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Ischaemic Heart Disease - Impact on Athletic Performance?

OobieDoobie profile image
65 Replies

Hi all,

This is my first post on this forum and am just looking for some community help really - I apologise for the lengthy post! Very interested to hear opinions and knowledge and maybe some lived experiences with anyone willing to share them:

History/Context: I am a slim, active 42 year old male with Type 1 Diabetes (20 years since diagnosis). I was diagnosed with Ischaemic Heart disease at the end of last year following a fairly bad attack of angina after running the Yorkshire 3 Peaks with a friend. I didn't know this was angina at the time and thought I might be having a heart attack for a short while until the pain quickly subsided and I was left feeling fine - I realise now I had been having these sensations but at a lesser intensity for a few years but put it down to being exhausted after long runs and bike rides. Long story short, I ended up having a CT Angiogram, ECG etc and a diagnosis of a 50% soft plaque buildup in the LAD. I have since been taking Aspirin, Atorvastin, Bisoprolol and Ramipril (although currently on a GP instigated hiatus from Ramipril at the moment due to some nasty side effects with peripheral neuropathy).

Problem: Recently I have been spending time in the hills training for the National 3 Peaks Challenge with friends next month. I am not as fit as I was before diagnosis but have kept reasonably active with running and cycling albeit not to my prior distances and intensity. I have noticed that I become terribly out of breath on the uphills and I end up with just no strength left in my knees. My heart rate is right up into the Zone 5 160s and 170s, I end up having to stop and rest very frequently. Initially I just assumed this was down to poor conditioning, and as I was walking on my own I had no-one to compare this to until last weekend when I climbed Blencathra and Skiddaw with a friend (a good 20 mile hike). It was then I realised that I was just having to stop and rest much more frequently than my friend to the point where it ocured to me that this could be at least partly down to my coronary artery disease. Blencathra wasn't too bad, but half way up Skiddaw I had to stop every 15-20 paces and I was breathing hard. My friend and I have up to last year run half-marathons together at a similar pace and our performance was very similar. The next day/afternoon I experienced the familiar angina sensation on a scale of about 7 (10 is the worst) for most of the afternoon.

Questions: My cardiologist was keen for me to continue exercising and doing the things I love, but one thing I forgot to ask during the appointment was around impact on performance, and now with the training for the national 3 peaks and with me experiencing problems I am kicking myself for not asking and I can't find anything directly related online. What I am asking is this: How will this 50% block in the LAD affect my athletic performance? It stands to reason that this would limit my ability, but I haven't been able to ask? Is it likely that I just won't be able to achieve the same levels of performance that I used to? Or, are my current experiences due to conditioning, and not doing enough hill work over a long enough period and I am just weak in these areas? I should state that I am able to run a 10k on the level at a decent pace (as proved on Wed this week) and climbed Snowdon and back in 3 hours two weekends ago albeit with having to rest although nowhere near as bad as Skiddaw (have previously climbed Snowdon and other mountains as well run the Yorks 3 twice and done a few other, flatter 20+ mile runs without this level of difficulty).

Any thoughts/comments/help on the above would be brilliant. I don't know at the moment whether I am expecting too much of myself due to a limitation due to the heart condition, or whether it is just a case of not enough uphill work/conditioning. I do know that I was not as bad at the ascents as I am now!

Much appreciated and sorry for the essay :)

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OobieDoobie
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65 Replies
MummaSoap profile image
MummaSoap

Hi OobieDoobie

Welcome to the forum, you put me to shame with your fitness levels!!

Whilst I don’t feel I can add any value in relation to your specific questions what I would say is it’s not a fair comparison if your friend doesn’t have any cardiac issues so I’m not sure this would be the best marker for you. Any inclines are going to impact your performance because they put more strain on the body.

To give you some context of my fitness levels, I get out of breath climbing the stairs and when I completed my exercise stress test my heart rate climbed to 264 BPM so your 160/170 sounds really encouraging to me but it’s all relative and it sounds like that’s very high for you.

The reason your cardiologist is probably keen for you to continue exercising if your tolerance has been good is because the heart like with any muscle - if you don’t use it, you’ll lose it.

I’m sure others with far more knowledge and wisdom than I will be along soon to help with your questions.

Keep us updated with how you get on with the 3 peaks!

Best wishes

Soap 🧼

OobieDoobie profile image
OobieDoobie in reply to MummaSoap

Hey Soap and thanks for the reply - a really quick response, which is really nice.

