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Post-Heart Attack return to cycling...share your experience

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Post-Heart Attack return to cycling...share your experience

Old 07-19-20, 12:57 PM
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Post-Heart Attack return to cycling...share your experience

I had a heart attack last August, two weeks after doing a 54 mile ride during a one day event tour. I am just now returning to cycling. I was long ago cleared by my cardiologist to return to physical training--just a month after the heart attack, actually. I did some hiking and walking, but never did get into higher intensity activities. I'll be sharing more details in the "Over 50" thread, as I turned 50 earlier this year. But I thought it would be nice to hear from other folks who have had a heart attack and how they incorporated cycling into their recovery regimen, and how they have progressed since. This could be very inspirational to others.

So, have at it!
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Old 07-19-20, 01:11 PM
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I had an open heart surgery Feb 2019 (not attack). The sternotomy has been the worst of it but the blood pressure med is also very limiting
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Old 07-19-20, 01:21 PM
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Originally Posted by Darth Lefty
I had an open heart surgery Feb 2019 (not attack). The sternotomy has been the worst of it but the blood pressure med is also very limiting
I had my aortic valve replaced when I was 25. The chest cracking caused the most pre-op annoyance, including back pain. But I was young and back on the trainer in 7 weeks.
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Old 07-19-20, 03:25 PM
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Originally Posted by indyfabz
I had my aortic valve replaced when I was 25. The chest cracking caused the most pre-op annoyance, including back pain. But I was young and back on the trainer in 7 weeks.
They're doing 'scopic robotic procedures now for mitral valves. It's coming along. But mine was a myectomy, they cut open my aorta to wiggle a knife through my valve into my heart to trim out a few grams of left ventricle sternum. No 'scopy for that yet.
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Old 07-19-20, 03:48 PM
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[QUOTE=Darth Lefty;21595980]They're doing 'scopic robotic procedures now for mitral valves./QUOTE]
Yeah. My department head had that a couple of years ago. The wimp took forever to come back to work.😀
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Old 07-19-20, 04:58 PM
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Originally Posted by Darth Lefty
I had an open heart surgery Feb 2019 (not attack). The sternotomy has been the worst of it but the blood pressure med is also very limiting
Which specific med, if I may ask, and how does it affect you?

I got an emergency stent a few years ago, and was encouraged to get back on my bike within less than a month. And I treated myself to a new bike. I was never a strong or fast cyclist, and am not one now, but I still ride whenever I can.
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Old 07-19-20, 06:22 PM
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I had quadruple bypass in Jan 2018 at age 56. My symptoms were occasional lightheadedness, out of breath while climbing stairs and occasional tingling in my left arm. Thankfully I did not have a heart attack and I was in reasonable shape from riding 100+ miles a week. Surgery was uneventful and only the chest cracking was painful for several weeks. Once I convinced the cardiologist that I just wanted to get back in the bike he okayed me to skip cardiac rehab. I was biking 37 days after surgery and back to my 100 miles a week a month later. I wear a HRM and have an avg HR in the 120s after a 25 mile ride. I watch my HR above 140 and top out at 160. Just keep riding.
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Old 07-19-20, 08:04 PM
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I had a heart attack 8 years ago at age 50 during an early season 25 mile solo ride. It was a simple out-and-back ride, but I didn't feel good the whole ride out, at the turn-around I felt like I had absolutely no energy. On the ride back my hands started to tingle and go numb, I got pain in my jaw, was sweating profusely, and started to get pressure in the chest. At about the 20 mile mark there were a number of hills, when I hit the first one and was barely able to make it up in a 30-28 gear I knew that I was done, so I did the only logical thing. I stopped and called my wife. She got me home, and after about a 1/2 hour things were better but no where near normal so we headed to the ER.

The first EKG showed an elevated ST, and the initial blood work showed elevated CPK and troponin levels. This was about 2 to 2 1/2 hours after I had my first symptoms. A half hour later the next EKG was normal, but my CPK and troponin levels continued to rise. They ended up peaking near levels that they said they would consider major heart damage had occurred, but with a normal EKG they felt I was out of immediate danger. Since it was a holiday weekend they decided to have the cardiac team treat me the next day.

