a bypass would enable you to undertake exercise that would probably be extremely beneficial for your future health why will they not do one? I presume it is either a benefit/risk decision or just economic? I would have thought if you cannot exercise to beneficial levels you may well end up needing one eventually? I sympathise greatly with your position, especially as there are some who have not given up their previous habit. Did they give you any explanation as to why the original stent blocked?
Yes, I did cycle similar distances before my HA. As far as intensity during my cycling - most of the time I would be able to hold a conversation and a bit more intense, out of breath but controlled on the hills. Most of the time I follow routes that I know well so I spread my effort and try to retain sufficient energy for the harder parts. I also avoid the extreme hills!
I have used a chest strap (Wahoo Tickr2) to monitor my heart rate while exercising. The strap connects via bluetooth and/or ANT+ and displays the live rate on a phone or garmin-type device. I often use it to stay in a general effort range and find it works quite well for that purpose.
I would recommend an electric bike. Some say it’s cheating but you can use the motor & gears to either get a strenuous workout or a more sedate ride, enjoying the fresh air etc.
Since having mine I’ve actually done more miles, more regularly and had more fun.
Yes indeed. I was an occasional cyclist before I had an electric bike. Since May last year when I got my bike I’ve done about 750 miles, or shd that be smoked😁. They really are great
I think there is a cure. If I were you I would push for a bypass. If you and your cardiologist think your situation will worsen in time and limit your Q of L then why not take that risk while too are relatively young? I haven’t had one but have two stents in LAD and the chance is there. I’m fell running while I can 😬
Well I had a bypass one year ago aged 77 and have played tennis when it was allowed last year and felt physically and mentally terrific. Can’t wait to get back at the end of March. Also I use my exercise bike. Another thing I find that I have to use up a lot of that “new energy” in order to sleep at night.
Interesting. Like you I was on the table for further stenting when they decided a CABG was the way forward. That was just before Covid so when lockdown came and they cancelled all elective surgery I just started to walk more and cycle. Took the view that if they were going to do nothing then I would!Fast forward and I have convinced the cardiologist that a CABG is not necessary given what I can do and given my decent quality of life. Like you I am not T de F - just half hour bike rides when the weather is good.
I think (personally) there is a lot to be said for listening to your body rather than placing all faith in ‘experts’ who often have differing opinions amongst themselves.
I’d say try your bike up and down the road for 5 mins then 10mins etc and just see how it goes. The only person who really knows what it feels like is you ......
I’m not a cyclist but I’ve been a runner all my life. I’ve had stents fitted but still get angina when I run. At the moment I’m waiting to see the cardiologist for another angiogram. He is keen to keep me running and is happy with my present routine which is to run till the angina pain comes on, then to walk until it subsides and then run again. It’s somewhat frustrating but it keeps me fit. Perhaps you could adapt your cycling similarly.
I’m the same. Has deteriorated a bit recently so being sent for MRI stress test. Ecg shows some damage. Had to stop mid run this morning, walked for a bit, then started again. My cardiologist and lipidologist are very keen for me to keep exercising
My feeling is that you definitely need a bypass. Sledgehammer and nut maybe, but it is the only way of ensuring the issues that you are experiencing are remedied.
After my heart attack in 2017, aged 65, I was referred for surgery and had a triple bypass the following year. The factors for the referral were that I was fit (hill walker), my lungs were in good condition (I have never smoked) and there was minimal damage to my heart.
At the consultation with the surgeon, he said some interesting things:
1. Stents can only be guaranteed for 10 years. Further intervention would be required at some point after that period if I elected not to go for surgery.
2. He would bypass my stents to remove the need for further intervention and suggested I would get at least 25 years before anything else was required. That would take me to 90, so I was very happy with that, besides I know people that had bypass surgery 40 years ago and they are still fit and well.
3. All things considered, carrying out a bypass operation would be more economical for the NHS in the long term..... fewer consultations, less intervention, etc.
Inserting stents at the time of my HA had a major effect on me. I lost 7kg in weight in the first week due to the improvement in my cardio-vascular system and it has stayed off. I was back walking the hills up in Scotland after 3 months and one of the first realisations was that it was easier getting up the hills and there was no longer any lactic acid build up in my leg muscles. The additional effect of the bypass surgery was minimal, but it was like giving me an insurance certificate. Once again I was on the hills after 3 months, as soon as my sternum had healed. I feel very honoured to have been put forward for elective surgery and intend to carry on with a lifestyle that respects the work of the surgeon. Incidentally, the cause of my HA was found to be largely hereditary.