You are absolutely right about probably unfairly comparing myself with someone without a heart condition, and yep the intensity level of a steep gradient can be very high. The worry I have is that I just don't know what to expect! Will training improve my fitness, or is this a hard limitation I now have? If it is a limitation then that is fine, I can adjust my expectations - what I don't want to do is to train myself to death 😀

I will let you know how I get on. 👍

MummaSoap profile image
MummaSoap in reply to OobieDoobie

Aww your welcome, I try to get to posts without any response quickly.

That makes an awful lot of sense. I imagine some of it will be a chicken and egg scenario but only you know your body best.

My advice (not a doctor) would be to try and get hold of your cardiologist’s secretary (details can often be found on your hospital’s contact list) to ask that specific question but in the meantime carry on your training but err on the side of caution. For example, don’t wait until your legs want to buckle underneath you before calling it a day; find your happy medium 😁

You might find that the more you train, your tolerance increases but that’s a very individual factor plus I don’t know specifically the implications of the 50% block on your ability to train.

Sorry I’m not much help!

Best wishes

Soap 🧼

Tos92 profile image
Tos92

Hi OobieDoobie

Welcome to the forum and to your first post.

I don’t have a great deal to add in terms of your physical performance when it comes to climbing however, I did notice you mentioned you had angina which you scored a 7/10 after a day of climbing.

Just a thought, as you didn’t state it as part of your medications; a GTN spray is often used to relieve angina pain as it dilates the blood vessels, making it easier for more oxygen to reach your heart. Would it be worth discussing this with your cardiologist to see if this is an option for you? It would be an easy carry on, i.e. you can put it in your pocket when you do go climbing or when you are out and about and use it when required for the pain.

All the best.

Tos

OobieDoobie profile image
OobieDoobie in reply to Tos92

Hey Tos - I didn't mention in my essay above that I do have a GTN spray prescribed, which I did use although I have to say I have not so far found it to be very effective. I am lucky in that the angina I experience isn't painful as such, its more the sensation of someone standing on top of my chest for hours at a time. More unpleasant than painful. The GTN just leaves me with a tingling sensation in my mouth and a headache and stuffy nose 😅

Tos92 profile image
Tos92 in reply to OobieDoobie

I’m sorry to hear it’s not been very effective for you. Usually the rule with a GTN spray is that you spray 1-2 puffs under your tongue. If it does not subside, you can use it two more times 5 minutes a part, which is 15 minutes in total. Failing that and it doesn’t work, it’s usually a trip down to the hospital.

Those are some of the common side effects to using a GTN spray unfortunately.

There are also long acting nitrates that come in oral form. I wonder if you would respond to those better. Of course, you would need to discuss this with your cardiologist first.

OobieDoobie profile image
OobieDoobie in reply to Tos92

I really do need to discuss these issues with my cardiologist. It makes me wonder if the sensation I am getting is actually angina or something else. Thanks for the advice Tos92

OobieDoobie profile image
OobieDoobie in reply to Tos92

I will definitely mention it to my cardiologist - but my appointment isn't until the end of the year.

Tos92 profile image
Tos92 in reply to OobieDoobie

End of the year is a long wait! If you do deteriorate before then or have new symptoms, I would try and chase them for an earlier appointment.

My doctor often says if I don’t respond to the GTN spray during chest pain, then it isn’t cardiac in nature however, at the same time, my GP is also not very knowledgeable of my heart condition as it can cause chronic chest pain and be unresponsive to treatment.

Keep us updated & I hope you have a lovely rest of your night.

RailRover profile image
RailRover in reply to Tos92

My heart related pain has never, ever responded to GTN spray, so that GP is dangerously wrong. Unstable angina tends not to.

Tos92 profile image
Tos92 in reply to RailRover

I’ve not had much luck when it comes to healthcare professionals understanding my myocardial bridging which is a congenital heart defect and the coronary spasms which arise as a result of it unfortunately.

I hope you are keeping well.

Milkfairy profile image
MilkfairyHeart Star

Hello,

It's not necessarily how much your coronary arteries are blocked rather how well does your blood flow through your arteries.

You can have angina or even a beart attack without significant blockages of you coronary arteries.

Non obstructive coronary artery disease NOCAD, causes angina/ ischaemia non obstructive coronary arteries ANOCA/ INOCA.

Sometimes the small blood vessels don't function properly, they fail to dilate or stay dilated in response to extra demands like exercise.

Or the coronary arteries go into transient constrictions.