The next day I was in the cath lab where they had both good and bad news. The bad news was that I had 70-80% blockages in the Left Cardiac Artery, the Circumflex, and the Left Anterior Descending Artery, and the blockages were located too far apart for them to install stents in all 3 before the anesthesia wore off. The good news was they saw no major heart damage and measured the ejection fraction at 74%, both indicating I had done little damage to the heart. So the next day I went in for a triple bypass. The surgeon said they found evidence that I had clotting that likely caused the MI and I had an abnormally narrow LCA, but after they restored blood flow to the heart everything was working normally. No damage as far as he was concerned. 3 days after that I was home.

By far the most painful part was the split sternum. My surgeon knew I was active and had added a few additional wires to help stabilize it, but it still takes 3 months to heal. The first couple of weeks a sneeze would have me sitting in pain for 5 minutes, not to mention the back/shoulder pain. That was probably the worst part of the whole ordeal. They had given me both beta blockers and blood pressure medication. As a result when I stood up I'd fall down, my blood pressure wouldn't increase enough to keep blood in the head. Dumping the blood pressure med fixed that.

Cardiac rehab was interesting. They are setup to handle people who are out of shape and need to strengthen the heart. They had issues with me since my heart was already strong. Early sessions were an eye-opener - they were the first time in my life I had worked out and didn't have discomfort in my chest. As they went on they discovered I developed an abnormal heart rhythm above 145 bpm. So I now have a hard redline at 145 bpm.

It took me a while to get back on the bike, almost 10 months. It was more confidence that I could ride without issues. Thankfully a co-worker who rode, along with his wife, a sports trainer as well as a cyclist, asked me if I wanted to ride with them. We went on several short rides (10-20 miles) and a few longer rides. It was enough to get my confidence back that I could ride again.

One of the cardiologist I see is a sports specialist, and he is concerned that I'm at higher risk to develop arrhythmia. The heart attack more than doubles the risk, and athletes who exercise more the 3 hours/week have a much higher risk. As a result he wants me to keep the total hours/week under 6 hours, and no ride should be longer than 2 hours. So my days of century rides is over. I now ride a couple of 1 hour rides, typically after work (normally they would be my commuting rides) and I'll take a couple of 2 hour/35-45 mile rides on the weekend.
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Old 07-19-20, 08:08 PM
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Originally Posted by Gresp15C
Which specific med, if I may ask, and how does it affect you?
Metoprolol. Puts a very low ceiling on my heart rate.
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Old 07-20-20, 07:22 AM
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Originally Posted by Darth Lefty
Metoprolol. Puts a very low ceiling on my heart rate.
Thanks. Same here. In my case, I was never a fast cyclist in the first place, and I didn't want to blame the meds when it could just be my lack of grit. But what I notice is that I can lumber along at a steady output, more or less forever. But when I'm with others and they want to go faster, I just don't have any more to give.
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Old 07-20-20, 07:48 AM
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I should say that the medicine that I'm on since my heart surgery is a lot less powerful than the cocktail I was on before. Surgeries are never a return to baseline, they always have their trade-offs, but I'll be able to chase my kids around for a few years while they are small. Who knows what the decades are going to bring?
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Old 07-20-20, 08:05 AM
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Originally Posted by Darth Lefty
Metoprolol. Puts a very low ceiling on my heart rate.
Originally Posted by Gresp15C
Thanks. Same here. In my case, I was never a fast cyclist in the first place, and I didn't want to blame the meds when it could just be my lack of grit. But what I notice is that I can lumber along at a steady output, more or less forever. But when I'm with others and they want to go faster, I just don't have any more to give.
I've had the discussion with my cardiologist about going off Metoprolol Succinate due to the heart rate limiting effect. I know and can feel that it limits my peak performance but it also helps enforce my 145 bpm redline. I can hit 135 pretty quickly, but it will take me several minutes of all out effort to hit 145. I don't race so I'm not too concerned about it, the benefits for a MI patient seem to outweigh the problems so I'm staying on it for now. I do think it is interesting that the cardiologist that wants me to limit my exercise also sees no issue with taking me off a performance limiting drug.
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Old 07-20-20, 10:09 AM
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I had a non-STEMI a bit over three years ago. Only symptom was I felt tired the day before -- after a 50 mile ride in early March (go figure!). Firefighters performed CPR, ambulance took me to the ER. No ST elevation, so the EKV looked normal; troponin was normal when I went in (although it went up later); it took about four hours to figure out 99% blockage of the LAD, and 6 minutes to stent it.