I wonder whether the pressures on the NHS affected the judgement that you have been given. Maybe now there is some light at the end of the tunnel as so to speak, there might be a difference in the opinion being put forward.
Whatever happens I wish you the very best for getting the problems that you are experiencing resolved. Kindest regards,
I use a ‘myZone’ chest strap monitor which bluetooths to my phone and gives real-time display. I have phone on handlebar clamp so can view at a glance. I would agree with others recommending an E-bike, my dad uses one and really benefits from the assistance.
A chest based HR monitor is going to be the most accurate - and as other posters have mentioned, you can see it on your phone mounted to your handlebars - my garmin setup also reports it to me every 5km's when I have my earphones in for music... I also use a Garmin watch and find it pretty accurate when I wear it 24/7 - it also looks at my HR variability, my Oxygen saturation etc... and catches blips whilst I sleep to... counts steps and such, so all activity can be tracked and trends and insights gathered...
Now, to enable you to keep cycling... get an e-bike like others have suggested, and also, get a smart trainer for indoor workouts - you have so much control and feedback on such things... HR, cadence, distance etc... you can even convert your existing bike to a 'smart enough' indoor trainer - You wil need the speed, cadence and HR sensors and some software to tie it all together... Strava is good and covers all riding and exercise - even just walking...
This is a good option to get small daily workouts in, no matter the weather or time of day... you will also be able to track your data and progress... (plus if you push it too far, or have a bad day, you can get off, rest in your own home, have meds or a phone handy if required) and when it is sunny, or you have cabin fever, get on the e-bike with more confidence that your exercise ability is proven up to a certain point that you can ride or train to...
Good luck with your endeavours, once you stop exercising, your health will go backwards... so small bits, frequently is your key to building and maintaining fitness as much as you have potential to do...
Invest in an electric bicycle. I have had stents fitted and use the e-bike assistance only on hills and in strong headwinds and have found it a great solution to the problems I was finding on steep hills. Cardiac rehab said I should exercise to a level where I was breathing more heavily but still could hold a conversation. On my Specialised Crosstrail Sport I was quite "out of breath" after cycling up hills and would find holding a conversation difficult. So I bought a Woosh Faro e-bike and now my cycling is a lot more pleasurable and the routes I take include steep hills which previously I would avoid.
Also a cyclist, I am having a slow recovery from stents with some follow-on issues, and having gone through a cardiac rehab course, I'm now limited to a max heart rate of 130 bpm for this year, at least. yes, you should definitely get a heart rate monitor -- the chest strap is around 40 euros and an inexpensive bar mounted cyclo computer is probably less than 100 euros. i also ride indoors on a turbo trainer. You will be slow, but at least you're keeping your legs moving!
Like you, I have been a cyclist for decades (5). I have an ICD fitted - this is like my very own defibrillator - and when this goes off, you STOP. After discussions with my cardiologists and a review of my lifestyle, they came up with a cocktail of drugs that seem to work. Maybe you could talk to your cardiologist about this.I think Prada47's idea of starting with a turbo is good.
I can give no info about monitors, since they would interfere with the ICD.
This is an interesting post. I have cycled and run regularly since I was a teenager and had a heart attack during a bike ride in August 2019 at the age of 57. I received a stent and got back into regular cycling after a couple of months. I have been left with moderate heart failure.
Picking up on a couple of points, I don't venture out on my bike unless I am wearing my heart rate monitor. I have come to realise that not all HR monitors are accurate, I am currently using a Polar M460 which I am very pleased with. I previously used a Wahoo Tickr through my mobile phone but found it a little inaccurate at times. I do try to ride within certain limits, particularly when I reach a hill. If I see my heart rate starting to 'race off' I know to back off the effort before the bpm reaches a certain point, otherwise I know I will start to get breathless. I don't get angina pains but the breathlessness has been scary on a couple of occasions in the past.
The other interesting dimension now, which I never really took much notice of prior to my heart attack, is the weather. Temperature - too hot or too cold and wind speed and direction all have to be taken into consideration now as I know they are likely to affect how my heart responds during the ride.
