Don't Ignore The Symptoms Of Heart Issues!!!!!!!!!

[Quietman]

This thread was prompted by reading of the passing of member Paradox. I only wish that I could inspire as many hikers as he did.

I hiked Skatutakee in NH last weekend and felt out of sorts. Had to stop a lot and catch my breath. Never happened to me before. Took a few walks earlier this week and had tightness in my chest, shortness of breath, and left arm pain. Today my dr says that I am looking at angioplasty or bypass surgery.

This said, I am not looking for any sympathy, just saying that I was really stupid to ignore the warnings that I was given on the Sakutakee hike. Dr said that I am very lucky as most don't get them, and definitely not saying that Paradox did ignore any warning signs.

I thought that it could never happen to me, and don't want anyone else to be the same. Don't ignore the obvious warnings just because we are hikers and exercise frequently.

Please learn from this!!!

RIP Paradox.

 

[hikerbrian]

Truth. My dad at 69 was as fit as they come, 5'7", 150 lbs, aerobic exercise several times a week, weight training on the weekends, etc. Felt off while rowing one day, went and hiked Cardigan the next day and had the same symptoms Quietman described. Tightness in chest, couldn't catch his breath, oral/gum pain; and these didn't subside when he stopped hiking. Never suspected heart trouble. I mean, he was in fantastic shape. Went to the dr's office the next day and was immediately sent to the hospital for emergency triple bypass surgery. He was 97% blocked in one artery. He never should have made it off the mountain. This was just about exactly a year ago, and I consider every single day bonus time at this point.

 

[RollingRock]

A friend in his late 40's that I hike with a lot experienced the same symptoms on a hike and doing yard work at his home. He was smart to get checked a few days later and had a stent placed in his heart. He is also on blood thinners now. Good thread as a reminder to everyone.

 

[peakbagger]

Some general cardiac rambling

Remember Jim Fixx, the individual who brought running back into the mainstream? Dead of heart attack at 51 despite being a big time runner. He had a family history of heart issues and thought he could run away from them. A former coworker passes away from heart attack two years ago on routine 50 mile bike ride, tall and thin athlete with few vices. They did an autopsy and reportedlyfound evidence of a couple of prior heart attacks.

First thing is its hard to beat inherited genetic conditions, things are getting better on that front but the goal is to square the curve to maximize life span, hard to outrun the genes Next thing to realize is "medical inc" in the US would much rather peddle lifestyle drugs than to deal with root causes. The European medical establishment have a different view of the causes of heart attacks and there are some folks who claim that a lot of atherosclerosis is caused by an inflammatory response to long term low grade infections in the body, gum disease, stress and smoking to name a few. Cholesterol is regarded as an intermediate issue. Its trying to smooth out the inflammation in the blood vessels which works in the short term but also restricts the vessel size and on occasion it will pull away from the vessel walls and plug the nearest tight spot. There is a test called precise CRP that grades the amount of inflammation in the blood vessels. Someone with a low number does not have to be so aggressive at treating other factors but those with high numbers have to be more aggressive. Its actually a far better indicator for an older women's risk of first time heart attacks as cholesterol numbers correlation with first time cardiac events are notoriously unreliable with that population. The problem with the test is it does not lead to a prescription for a long term drug. There was big JAMA study on this approach but it was not well received and several lesser followups had questioned the value. Web MD seems to still support it https://www.webmd.com/heart-disease/guide/heart-disease-c-reactive-protein-crp-testing#1

The current drugs of choices are statins and they do have significant side effects to some folks including myself and I went through a couple of years of side effects before I had to give them up. Joint issues, sore feet filling up with fluid after a hike, insomnia and a few others. I am not the only one, I have run into several folks prescribed statins that had serious side effects which impacted them significantly and it took them awhile to figure out what the cause was. I know other folks who can take them with no side effects and their cholesterol numbers reflect it.

I have heard from a couple of heart surgeons over the years that the plaques that cause the problems in the sixties probably were deposited in the 40s and 50s. By the time statins are prescribed there are already arterial plaques slowly waiting for their time to break loose. Reduce the amount of overall inflammation in the system and they may not break loose and new ones may not form. The bummer is the prescription to reduce inflammation is not easy, its lifestyle modification and maybe better dental treatment. About the only drug is low dose aspirin as its a systemic anti inflammatory. Unfortunately fortunes are not made with over the counter drugs so the quest goes on to hook folks on newer long term prescription drugs.

Due to my "statin intolerence" I have been a guinea pig for various other drug combinations including very high dose Niacin which has some interesting side effects. The usual game for statin intolerance is go to a specialist to see what drug has the least side effects and convince the person to take it and hope a better drug comes out. At some point my doctor figured it was time for the cardiac stress test and some sort of cardiac test where they inject dye and take scans of the blood vessels. When the tests were finished the cardiac doctor said no plaques or signs of plaques and I maxed out the treadmill. I wouldnt mind having it done in another few years and see if they can compare the two tests but most insurance plans discourage testing as it costs too much. My favorite past doctor knew I hiked most weekends and figured I was doing stress tests every weekend.