Rehab was interesting. Cute young nurse read me the riot act in 15 minutes on my diet before I left the hospital, with my M.D. daughter and B.S.N. wife taking notes. P.T. took a couple weeks, although by the time it was over I had my balance back (and cut my metoprolol down to half the smallest pill a day -- what the heck is "conductility?"). The first week in rehab we were watching the Food Network, until one lady asked, "We're all cardiac patients here. Why are you showing us all this delicious food when a serving of the first dish has 2,700 calories and the second one has 3,400 calories?" We never watched the Food Network the rest of the time I was there. I've taken off 45 +/- 5 pounds. All those fun machines! Show me the stationary bike and the rowing machine and I start sweating -- and my EKV leads start falling off.

A month into rehab, doctor, rehab nurse, and wife nurse agreed I could get on my bike for a short ride. Rode down to a quiet, dead-end street half a mile from home, did a couple laps, came back with a total of three (3) miles for the day, and collapsed into the Lazy Boy. I persevered, and did a one-week supported tour the next summer (some 400 miles in a week).
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Old 07-20-20, 01:16 PM
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Originally Posted by pdlamb
I had a non-STEMI a bit over three years ago. Only symptom was I felt tired the day before -- after a 50 mile ride in early March (go figure!). Firefighters performed CPR, ambulance took me to the ER. No ST elevation, so the EKV looked normal; troponin was normal when I went in (although it went up later); it took about four hours to figure out 99% blockage of the LAD, and 6 minutes to stent it.

Rehab was interesting. Cute young nurse read me the riot act in 15 minutes on my diet before I left the hospital, with my M.D. daughter and B.S.N. wife taking notes. P.T. took a couple weeks, although by the time it was over I had my balance back (and cut my metoprolol down to half the smallest pill a day -- what the heck is "conductility?"). The first week in rehab we were watching the Food Network, until one lady asked, "We're all cardiac patients here. Why are you showing us all this delicious food when a serving of the first dish has 2,700 calories and the second one has 3,400 calories?" We never watched the Food Network the rest of the time I was there. I've taken off 45 +/- 5 pounds. All those fun machines! Show me the stationary bike and the rowing machine and I start sweating -- and my EKV leads start falling off.

A month into rehab, doctor, rehab nurse, and wife nurse agreed I could get on my bike for a short ride. Rode down to a quiet, dead-end street half a mile from home, did a couple laps, came back with a total of three (3) miles for the day, and collapsed into the Lazy Boy. I persevered, and did a one-week supported tour the next summer (some 400 miles in a week).
tissue that has the ability to transmit electrical signals like a nerve.
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Old 08-24-20, 06:01 PM
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The Beta-blockers ( metoprolol, carvediol and others) that are the standard of care post MI make max HR almost impossible to use as a metric for training.
The consumer level HRM are not FDA quality, and are pretty bogus in terms of monitoring for maxHR and unless using R-R interval monitoring , for rate related AFib.
That's why you got the adenosine. They create data that is hard to make sense of, and why the things the doc uses cost $2500.
RPE is prolly as useful as the sensors. Garmin is promoting a Resp rate logger that may be more useful and hands down more practical, and it is still working out what will be compatible outside the limited Garmisphere.
Converting watts to METS for exercise is a nightmare, and , if you are not a jogger , the ETT will stress muscles you don't usually use and make you biking capacity an awkward correlate.
And that doesn't even approach thee issue of what happens if you get hit by a car while on blood thinners or DAPT.
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Old 08-30-20, 07:50 PM
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Originally Posted by Darth Lefty
Metoprolol. Puts a very low ceiling on my heart rate.
Yep. It is a governor for sure. The meds are the hardest part. Over time though, My body has adjusted to Metoprolol. When I first was put on it, I hit a brick wall at about 10 miles, was quite a surprise.
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Old 08-30-20, 10:59 PM
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My stent was installed during the winter, and by summer, we had booked a hiking vacation in the Rockies. Of course I went along. We had it in our plans to hike a couple of "fourteeners" which are peaks above 14000 feet altitude. There's a certain number of them, and most of them are attainable without the need for actual climbing. I was on the Metropolol, as I still am.