Regarding e-bikes, 12 months before I had my heart attack I had purchased one in order to keep up with my wife who had purchased one before me. I still have my e-bike but actually ride it much less than I once did, E-bikes are great fun and they do have various power settings but because I am still reasonably fit, for me they make a bike ride a bit too easy. For me I feel it is beneficial to push myself with the cardio exercise while I am able, but obviously there is a need to be cautious about it.
I would suggest purchasing a good quality heart rate monitor and seeing if that makes a difference.
I too was a cyclist pre CABG in 2015 up to 200 miles per week max 70 in one day ,all came too an end .had chest and lung complications post op ,still have a separated rib ,at sternum,so cycling is so painfull now in the foreword outstretched arm position ,and I also have varicolces probably as a result of riding razor bike seats for years , waiting for surgery to repair rib ,all on hold since COVID ,and last year diagnosed kidney cancer ,so surgery is on hold again ,getting immunotherapy treatment now ,I’ve always been a fell walker but this has gone from 15 mile mountain walks to 1 mile strolls ,really disheartening ,If you can get away with stents and not CABG then seriously push for it as maybe I was a bit unlucky in my complications and stents could not be used ,in my mind this is a serious operation and when you sign your life away on that consent form ,you really do take a big chance on the outcome ,it does sometimes feel your life has stopped
,then COVID comes along ,
Saying that I am 68 now and I have had a full life of adventures ,travel great jobs and a fantastic partner and family ,who I am so proud of ,met some fantastic characters ,I am quite pragmatic about my future and hope to go on enjoying my life without worry ,which I find strange as my family are more concerned about my position than I am .
There are lots of people in worse situations than I am in .
I am 76 and have recently been introduced to a virtual walking app called the conqueror. In this app you can enter various challenges where you go for a walk at your own pace and book it against a challenge such as Hadrian's walk . That particular one is ninety miles and there is no time in which you have to complete it.
A mile a day is 7 miles a week and you can measure your progress as you go. There are others with a lot lesser distance. You can indeed walk across the English Channel if you wish - about 21 miles.
It's all a bit of fun and they send you on line post cards as you go, promise to plant trees, etc. At the end of your trip you get a very solid medal .
Hi Compas.....I recognise many similarities with my case, but I had quite a different outcome. I have always been a keen cyclist but at 64 yrs old in Autumn 2017 I started to experience slight chest pains going uphill at the start of a long bike ride. I was referred for an angioplasty after treadmill tests but the op was halted during the angiogram procedure as the cardiologist found I had 95% stenosis in the LAD and significant blockage in two other arteries. I had made quite a big deal about wanting to continue cycling so it was decided to refer my case to a Multi disciplinary team who suggested that at my age and general fitness a bypass would offer the best outcome, being the one that would allow me to return to cycling at the level I was before. Bottom line is I’m now close to 3 years post op.....ride about 40 to 70 miles per week (4500 last year). In winter I do tend to do a bit more inside on a turbo as I was advised against vigorous exercise in low temperatures. I always use a heart rate monitor on every ride and know (following advice from cardio physio) to back off when my heart rate gets to around 120 bpm (quite easy to do in the hilly Peak District....!) even though I feel I could go harder.
I’m also on 5mg Bisoprolol beta blocker and forgot to take them last week before a turbo session. Net result was a heart rate raised by about 15 -20 bpm which I was able to identify because of the heart rate monitor....so I would suggest it’s definitely a good idea to use one. Hope that helps....
Hi again Compas....further to my last comment....I do apologise as I just re-read your post and saw that you were keen to avoid the CABG option. The main thing is I would definitely recommend the heart rate monitor as a means of staying aware of how your body is coping with the physical exercise if you are planning to go beyond fairly gentle limits. Good luck with the onward consultations...!
Thanks for your reply. My position regarding a CABG was really based what was said by the the cardiologists during my angioplasty and I thought that would be the generally accepted position. I have been surprised by the number of responses I have received to my post that advocate the CABG route as the way ahead. It has certainly expanded my own view and I will be interested to hear what the view of my local consultant cardiologist will be. It will be a few weeks before I get to see him so food for thought meanwhile. Thanks.
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