Question- Pre Heart Attack symptoms/future management.

[baly_2023]

Hi,

I'm back at work, getting on with life, taking my meds, being a good boy.

Had my STEMI in Nov 23. One culprit the LAD, all the rest were fine and I showed no residual heart disease, all other pipes were fine.

One question that I haven't had a clear answer from the cardiologist is this?

What should I look out for in the future?

Why am I asking?

Months, weeks, days, hours leading up to my HA I had no symptoms.

I would excericse hard, be physically active, had no chest pains, tightness,no shortness of breath, go for long walks but never had a moment of concern.

But it seems I went from code green to code red at a flick of a switch.

So any recommendations on specific health checks and at what time intervals I should ask for to ensure a similar event doesn't catch me out in the future

many thanks baly

[Happyrosie]

your doctor will be asking for a review annually, part of which will be blood tests.

Did you not have cardiac rehab? They will have gone through this with you.

[baly_2023 in reply to Happyrosie]

yes I had cardio rehabilitation but they didn't go through this. I will ask my doctor.

[Lowerfield_no_more in reply to Happyrosie]

Certainly no annual review after my NSTEMI. After cardio rehab I was discharged by the cardio team team. And the only testing I have is the annual lipid test, and no one has ever contacted me about those unless I have asked a question, and I have been on statins for over 25 years, and have a natural total lipid level of 9+!

[Teddy2022 in reply to Lowerfield_no_more]

Same here. No review after my NSTEMI either after cardio rehab. Just bloods done but haven’t had them done for over 6 months now. I now have an incidental finding of an aortic aneurysm, two years to the month, from my initial HA. Still waiting to speak to a cardiologist about my new diagnosis

[Mikeysaab]

I was in a similar situation, no symptoms or history at all then a HA out of the blue on Boxing Day. The deep question in my mind is ‘could it happen again?’. Like you I’m taking my meds, eat healthily and exercise. I joined the cardio rehab classes which have been brilliant, went to see my GP to discuss it all and he has me down for a review at the end of April. I will also join anything offered post cardio rehab. I can’t think of much else I can do and I think it’s important to try and live life normally as possible. Wishing you all the best as you ‘adjust’.

[baly_2023 in reply to Mikeysaab]

thank you and best wishes to you too ,I will ask my GP about future tests.

[Teddy2022 in reply to Mikeysaab]

Hi I did all of that too but left in mental tatters now. Should we be monitored more, I think yes, my aneurysm may have been picked up sooner

[Chappychap]

Annual checks at your GP for all heart patients are pretty much the standard here in Hampshire.

The check up is conducted by either your GP or a specialist practise nurse. It consists of a number of blood tests, an ECG. Your weight/BMI, heart rate and blood pressure are all checked, and there's a discussion about your life style choices and your medication.

Some key metrics that you can monitor are lipid levels, HbA1c, blood pressure, and weight. If you think that stress played a role in your heart condition then you may wish to also monitor your cortisol levels, but this will have to be done privately as it's not part of the standard annual NHS blood tests.

Having said all this there's no really effective early warning system for a heart attack. For those of us with heart disease (atherosclerosis), there are plaques scattered throughout our arteries, some will slowly harden and become stable, others can suddenly rupture and spill their waxy, liquid contents into the artery. The moment this contacts blood it solidifies, which can block the artery causing the heart attack (or stroke if it happens in an artery feeding your brain).

There's some evidence that statins, besides reducing lipid problems, also act to stabilise plaque. So that's double the reason to take them!

You questioned in your original post whether or not you had residual heart disease. I'm not medically qualified so you should really discuss this with your GP, but the likelihood is that you do have heart disease, but it may not be particularly advanced.

And here's one of the key dilemmas about heart disease, some people have seriously obstructed arteries but have never had a heart attack (I fell into that category), other people have relatively clear arteries but may have multiple heart attacks at an early age (think footballers having a heart attack on the pitch). The difference is their genetic propensity towards stable or unstable plaque.

All any of us can do is seriously tackle life style changes (and as well as the obvious ones like smoking, lack of exercise, poor diet, and obesity; there are several others ranging from gum disease to sleep problems), take our meds, monitor our key metrics...and hope for the best!

Good luck!

[Lowerfield_no_more in reply to Chappychap]

Annual checks at your GP for all heart patients are pretty much the standard here in Hampshire.

The check up is conducted by either your GP or a specialist practise nurse. It consists of a number of blood tests, an ECG. Your weight/BMI, heart rate and blood pressure are all checked, and there's a discussion about your life style choices and your medication.

All I can say is Wow! Nothing like that where I am elsewhere in southern England, As I said above all I get is an annual lipid test, and no feedback unless I specifically ask for it, and an occasional BP check if I happen to be with the nurse for anything. As for medication reviews for all my ailments that has never happened unless I asked for it.

[Lowerfield_no_more]

Be assured you are in a better place now compared to before. No doubt you have been prescribed medication, perhaps statins and an anti-platelet or anti-coagulant, and with the life style recommendations which are certainly covered within the cardio rehab course and on the BHF webpages including diet, exercise, body weight, alcohol and smoking, all this means your heart health risk has been reduced. Whilst medication will be a constant going forward, some for life, lifestyle measures are solely down to you and your resolve to 'do your best' to keep at it. Nonetheless whilst your heart risk has been lowered it cannot be reduced to zero, so all you can do is to be thankful you are still here, enjoy life, but be vigilant as to warning signs that things may not be as they should be, typically unexpected chest pains when you should of course be seeking medical attention.

[baly_2023 in reply to Lowerfield_no_more]

Chappychap Lowerfield_no_more thanks both for you replies, some good points and best to keep on that preventative mindset and take medicines.

The cardiologist report said he has no residual heart disease which I assume is a good thing.

[Jack2019]

There are two types of issues a person can have, without knowing, that can cause sudden heart attack. One is cardio vascular disease, that is your soft plaque ruptures in the arteries creating a clot, two is actual heart abnormalities , such as electrical issues, dissections, valve problems or heart failure etc.. So it is important to know what issue caused yours. If it is artery disease then life style plays a huge roll, if it is an actual problem with the heart, then that means interventions of some sort, eg. a pace maker. Unfortunately most heart attacks catch people by surprise. We are fortunate we survived and have another chance, perhaps even in better heart health than pre heart attack, to make necessary changes and/or receive modern interventions. Doctors and tests can not predict future events with certainty since there are so many factors. Eg. age is a huge risk factor but clearly not every older person has a heart attack, people with very high LDL or very low LDL and everyone in between do and do not have heart attacks.