During the mountain hikes, I noticed that I could pretty much handle any distance or altitude, but only by trudging along at a particular pace. So, the kids would of course bound on ahead, while I trudged, and eventually they'd get tired and have to rest, and I'd catch up with them. I wasn't really thinking about the meds at the time, and just felt lucky to still be able to do the things that I enjoy.

I noticed one other thing. Before "the event" as my cardiologist refers to it, I was getting really tired in the afternoon at work, and also had a hard time driving for any distance without getting sleepy and having someone else take the wheel. After the stent, my "endurance" for just getting through a regular sedentary day went up. Now, this could also be because I changed my diet. I was at about 175, and lost 25 pounds, most of which I've kept off since then.
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Old 08-30-20, 11:01 PM
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Originally Posted by bikebikebike
The Beta-blockers ( metoprolol, carvediol and others) that are the standard of care post MI make max HR almost impossible to use as a metric for training.
Indeed, I asked the cardiac rehab person: What HR should I target? She said, don't. Instead, one of the goals of the rehab training is getting people to recognize other hallmarks of an appropriate workout level when they're exercising on their own.
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Old 09-01-20, 12:40 PM
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As someone who has a lineage of males in our family dying of heart attacks, reading stuff like this scares me.
I'm turning 50 this month, and I had a CT scan two years ago for the first time. They did find some blockage in my LAD. I want to say I had a calcium score of 160, with 100 in my LAD. I'm on daily does of Crestor now, 20mg, and a Vitamin D3 pill a day too.

I feel great. I usually ride a century a month, after work rides of 20-30 miles, and weekend rides of anywhere from 30-80 miles. But based off what I read above, most of you felt great up until 'the event". So every year, X-Rays, checkups, and daily doses of Crestor
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Old 09-09-20, 05:59 PM
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I guess i'm the latest member of the club. 17 days ago I had bypass surgery. I'm 56. I had no normal symptoms. The day of my event(s) I had what looked like 2 seizures in a span of 2-3 hours where I passed out for 30 seconds or so - no pain. My wife saw the last one & quickly called 911 ( 1st hint - don't delay this step) From the ER they had taken me up to neurology for tests again because it appeared they were seizures. I had a massive "seizure" there but really I went into cardiac arrest ( technically not a heart attack). They had to perform CPR. My wife had to witness this and a scary moment when the CPR equipment was not where it was supposed to be but her heroine in the story is a small ER doctor who ran their emergency portable backpack kit up two floors - fast! Angiogram confirmed the Left Anterior Descending ( "the widowmaker") was 100% blocked. And this stopped the blood going to my brain in what is called a cardiovascular syncope, passing out/ fainting. Bypass the next day. They could only fix 1 of the 2 they wanted but the other one is small. Their is no damage to the heart muscle, in fact they say my "squeeze" is exceptionally strong. and my heart had apparently adapted and opened up extra small arteries that helped pump the blood - hence no chest pain.

My dad died of heart disease at 70 with his 1st heart attack at 51. So had done a stress test 3 years ago and a calcium test 18 months ago. I passed with flying colors and less than 10% risk according to the calcium test. As I learned now at the age I am, and younger, the calcium test can be misleading because the blockage is more of a "jelly" than a calcification. Wish I had known. Go whatever extra mile your doctor tells you if you have family history- wish I had taken his diet advice to heart ( sorry).

