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So How Come I Had A Heart Attack?

01 Jan

When the news of my untimely demise broke, several questions, especially among my colleagues who knew my lifestyle, have buzzed. Why will this happen to him when he regularly works out in the gym? He keeps posting healthy food, why? He doesnt binge, he watches his food intake, he was fit. Why the heart attack?

I, myself wondered afterwards why this had to happen to me at my age of 38. Although, while not common, heart attacks may happen to adults as young as 25. When I was still in training in Manila, I had been working out at a popular gym for a year, though it was more for vanity’s sake, dysmorphophobia (fear of body deformation) — I was not sexy. When I went back home, just as soon as I was able to afford it out of my own income, I resumed working out, for the same reason. One day when my knee got injured, had my blood test done and accidentally discovered that I was having elevated triglycerides and cholesterol, my paradigm shifted and my workout was now a means of modifying my lifestyle. I only drink alcohol occasionally; I don’t smoke nor havent done drugs. Aside from this, I already began watching my food intake and started taking statins in an attempt to lower my abnormal lipid levels. No matter how much I tried, I was never able to bring my abnormal fat to normal or near normal level at the least.

I wasnt a perfect patient. I admit there were lapses on my medications and workouts. But overall the days I took my medicines were way more than when I didn’t; on days I was lazy, I still manage a day a week to work out. To check if I there were blocks in my coronary arteries (which will manifest as ischemia or infarction via ECG), I had ECG and all studies I had done showed normal results. This means that my heart walls were supplied with blood adequately. This means there are no clogging or narrowing of my coronary arteries. This then gave me an assurance, (a false assurance) that what I was doing with myself as far as my lifestyle modification, was effective. I however forgot to do a stress echocardiography.

Months before the tragedy, there were occasions when I was doing cardio exercises, I would feel chest tightness and slow down for a while. The chest tightness would abate and I will resume my routine. I was able to do latin dancesport, which is a rigorous dance. This could easily elevate the cardiac rate and trigger chest pain. But I was able to endure, finish all rehearsals without feeling any chest pain or tightness. I competed, did ridiculously difficult routines, finished them without tiring in the middle of the dance. And of course, we won.

Previously too I wasnt able to do running on treadmill. But two weeks before my attack, my endurance was already improving a great deal. I was getting inspiration and started to prepare for long distance running. In fact, five days to the attack my longest running time was seven minutes as opposed to the week before when I could only endure two mins then alternate with walking. (I know this is incomparable to runners out there). I was aware that my recent lipid levels were still abnormally deranged, the reason why I have intensified my dieting and workout. I didn’t miss my medication. The latest ECG was normal. With five years of such abnormal cholesterol levels, there should have already been narrowing of my coronary arteries and this will show as ischemia on ECG at the least. But there were none! So why would I suspect that I have some coronary artery block/s?

After I collapsed, became pulseless and revived, the team captain did an echocardiography, which showed that the septum of my heart was not moving. This must mean there was infarction or ischemia of the said wall and thus the non-mobility. When angiography was done, what surprised everyone was that there were two coronary arteries that were completely blocked and another one which was almost completely blocked. And for blocks to occur, this occurs over a period of time, not just at a whim, not just at the time when I was dancing during that Christmas party. So why then that if there were complete blocks, how come it did not show in my recent ECG tests? The interventional cardiologists, in addition to the finding complete blocks, found out that there were several collateral vessels. These collaterals were responsible in supplying blood to my heart walls not supplied by the blocked arteries, hence it was as if I was still normal. And this would explain why I was able to endure my workouts, why my ECG results remained normal and why I was still alive.

When my cardiologist attempted to dislodge the block and open the clogged coronary arteries, it was hard enough. Forcing to stent my coronary arteries might throw an embolus which might be displaced to brain arteries and cause a stroke. They did not continue such attempt anymore and thus the only option left was for me to undergo an operation.

What does this imply? The hardened block only means that the cholesterol depositing into my coronary arteries have been chronic event, longer than when I discovered I had a cholesterol problem. It could have started as early as childhood. Thus no matter how much dieting, working out I do or medications I take recently, it was too late to prevent the blocking, these could have not prevented me from having a heart attack. The attack may have just been delayed, but it was bound to happen. It was just waiting for the right trigger. On that tragic night, even if I keep denying it initially, I might have been fatigued and stressed, enough that the threshold for the heart attack to occur was reached.

It is not an assurance that just because one doesnt drink/smoke, works out, eats healthily, take medications, he is spared from cardiovascular diseases as stroke or heart attacks. Sometimes, even rigorous lifestyle modifications (diet, exercise, modifications) may not be sufficient to alter (suppress/express) the expression of a genetic abnormality (familial dyslipidemia) and hence, it will still manifest. (Boy, haven’t I just made myself an example of epigenetics, the subject I teach my students?)

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4 Comments

Posted by on January 1, 2013 in Personal

 

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4 responses to “So How Come I Had A Heart Attack?

  1. Mailman

    January 1, 2013 at 2:20 pm

    Hi Doc, nothing beats an article taken from personal experience. Very enlightening. Nobody can be complacent. As they say, “traydor ang puso”.

     
    • drclintonb

      January 1, 2013 at 2:22 pm

      Indeed. Thus my willingness to share so others could be saved from tragedy that I went through.

       
  2. Imel

    July 10, 2014 at 3:41 am

    I just came to your blog when I am trying to google my so many questions about why did my husband just like you a strong, active, athletic, healthy conscious ended with a Cardiac Arrest while playing basketball at YMCA with a LAD 100% blocked but with collateral circulation that supplied the affected area. Cardiologist unable to unblocked and stent it since it has been there for decades so he had Heart Bypass with LIMA. With God’s grace and prayers he is now home recovering and healing. Reading your article enlightens me a lot, I am a nurse myself and I tend to blame myself “what did I miss?How did this happen?” but as what you have said it was bound to happen no matter how cautious we are.I am just so thankful that the good LORD spared your life and my husbands life.GOD is good! I have still questions in my mind but I will continue to read your article maybe I will have the answer. Thanks, God Bless. Glad to know you practice in Baguio. We hail from La Trinidad,Benguet migrated in US.

     
    • drclintonb

      August 14, 2014 at 1:22 am

      check on the quality of food that you eat, no matter how much he exercises. Of what causes one to gain weight, 90% of which comes from the diet, only 10% from exercise.

      Here’s one thing I can share: do not avoid bacon, but dont indulge on it on a daily basis. He may have some saturated fats but on moderation.
      Second, avoid simple sugars (pastries, chocolates – unless dark, and occasionally) as simple sugars and polyunsaturated fatty acids apparently causes inflammation of blood vessels which traps cholesterol, even if your cholesterol level is normal –> blockade of artery.

      He is lucky that LIMA was used for his bypass. I learned that the patency of which lasts for about 10-15 years. Unlike saphenous grafts (which was used in my case) which only lasts about 5 years.

       

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