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?)