Diabetes is associated with endothelial dysfunction which is thought to be a cause of both obstructive and non obstructive coronary artery disease.

diabetes.co.uk/diabetes-com...

ncbi.nlm.nih.gov/pmc/articl...

It might be worth seeking out a Cardiac Rehab specialist or sports exercise professional to help you.

Beta blockers can also affect your ability to exercise.

Here's a link to the British Association of Cardiovascular Prevention and Rehabilitation

bacpr.org/

OobieDoobie profile image
OobieDoobie in reply to Milkfairy

Hey Milkfairy,

Wow, I wasn't previously aware of pretty much anything you posted, which just goes to show how ignorant I am of my own condition. Plenty of reading to be done here and excellent advice re: rehab specialist/sports exercise pro. Thank you!

Identiy profile image
Identiy

What about having a stent(s) to open the artery to a greater diameter?

OobieDoobie profile image
OobieDoobie in reply to Identiy

The cardiologist said they wouldn't normally bother at a 50% blockage unless I was consistently finding the pain from the angina too much, then they would revisit it.

Steve_G profile image
Steve_G

My background is in pharmacology - the science of how drugs work. Bisoprolol, which so many of us take, is a cardio specific beta-blocker. This means it preferentially blocks the hearts beta sub-class of receptors for adrenaline. This blockade results in both negative inotropic and negative chronotropic effects - it reduces both the force of the contractions of the heart and slows it down. In other words, it reduces and limits the hearts capacity to work and therefore its demand for oxygen. With a lower demand for oxygen the risk of angina is reduced but with a lower cardiac capacity for work you might expect lower performance levels. This could be contributing to the effects you’ve noticed.

MountainGoat52 profile image
MountainGoat52 in reply to Steve_G

I totally agree Steve. I was initially put on 3.75mg Bisoprolol and had severe problems with it, even having feelings of impending doom. In consultation with the Clinical Pharmacist at my GP practice, the dose has been reduced to just 1.25mg. Even so, the effect of the medication is felt when I am out climbing the hills.

I have considered requesting a review to determine whether I would benefit from stopping the beta blocker. However, the amount of time that I am out climbing is a really small percentage of my time, so I am willing to accept a reduction in performance in favour of the overall benefit that it provides.

Gerald

RailRover profile image
RailRover in reply to MountainGoat52

Concur with this. I came off Bisoprolol for these very reasons. I felt it was doing more harm than good by limiting the heart function, and a cardiologist agreed with me.

OobieDoobie profile image
OobieDoobie in reply to MountainGoat52

I am definitely going to have a discussion about this with my GP and the Cardiologist.

VickyHK72 profile image
VickyHK72

I can see you’ve already got some great responses here and I’d definitely see if you can get an appointment with your cardiologist earlier than the end of the year - it’s really frustrating when you think of questions after the event!

Diagnosis wise I think we’re in a similar place, fitness wise you are light years ahead of me! I took up running after my diagnosis but recently an Achilles injury that won’t resolve has meant I’ve returned to swimming (which I did competitively as a kid) which I’ve been a bit nervous about but the club are aware of my condition so I feel in safe hands. There is a FB group called healthy hearties run by a cardiac nurse who specialises in getting people into fitness when they have a diagnosis. She does zoom stuff and also one to one do just thinking in the interim it might be worth you trying someone like this. She has the cardiac experience but also her focus is fitness and exercise so just taking she could perhaps help. Wishing you the best. Vicky

OobieDoobie profile image
OobieDoobie in reply to VickyHK72

I will definitely check this out. Thanks Vicky.

bwiltshi profile image
bwiltshi

Again I have never been in your league of fitness, however prior to my heart attack at the age of 60 I was a keen walker, cyclist, swimmer, etc.Like you, I had angina attacks that I didn't recognize prior to my heart attack. My my heart attacked occurred while I was safely on the sofa, with a fairly undramatic trip to hospital, followed by stents and meds, and a swift return to virtual normality. I suspect the outcome wouldn't have been the same had it occurred in the middle of an extreme bout of exercise in an isolated place. So from my inexpert experience I would suggest you exercise some caution.