Since March I had lost almost 50 pounds (225 to 177 at 5' 9") by pounding out the miles and changing my diet, mostly. I was putting in 40-60 miles a day 5-6 days a week. I wrote down everything I ate and estimated calories burned so I could manage the weight loss. BUT after a 60 mile ride I figured those calories could include a decent amount pastries or ice cream or cupcakes etc. I have had a ( super) sweet tooth forever. Sugar. That needs to change. If you have a sweet tooth please watch it. Calorie composition matters, especially if genetics don't favor you.

I am up to 4.5 miles per day of walking. My heart is not damaged. I am not experiencing side effects from the drug mix (statin, blood pressure, blood thinner, aspirin and a heart rhythm drug.) They think I can get off the arrhythmia drug in 2 weeks and hopefully the thinner in the next 3-6 months. My cardiologist friend thinks with an "improved" LAD my cycling might actually improve. Let's hope.

Thanks for bearing with me. I had a couple of questions for my predecessors; what physical hurdles and mental hurdles did you have to clear to get back on a bike? What about your spouses mental hurdles? Are you still on a blood thinner, if not what had to happen to get off that? I lost a bit of muscle in the hospital ( down 10 more pounds) - what kind of resistance training has anyone picked up? how long after the chest cracking?

Thanks.
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Old 09-10-20, 09:17 AM
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Welcome to the club. Sorry you're here. Glad you're still here. :/

Originally Posted by Beldar77
I guess i'm the latest member of the club. 17 days ago I had bypass surgery. I'm 56. I had no normal symptoms. The day of my event(s) I had what looked like 2 seizures in a span of 2-3 hours where I passed out for 30 seconds or so - no pain. My wife saw the last one & quickly called 911 ( 1st hint - don't delay this step) From the ER they had taken me up to neurology for tests again because it appeared they were seizures. I had a massive "seizure" there but really I went into cardiac arrest ( technically not a heart attack). They had to perform CPR. My wife had to witness this and a scary moment when the CPR equipment was not where it was supposed to be but her heroine in the story is a small ER doctor who ran their emergency portable backpack kit up two floors - fast! Angiogram confirmed the Left Anterior Descending ( "the widowmaker") was 100% blocked. And this stopped the blood going to my brain in what is called a cardiovascular syncope, passing out/ fainting. Bypass the next day. They could only fix 1 of the 2 they wanted but the other one is small. Their is no damage to the heart muscle, in fact they say my "squeeze" is exceptionally strong. and my heart had apparently adapted and opened up extra small arteries that helped pump the blood - hence no chest pain.
Some of this sounds familiar. My wife was convinced I'd had a stroke. Fortunately for me, one of the cardiologists she know saw her crying in the ED hallway and said, "Let me take a look." 99% LAD blockage, fixed in 6 minutes with a stent. Took me longer to recover, though.

My heart is not damaged. I am not experiencing side effects from the drug mix (statin, blood pressure, blood thinner, aspirin and a heart rhythm drug.) They think I can get off the arrhythmia drug in 2 weeks and hopefully the thinner in the next 3-6 months. My cardiologist friend thinks with an "improved" LAD my cycling might actually improve. Let's hope.

Thanks for bearing with me. I had a couple of questions for my predecessors; what physical hurdles and mental hurdles did you have to clear to get back on a bike? What about your spouses mental hurdles? Are you still on a blood thinner, if not what had to happen to get off that? I lost a bit of muscle in the hospital ( down 10 more pounds) - what kind of resistance training has anyone picked up? how long after the chest cracking?
I took me a couple weeks of physical therapy; one week to get my balance back, and another week to get my wife comfortable with my balance. I got (and still get) lightheaded when I stand up; I've only gone down once, a mostly controlled collapse that she saw, unfortunately. My cardiologist cut out one BP med and cut the other one in half shortly after that. After PT, I went into three times a week cardiac rehab, and with the approval of rehab nurses and my cardiologist got back on the bike about two weeks after that. 50 mile ride two days before MI and I was a little tired, slow 7 mile ride a month later exhausted me. But it was a sweet ride, just being back on a (moving) bike!

