After my initial heart attack in Oct 2019, having lived a blameless lifestyle, very fit, no BMI issues etc. I followed the cardiac rehab + lifestyle to the letter. Only to be followed in July 2021 by what I thought was just an unstable angina attack but transpires to be another NSTEMI. Spent 7 nights in hospital and had echo and angiogram. No stenting needed - just sluggish flow.
I'm medically managed: the usual tablets, and I'm now also back on the dreaded Ticagrelor (bruise-city here we come!) for a year.
So what experience have others had regarding two heart attacks - what does this mean for the future and how do you cope psychologically?
Still keeping fit - cycled 30k on Monday and 45k yesterday before realising after my 'Post MI Review' with a nurse at the surgery this morning that I'd had a heart attack in July!!!
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Heartattackvictim
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Sorry to hear that you had a second NSTEMI. Were you advised if the likely cause and if so a course of action to avoid a further episode? Also, I wonder whether you were given any specific advice as to what you should be doing at this point.
I think the fact that you are fit bodes well for the future. Maybe the best course of action is to ease off for a while to give your heart a rest and gradually build back up to your usual fitness level. I haven't had two attacks, just one when I had stents, with a triple bypass 11 months later, so there are some parallels. I was on Prasugrel for 11 months and then Clopidigrel for a year. Neither caused bruising, but I had to be careful not to cut myself.
I found steadily increasing my level of exercise worked well and keeping positive was a great help. My interest is hill walking and I am now capable of climbing several Munros in a day. Looking back, I don't think that I could have done that before my heart attack.
I hope that you can get some answers to the questions that you have. My best wishes for the future.
Thanks Gerald. The nurse was stumped really as to what else I could do - and the consultant said to me in the recovery bay after the angio when I pressed him about exercise: "you can get back to it but give it a week!" So I have.
I'm managing angina triggers: cold, windy afternoons in particular. Also both my heart attacks were stress-related (I think) so as there is little scope for physical improvements (of diet and exercise) I'm going to seek out help psychologically eg mindfulness (which I have to say has never been a strong suit of mine) as I tend to blast straight on with life!
Yes stress has a lot to answer for. I had several months of stress before my HA , having worked late the night before to get information out to clients. In combination with an hereditary factor (high homocysteine level which is associated with blood clots), it all came to a head.... blue lighted to the local cardiac unit, two stents fitted and sitting up in recovery having a ham sandwich inside 90 minutes from calling 999. The NHS at its very very best. 😀
Most heart patients are unfortunately not particularly fit, so when such as you or I present with problems, we don't conform to what the medical staff expect. Fortunately for me the doctor that inserted my stents saw that I was fit and referred me for further treatment. Following both my HA and bypass I was back climbing Scottish hills just 3 months later, indeed while I was still under the care of the local hospital and much to the bemusement of those whose care I was under.
I understand where you are coming from in respect of the "just do it" approach to life. I was self-employed for over 28 years and in such an environment you have to be a strong and often quick decision maker. However, I would say that since my HA I have adopted a more laid back approach. Those around me can find this annoying at times, but since stress was a major factor in me having the HA, I feel that this is best for me. It does require a change of mindset and I hope that you can make the necessary adjustments.
As I said, maintaining a positive attitude is key. When you are back on your bike do take time to stop and relax and take in the view. It is part of maintaining the balance. I thank my surgeon when I stand atop the Munros.
Gerald, this sounds like me as regards working: I'd been working incredibly hard the three days beforehand including one of the most acrimonious meetings I've ever been to (in almost 40 years of working) where I called out systems failures only for senior management to attack me and try to impugn me. When they found out I'd been carted off to hospital in the night they were blame shifting and even getting minutes of the meeting rewritten. I'm well rid of them and work.
It sounds like you definitely are well rid. I went self-employed because of the Spanish Inquisition every Monday morning. I was senior management in an Architects' practice and took the can for every little thing, whether or not it was my fault. Becoming my own boss got rid of such problems, but initiated others - at least I was in control..... most of the time. 😀
My problem was closing the business which proved to be much harder than setting it up. Then there was a period during which I worked as a consultant for three clients that said they just couldn't cope without my input. The workload at this time was quite heavy and that's when I had my HA. I think it shocked them because they knew I was fit. I was finally "allowed" to retire last year after three years of consultancy I miss work like a sore thumb!
While stress appears to have been a major issue for you, don't discount hereditary factors. It look the pathology department of my local hospital to discover that I had a high homocysteine level..... simply solved by vitamin B, yet I had to explain it to my GP. Thankfully my GP has agreed to including it in my annual blood test so it i's bei g monitored.
Oh, and another thing is to be pro-active in respect of your medication. If you are being prescribed medication that causes issues, do discuss it with your GP and get an alternative prescribed. I have got mine to the stage where I take 5 pills with my breakfast and then I can get on with my day. It all helps with keeping stress levels low.
You have my sympathies. We're all trying to identify the root cause of our heart problems, the life style factor that we can change in order to radically reduce the risk of future cardiac events. For some it's pretty obvious, smoking, obesity, sedentary life, lousy diet, etc.
But for others, like yourself, it can be very frustrating to know what more can we possibly do to protect ourselves?
I don't pretend to have the answers, but I've been astonished at just how many factors there are that can cause atherosclerosis and trigger heart attacks. Here are just a few that I've come across.
Apo E is a gene with three main variants, if you're one of the roughly 20% of the population with the E/4 variant then you have an increased risk of both heart attacks and Alzheimers. The research isn't finalised, but as I understand it carriers can reduce their risk profile back to the level of the general population, but it requires an ultra low fat diet and barely any alcohol. The NHS rarely give DNA tests, but there are private test options.
You mentioned stress, and yes it's an important cause of heart problems. However, even though we usually think of stress as "too much to do in too little time", stress can have many other causes. Poor sleep patterns for example are a big cause of stress, which is why shift workers are at an elevated risk of heart attacks. I used to have a job that involved a lot of long haul travel and the attendant jet lag, my annual company medicals showed raised Cortisol levels which I believe contributed to my heart issues. Sleep apnea is another sleep related issue where there's an established link to heart disease. Again, the NHS doesn't normally test for Cortisol amongst heart patients, but private tests aren't too expensive and could give you a valuable clue regarding how to adjust your behaviour.
Air pollution is increasingly being identified as a risk factor, be that passive smoking (which in truth almost all of us experienced until fairly recently) or living close to main roads, or even oddities like simply living in Southampton and being exposed to the exhaust of cruise ships!
Gum disease and heart disease are closely connected, Anyone with heart problems should discuss their gum health with their dentist and it might be necessary to step up oral hygiene with daily flossing. This is another one with a genetic dimension, if you're a carrier of the Interluekin 1 gene then you're at an increased risk of gum disease migrating into heart disease.
The standard NHS blood tests for heart patients includes an HbA1c test. Look at this score carefully, if it's too high, or on an increasing trend over time, then you may be suffering from insulin resistance. Many GP's won't flag this until it tips over into danger territory, but there is evidence that a low but rising trend may be the culprit behind coronary heart disease.
And there are many, many more potential causes out there. None of this is straightforward, but personally I'd be reluctant to conclude that any of us are powerless to improve our odds.
Chappychap that is such a detailed and thoughtful posting - thank you so much for taking the time to set this out. I now have access to my patient records and tests, so I'm going to search out the HbA1c result (s). All the best, John
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