Again from my experience, and contrary to what my cardiologist advised, but with the benefit of hindsight. Following my heart attack I focussed on getting myself really fit, and within 6 months I was in a condition that was the envy of most contemporaries. I still got a hint of angina when I was really going for it, which went as soon as I took my foot off the pedal. But then as the months passed the angina became more intrusive and led me to further stenting. No reason given why my arteries were re-blocking and was advised to keep exercising. However same thing happened, in time, angina became more intrusive again and I developed frequent ectopic heart beats Then the pandemic arrived and for various reasons I toned down my exercise regime to just long non extreme country walks. The ectopics went away, as did the angina because I wasn't pushing myself. I probably felt a lot healthier without the constant exercising. I have been treated for heart failure using meds, and had a series of echocardiograms and MRI's ECG s etc with a diagnosis of all manner of enlarged, and damaged heart components as well as issues around the synchronization of the left and right ventricles. All these being consistent with my coronary history, muscle scarring and advancing years. Personally and without any scientific basis, I suspect I pushed myself too hard post heart attack, and ignored the signals my angina pain should have told me, I was doing too much. I think I should have moderated myself, but I think I had become blindly obsessed with fitness to my detriment. So again I would advise some caution and perhaps listen to your body.

OobieDoobie profile image
OobieDoobie in reply to bwiltshi

I have to say, if I hadn't already committed to this event (we are paying a company to do the driving etc), I would probably back away. I am going to just see how it goes on the day. If I am struggling I will just bow out and head back down to the transport - it is not worth dying over!

FindingCaradoc profile image
FindingCaradoc

Welcome to a club you would rather not be in.... although 20 years older than you I have a very active background myself, although not ever as fit as yourself by the sound of it, I ran and finished the Yorkshire 3 Peaks fell race in 2019 (having taken up fell running in my mid fifties) and I am also a keen long distance cyclist, not very fast but I keep going, as well as a hillwalker (climbed all the Munros) and Mountaineer (Matterhorn for my 50th birthday treat!).

I had an NSTEMI (relatively mild) heart attack last year - out of the blue - despite a good weight and being fit for my age, which I put down to some family history and a less than ideal diet over the years (too much chocolate and cake mainly 😂). I ended up with two stents. I also have a background of AFib and ended up having a Catheter Ablation last September, which so far has been successful. I was on Bisoprolol, but this was stopped after my ablation. I remain on Apixaban and two blood pressure medications, as well as a high dose statin.

My experience is first and foremost not to underestimate the effect of heart disease on your anxiety levels and how that can impact on your physical wellbeing. With regard to cardiac performance, despite building back some decent fitness, I am finding my cycling FTP is around 25% lower than pre heart attack. Also (as the opposite problem to many) I can't get my heart rate very high at all (even factoring in my age) and 130 is about tops even eyeballs out! It rarely gets above 100 on modest effort. I should add I am technically bradycardic with a resting HR typically in the high 40s but sometimes lower.

Again from my experience I would not be too optimistic about getting useful information on athletic performance from your general Cardiologist, as you will not fit their typical patient profile and unless they happen to have a very active background themselves the attitude will be along the lines, well you are pretty fit and healthy so what's the problem (or something on those lines).

One obvious factor in your performance will be the Bisoprolol (you don't mention the dose) and that may be a specific point you can discuss and get another opinion on as to whether this can be reduced or possibly even stopped at some point, but only if agreed with the Medics of course.

If you want to get more specific guidance I would see a Sports Cardiologist if you can, which unfortunately will probably mean going private if that is an option for you. I am thinking of raiding my piggy bank and seeing Professor Sanjay Sharma later in the year, who is one of the UK's leading Sports Cardiologists and who has been recommended to me by a number of people.

Finally, you may find it useful to join the Cardiac Athletes group on Facebook, which I believe was started by a Cardiologist who is a keen sportsman. All the best with your future health and outdoor activities.

bagsypartime profile image
bagsypartime in reply to FindingCaradoc

I think you've had some really good replies and a lot of sense spoken.Heres my two pennies.

1.The diabetes as stated above is a complicating factor.

2.Some runners do too much exercise.What is too much? Don't know.

3.Blocked arteries form collaterals that are a natural bypass.Exercise stimulates this pathway.

4.Sauna dilates blood vessels and is very good for coronary health.Cold constricts and is also good exercise.This also stimulates other hormones you didn't even know you had.

5.You don't mention strength training.Muscles may slow runners down but you do need them, and the stronger you are the fitter you are.

Milkfairy profile image
MilkfairyHeart Star in reply to bagsypartime

Just a thought.

Cold can trigger angina, using saunas can be an issue too.

bagsypartime profile image
bagsypartime in reply to Milkfairy

Running can trigger angina; he wants to run.

Milkfairy profile image
MilkfairyHeart Star in reply to bagsypartime

"4.Sauna dilates blood vessels and is very good for coronary health.Cold constricts and is also good exercise.This also stimulates other hormones you didn't even know you had."