I was on an anticoagulant for a year, part of standard of care. Drop a spoon on your foot and you get a welt the size of a baseball. Boy, I'm glad to be off it even two years later! Do what the doctor tells you -- there are standard protocols to minimize overall risks that a good doc will follow.

I doubt you lost 10 pounds of muscle in 17 days, but it may be possible. My weight loss was part fluid (no salt in sight!), a bit of fat, perhaps some muscle, but I certainly lost coordination. Ask your doctor for a prescription to cardiac rehab. Mine got me moving on a treadmill and hand crank (not sure what they call it), then added stationary bike, rowing machine, elliptical, and finally free weights. And it's free (with medical insurance, assuming you've met your deductible).
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Old 09-10-20, 03:26 PM
  #22  
Beldar77
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Of course not all muscle

Originally Posted by pdlamb
Welcome to the club. Sorry you're here. Glad you're still here. :/



Some of this sounds familiar. My wife was convinced I'd had a stroke. Fortunately for me, one of the cardiologists she know saw her crying in the ED hallway and said, "Let me take a look." 99% LAD blockage, fixed in 6 minutes with a stent. Took me longer to recover, though.



I took me a couple weeks of physical therapy; one week to get my balance back, and another week to get my wife comfortable with my balance. I got (and still get) lightheaded when I stand up; I've only gone down once, a mostly controlled collapse that she saw, unfortunately. My cardiologist cut out one BP med and cut the other one in half shortly after that. After PT, I went into three times a week cardiac rehab, and with the approval of rehab nurses and my cardiologist got back on the bike about two weeks after that. 50 mile ride two days before MI and I was a little tired, slow 7 mile ride a month later exhausted me. But it was a sweet ride, just being back on a (moving) bike!

I was on an anticoagulant for a year, part of standard of care. Drop a spoon on your foot and you get a welt the size of a baseball. Boy, I'm glad to be off it even two years later! Do what the doctor tells you -- there are standard protocols to minimize overall risks that a good doc will follow.

I doubt you lost 10 pounds of muscle in 17 days, but it may be possible. My weight loss was part fluid (no salt in sight!), a bit of fat, perhaps some muscle, but I certainly lost coordination. Ask your doctor for a prescription to cardiac rehab. Mine got me moving on a treadmill and hand crank (not sure what they call it), then added stationary bike, rowing machine, elliptical, and finally free weights. And it's free (with medical insurance, assuming you've met your deductible).
Thanks for the kind words.

I know you are right and it was not all muscle, it just looks and feels that way in the mirror. The doc is now having me split my BP med in half and take one half in the morning and the other at night because I told her I was getting lightheaded when I stood up.

I want to do what it takes to get off the blood thinner because I don't want to take big risks but I do want to get back on the bike at least once, even if it is only 5-7 miles, before the snow flies here to get over that mental hurdle. I'm fine riding indoors for the winter to mitigate risk. but I hope to be occasionally outdoors at least in the late spring.

I am signed up for cardiac rehab starting next week. I hear that it is geared for people on the older end of the spectrum and that it might be too easy for me. Yours sounds more like what I would have hoped for.
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Old 09-10-20, 05:23 PM
  #23  
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After getting a ridiculous calcium score I'm headed to Johns Hopkins for a CT coronary angiogram next week. I had a stress echo this morning. I hope I can avoid going over the edge but all of your messages are very educational.
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Old 09-10-20, 06:53 PM
  #24  
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Good luck

Originally Posted by Marylander
After getting a ridiculous calcium score I'm headed to Johns Hopkins for a CT coronary angiogram next week. I had a stress echo this morning. I hope I can avoid going over the edge but all of your messages are very educational.
Marylander

Given that you are going for an angiogram I gather ridiculous is being used in the negative sense. I wish for a great outcome for you next week.
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Old 09-10-20, 07:43 PM
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Originally Posted by Beldar77
Given that you are going for an angiogram I gather ridiculous is being used in the negative sense. I wish for a great outcome for you next week.
Right, my coronary calcium score more than doubled in 2.5 years. I won't say the actual score as that might give someone else a heart attack. I'm certainly hopeful myself at this point. Thanks!
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