OobieDoobie profile image
OobieDoobie in reply to bagsypartime

Oh the joy of diabetes - the gift that never stops giving - it is always a complicating factor. It is bad enough just managing blood sugars when exercising let alone the damage and alteration to the body's mechanics! I think I am definitely over-doing it at the moment and need to dial it back. I strength train twice a week at the moment.

bagsypartime profile image
bagsypartime in reply to OobieDoobie

When i got a chest pain upon exercise and went to docs they did a blood test.They said you have hypothyroidism and need to take levothyroxin for the rest of your life.I expect i had had this for many years and the lack of hormones damages the arteries and lowers testosterone.Thats why i like to lift weights.

But as you say these underlying conditions damage us in ways we don't understand.And the stuff you take does more damage-statin for examples- again lower testosterone.

I think vitamins are good, and if your condition gives a known deficiency or poor absorption then double down on these.The lining of the arteries is called the epithelium ,it's a very clever thing almost with it's own brain, but delicate and needs looking after.

All the things we do-the more enlightened do- such as Sauna he! he!- are not just good for the heart but also help keep dementia away.

Milkfairy profile image
MilkfairyHeart Star in reply to bagsypartime

The inner lining of the blood vessels is the endothelium. It is indeed a very important and under appreciated organ of the body.

Statins can help to improve the function of the endothelium when it's not working as it should.

Endothelial dysfunction is the precursor of both obstructive and non obstructive coronary artery disease.

The epithelium is the outer layer of an organ.

bagsypartime profile image
bagsypartime in reply to Milkfairy

Yes endothelium not an excuse but spellings altered.I agree with what you say and take statins myself.Plus cq10 to mitigate

Quite a big subject.Some say that eating plants can reverse plaque.Debate about olive and fish oil being good/bad(causing inflammation) etc.My plan was to eat plants to get out of CABG, but was unable to convince anyone else.

In support of my argument (which i lost) a study looked at elective CABG against patients who were recommended but did not take surgery.20% who did diet and 5hrs exercise per week had improved anagrams, the majority who perhaps didn't exercise so much didn't change.About 8% died.

8% sounds harsh but remember some who have surgery die too.Left anagram in to show my point about spelling.

Milkfairy profile image
MilkfairyHeart Star in reply to bagsypartime

The percentage of people dying from surgery is much lower.

Surgery and stents also increase a person's quality of life by treating their symptoms of angina.

Then some of us live with non obstructive coronary artery disease NOCAD, still at risk of heart attacks, strokes, heart failure and major adverse cardiac events.

It's not how much your blood vessels are blocked rather how well the blood flows through the coronary arteries and smaller blood vessels.

bagsypartime profile image
bagsypartime in reply to Milkfairy

fair summary.The point was doing nothing is also an option.I was frightened of the operation and preferred the doing nothing route (diet and exercise of course).Any data that supported this idea was what i sought out.

nomad (spelling) is the first time i am hearing about it, no obvious blockage but poor flow.It's a multifaceted subject.I should be very grateful for my treatment ,i'm recovering well.Thanks for educating me on a couple of points.

Milkfairy profile image
MilkfairyHeart Star in reply to bagsypartime

NOCAD, non obstructive coronary artery disease 😊Usual causes are microvascular dysfunction and coronary vasospasms.

My coronary arteries have the pesky habit of going into transient constrictions, vasospastic angina.

I understand your reluctance to have major surgery unless necessary.

I wish you well in your continued good recovery.

BHFnurse_June profile image
BHFnurse_JuneBHF Nurse in reply to bagsypartime

Just to add that saunas can put an extra strain on the heart. So, if you have a heart condition check with your doctor before using one. Cold weather can also affect your circulation and put extra stress on your heart. So, if you have a heart condition, it’s a good idea to take precautions when exercising in cold weather. For more info, see our web page on cold weather: bhf.org.uk/informationsuppo...

Flimflab profile image
Flimflab in reply to FindingCaradoc

I would be interested in hearing about your experience at as I am considering (trying to justify to my wife) using the same Sports Cardiologist, although I am not sure we can discuss speific cardiologists in the this forum/community?

FindingCaradoc profile image
FindingCaradoc in reply to Flimflab

His name has come up on this forum before I believe… not saying I can personally recommend him of course 😀 - other Sports Cardiologists are available

OobieDoobie profile image
OobieDoobie in reply to FindingCaradoc

Wow it sounds like you are incredibly active, and taking up fell running mid-fifties is quite something! From a performance perspective, I guess I wouldn't usually be too bothered as the activities I do are just for my own pleasure and sense of adventure. I haven't bothered entering any fell races for example although prior the heart issues I was planning on doing Lakes in a Day (but not for the competitive aspect, just for the practical support and safety aspect). The original question above came about because I was able to compare my own performance for the first time in a few years with someone who prior to my problems, was a similar fitness level to me, and I ultimately wanted to set some expectations to myself in regards to the National 3 Peaks next month. The replies on this thread have been fantastic so far with some great suggestions and lots of further reading, and I think I would explore that before splashing out on a Sports Cardiologist. I think that I just need to dial back the more extreme activities I was used to and probably for a general health perspective that isn't a bad thing.

Flimflab profile image
Flimflab

Hi and welcome to the Community and I am glad your blockage was picked up early I assume you have discussed the level of exercise you want to do with your cardiologist, if not the impact in may have on your performance? I agree with the comment on bisoprolol, I found it hard getting out of bed when I was on it for a short period of time while waiting for a stent.

I also had an LAD blockage, that was picked up early although mine wasn't found until my 60's when it was 90% blocked. I had a stent fitted in August last year. I haven't found any research on it but I personally believe I have seen a significant improvement in both speed and endurance as a result of the stent, but your cardiologist may not believe a stent is needed at this stage for you.

On the bright side once your condition has been addressed and you have had time to adjust to medication you may find your performance improves, but also you can have a higher training load.

Personally I believe a stent improved my performance, although my blockage was significantly greater than yours, Before I had a stent put in I was taking 30 minutes for a Bushy Park parkrun, maybe needing to stop occasionally (although not breathless) and I was also having mild "warmup angina" in training. Once the stent was in my time was 25:10 with better endurance as well. I have no proof, but most of this I would put down to fixing my hearts blood flow.

It probably means that my training was also limited by my LAD blockage.

Medical clearance and support,

My NHS cardiologist signed me off with "run how you feel" but would not discuss a heart rate limit. On parkruns I now hit 180 bmp, which causes me concern as it is very high for my age. I've had more than I could have expected from the NHS and I probably should throw some of my own money at a sports cardiologist to get any further reassurance and advice on sensible limits, or a supervised HR Max test, to be happy I am not taking unnecessary risks.

Other sites

Another site you may find of interest is cardiacathletes.com/ which is more sport/competition orientated you may want to post your question in their Facebook group too?

Good luck and I look forward to hearing what you find out.

OobieDoobie profile image
OobieDoobie in reply to Flimflab

Really interesting to note that your condition was only picked up at 90% blockage. This does make me wonder if a 50% blockage has any effect on performance at all. Also interest to hear your experience with Bisoprolol - which seems to be a common theme. I will check out the cardiacathletes group - thanks for the heads up. Much appreciated.

I am very impressed with what you can achieve and have achieved. I have to admit I carnt give too much advice , as my condition is congenital. At 17 I went along the penine way and went up this hill to get to kinder scout, thought I was going to die. But just assumed I was unfit and just shrugged it off and I am no way in your league and have never have been. However 40 years later I find I have a congenital issue. Which unfortunately I was born with. However the tests I have had In the last year. Have been thorough, mri, two echo's. 4 ecgs. Ct scan. Xrays. However I personally think a stress test might be worth going for if you have not done so already. I have another cpet this year. Iam currently going to the gym and doing basic cardio work. The advantage of cpet test is it can show if the problems are either heart related or lungs. But the two parts, lungs and heart have to work efficiently together. Also it can see how your blood pressure is effected by exercise. I hope you get your answers but the heart is a complexed system.. a very simple pump that we take for granted. But exercise does help as it is a muscle.

OobieDoobie profile image
OobieDoobie in reply to

Thanks Felly - I was half expecting a stress test to be offered, but I don't think they will commit the resources to someone with only a 50% blockage. PS sorry to hear about your own issues, and I hope they don't stop you doing what you enjoy.

in reply to OobieDoobie

I understand that you are concerned. What ever fitness level you are at, does not not matter. Its that something does not feel right. And you mind a body wants answers. I hope you find your answers. Personally I have found that my issue has just mentally put the brakes on. But you have to keep going, just a bit slower. Take care.

RailRover profile image
RailRover

I've never heard of a 50% occlusion causing severe angina? I would have thought a high proportion of the population is walking around with this level of stenosis or more. I was 20 years older than you and pretty fit when I had my heart attack. I'd had no previous symptoms of angina, but when I had angioplasty and a stent to the RCA, my main arteries were all 90%+ blocked. Since then have had triple bypass to the other main arteries.

From my own gut feeling I would be careful. Exercise and keep your fitness to high level by all means, but given your experience I would be very wary of extreme events, and the 3 Peaks is an extreme event. I understand how exhilarating conquering such challenges can be, and how frustrating to abstain from them, but pushing too far can have devastating consequences for everyday life and that must be the priority.

Milkfairy profile image
MilkfairyHeart Star in reply to RailRover

You can have completely unblocked coronary arteries and still experience ischaemia/ angina non obstructive coronary arteries. INOCA/ANOCA. Even a heart attack, Myocardial Infarction non obstructive coronary arteries, MINOCA.

aka, Non obstructive coronary artery disease NOCAD.

Microvascular and vasospastic angina.

RailRover profile image
RailRover in reply to Milkfairy

Exactly. This is what I was getting at, so I wouldn't be pointing the finger of suspicion at those 50% blocked arteries.

Milkfairy profile image
MilkfairyHeart Star in reply to RailRover

It's how well the blood flows.You have to look beyond the blockages 😊

RailRover profile image
RailRover in reply to Milkfairy

And as in my case, it was flowing in sufficient quantity to sustain my activities without any symptoms or problems - until a bit breaks off, a clot comes along that cannot pass the chicane and then I was on a mad dash to A&E with a pulse declining down to 20 before they thrombolysed me and stabilised the situation. All happened in a whirl. These arteries are unbelievably narrow for the vital function they perform, between approx 2mm and 4mm in diameter, so when you consider a 90% blockage of that. Quite mind boggling.

Milkfairy profile image
MilkfairyHeart Star in reply to RailRover

Then there's the issue when the blood vessels don't function as they should.Coronary vasospasms or microvascular dysfunction.

I have unobstructed coronary arteries. I am still at risk of a heart attack, stroke, heart failure and major adverse cardiac events because my coronary arteries go into transient constrictions causing a lack of blood supply to my heart.

OobieDoobie profile image
OobieDoobie in reply to RailRover

You are right to question this as I don't even know if what I am experiencing is angina. All I know is it feels like a restriction/pressure in my chest so I and the cardiologist have assumed that is what it is. It might not be!

OobieDoobie profile image
OobieDoobie in reply to RailRover

Yes I think your advice around extreme events is true - I mentioned to someone else above that if we hadn't already paid for a private charter (driver etc) then I would have backed out. I am just going to do a peak at a time and if it isn't working, I will just back out. Definitely not looking to put myself through anything like this again.

TC3bc profile image
TC3bc

You hit the nail. I'm out of here.Never read so much self pity an whingin from so many...Get a grip for Pitys sake

MummaSoap profile image
MummaSoap in reply to TC3bc

There’s absolutely no need to be rude and make such a sweeping statement about a community you’ve only just joined. Yes lots of people are struggling but many people are also finding positive ways to cope and live with their conditions and have been able to get their lives (albeit sometimes a different version) back. I urge you not to judge others so quickly.

Your decision to leave is probably the right one for you.

Wishing you luck for the future and perhaps next time, when you can choose to be anything, you’ll choose to be kind.

Best wishes

Soap

bagsypartime profile image
bagsypartime

I don't think he gets what the question is.I for one was impressed by oboe doobe and didn't think that he was trying to brag- and if you are reading this it was a good question that got some educated answers that were well worth reading.That is how i learn things on this forum.Usually my own questions go nowhere.

One aspect i'd like to pick up basically because your blockage falls below any threshold (70%) the docs have lost interest in you, and really don't want to be conducting tests just for the sake of it.As someone else said a lot of people who have never been tested would be 50%, this is not to diminish your concerns and you mention shortness of breath as a worsening symptom.

As far as they are concerned you had the tests and this is where it led.If you had been stunted, or as in my case cabgx2, once they've done all they think they can do that's it.They don't really give advice.In my opinion (and it is only my opinion) even if you see a sport cardio surgeon he will still only speak in bland generalities.

OobieDoobie profile image
OobieDoobie in reply to bagsypartime

Absolutely not trying to brag at all - just setting context around my fitness level and why I am concerned. It isn't meant to impress anyone or upset anyone - that is certainly not my intention. I just can't find any answers to my questions elsewhere. Certainly not with only 5 mins with my GP and I can't see the cardiologist until the end of the year. This forum has been so helpful and the question seems to have stirred up quite a lot of conversation!

OobieDoobie profile image
OobieDoobie in reply to bagsypartime

This is why I am asking the question - I have no idea if a 50% blockage should even be noticeable by me, or is it the medication causing me problems? What is the angina sensation all about in that case? I am just totally ignorant to it all, which is why I joined this forum 😀

Cyclefitness profile image
Cyclefitness

I found this book very useful to understand what damage a lifetime athlete may have occurred to the heart.

This book gives a very good insight
Kwakkers profile image
Kwakkers

Hallo, bonjour et gutentag. Another `newbie`; welcome to the forum. First, get a GTN spray.

Then adapt your running; start slow and build up s-l-o-w-l-y. You`ll soon "feel" when summats not right.......and STOP. Use the spray to ease the feeling and every day you`ll learn more about yourself.

My first (yea, first) heart attack was in `85 and I learnt to use the spray before exercise.

When the cardiac arrest occurred in 2011 the medics discovered I`d had five attacks, so they couldn`t operate. Implanted a defibrillator instead.

For 10 years I`ve been swimming 3 times a week and feel cathartic. 73 now and of course I`ve learnt to relax, listen to my body and call the helpline if needed. I also get a call if my heart is running a bit fast. Don`t knock the NHS......brillllliant back-up.

Oh, almost forgot. My aorta was about to "blow" after the arrest. Again, great back-up.

Read what you can. Listen hard to what the Medics say. We are ALL different and the pills have subtle differences with all of us. Listen to your body.

The rest of you commenting are damn lucky. You all seem to have returned to your sports, albeit less energetically than before. My (so-called) `Mates` at the judo club didn`t want to know me; can`t think Why, haha.

Fabrice Muamba (he of 78 minutes fame) popped into my hospital six months after me and we all (defibrillator wearers) had a chat. Tooooo much `high-level` sports training seems to be a factor in all this.

Like I said......take it EEEZEE.

Ta-ra.

bagsypartime profile image
bagsypartime in reply to Kwakkers

I'm trying to run.I go 60sec at 5mph then two min recovery on a treadmill.And I'm pretty out of breath.My gym work on the weight machines is more respectable.I've got one of those gin spray things and was quite insulted when they gave it to me and would never use it.Which goes to show we've all got different attitudes.

Ive got travel insurance £163 post cabg, but the spray was nuisance insurance wise previously because it is for angina and they give it to everybody-even people like me who don't/didn't need it.They said if i got excruciating pain use the spray.Initially I had angina when i tried to run, but then lost weight etc and never had it again, but by this time i was on the radar and my wife made me have the op etc.

To explain a bit more lost my holiday 3kplus because i had the spray.I cancelled the holiday because the surgeon said i might have an op (I did), not because i had angina but the insurance said because i had the spray it was a preexisting condition.

OobieDoobie profile image
OobieDoobie in reply to Kwakkers

Definitely going to be taking it easy. If I am not feeling right during the event then I have decided I will just come back down to the transport. No intention of signing up for anything in the future.

in reply to OobieDoobie

I think you are wise. Just let your body tell you what it feels. If you have time read some articles on the British heart foundation from well known sports personalities. Such as Graeme Souness and Roger Black. Both with heart issues., both different. It opened my eyes.

OobieDoobie profile image
OobieDoobie

Lol, that must mean that my 20 minute appointment with a cardiologist means that I now qualify to call him 'my cardiologist'. 😀

Milkfairy profile image
MilkfairyHeart Star

That's what happened to my brother in law. He had been reassured that his stress test showed no ischaemia, got on his bike and pushed himself a little too much.

He had an out of hospital cardiac arrest due a heart attack.

He's still with us, thanks to the quick action of an off duty life guard.

Always worth seeking out a cardiac rehab or exercise professional to help.

Persevere99 profile image
Persevere99

Hi

Did you know that only 20% of athletes tolerate statins compared to 80% of the general population.

Did the cardio tell you that for full informed consent to be given?

I bet they did not.

Google ‘what is the number one side effect of statins”? And, 100’s of answers will say just 1 thing - muscle aches.

Now, ally that with the fact that an athlete needs a good muscular system to exercise at their Max and what do you get? Way Below Par exercise.

See this Athletes and Statins study by Sinzinger and O’Grady for the truth.

Br J Clin Pharmacol. 2004 Apr; 57(4): 525–528. doi: 10.1111/j.1365-2125.2004.02044.x

Persevere - a lifelong high level exerciser

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