Years ago at VFTT gathering there was a hiker who I was talking to. Somehow the issue came up that he was living on borrowed time. No male in his extended family back several generations had made it over 50. He was 51. I am curious if he is still around.

 

[SpencerVT]

I think the moral of this story can be expanded to: Don't ignore symptoms of ANYTHING.
i.e. Hypothermia, Cancer etc....
My Aunt had pains for a long time and kept putting it off.... "didn't like going to doctors" type of thing - turned out she had Stage 4 lung cancer, which they could have caught up to a year earlier had she not put it off.
Hypothermia - same type of thing, you always gotta pay attention to symptoms and take what your body is trying to tell you seriously.

Good thread.

 

[JoshandBaron]

The current drugs of choices are statins and they do have significant side effects to some folks including myself and I went through a couple of years of side effects before I had to give them up. Joint issues, sore feet filling up with fluid after a hike, insomnia and a few others. I am not the only one, I have run into several folks prescribed statins that had serious side effects which impacted them significantly and it took them awhile to figure out what the cause was. I know other folks who can take them with no side effects and their cholesterol numbers reflect it.

That's the boat I am in. I was put on statins at age 30 because I lost the genetic lottery but the myalgia was so bad I had to come off of them. They didn't seem to have a significant enough effect on my cholesterol numbers that the doc decided a better diet and continued exercise was more effective. Last we spoke about it he was having reservations about statins' overall effectiveness and that the school of thought on them was changing. 35 and my numbers are still elevated but lower and I'm not in constant pain. No sense in trying to prolong life if you can't do the things that make you happy.

 

[Nessmuk]

Currently 67 yo, always had been fairly fit and athletic. A marathon canoe racer for the past 22 years (in the Adirondack 90 miler), including 3 Yukon River Quest 440 mile races and two Yukon 1000 mile races. As a kid I was a pretty good sprinter in track, but always hated long distance running. Always enjoyed hiking/backpacking for especially long distances easily and can paddle a canoe literally 24 hours at a stretch without distress. Biking long days was easy too.

But then Two years ago, during training for my upcoming Yukon race, I was pushing really hard riding a mountain bike on gravel roads in hilly terrain. Felt really good that day. The next day I felt like a slow slug on a road bike and returned home early. On the next day I suffered a TIA stroke, cause immediately unknown. Basic heart function checked out good, no artery problems, blood was good. However one cardiac specialist suggested checking for a patent foramen ovale (PFO), a hole between the upper chambers of the heart. A PFO is there because when in the womb, there is no need to send blood to the lungs, as is done to pick up oxygen when breathing after birth. As soon as you are born, a flap (the foramen) is supposed to close the PFO hole. But in as many as 26% of the population that fails to occur. Test showed that sure enough, I had an open PFO. Small blood clots are common in everyone, but are normally easily filtered out by the lungs. But if some blood is being shunted across the PFO, clots can make their way to the brain and cause a stroke. Thought is I probably developed a clot during my hard bike riding day. Bingo.

I recovered quickly from the TIA with no lasting bad effects (that I know about), but one cardiac doc put me on Xarleto, a powerful blood thinner to prevent future clots. I was cautioned to not stray at any time farther from a hospital than 2 hours because of potential ease of bleeding problems from thin blood. That meant the end to my Adirondack back country hiking and marathon canoe racing. Unacceptable. Most people (26% of the population) ignore a PFO if discovered and just stay on drugs. Not me! I found a nearby surgeon who specializes in closing the PFO and was willing to schedule me quickly for a repair. Thankfully (as is so far unusual for this procedure among other surgeons) he does the surgery with a probe manipulator sent in through the ribs, and did not have to crack my chest to open my heart. He found my PFO was 75% open, so he sewed around it twice, closing it permanently. What would normally have been a 6 month open chest recovery was now going to be only 6 weeks for me. No more drugs of any kind are necessary and I am cleared for all activity and exercise!

Two years later and I am still going strong, with another marathon Yukon canoe race behind me plus a couple of annual 90 miler and other races, along with hundreds of miles of training both on water and on machine, and all other means of exercise and hard work.

 

[ChrisB]

I think the moral of this story can be expanded to: Don't ignore symptoms of ANYTHING. i.e. Hypothermia, Cancer etc....

Amen Spencer.

Question -- Has anyone ever had a routine arterial scan?

I get come-on mailings about twice a year from outfits who'll "Be in my area soon" with a mobile scanner. For about $150 they will scan an evaluate all major arteries for blockage, evaluate bone density, and do a few other tests.

I've often thought of doing it, but have not. I don't think insurance pays for it either.

cb

 

[Stan]

Amen Spencer.

Question -- Has anyone ever had a routine arterial scan?

I get come-on mailings about twice a year from outfits who'll "Be in my area soon" with a mobile scanner. For about $150 they will scan an evaluate all major arteries for blockage, evaluate bone density, and do a few other tests.

I've often thought of doing it, but have not. I don't think insurance pays for it either.

cb

My wife and I each had one, probably out of curiosity at the time, and they did not reveal any blockages, which gave us a modest peace of mind. We discussed it with our primary care physician, whom we admire and trust, and his take was they could offer false positives and negatives. I think anyone should consult their most trusted physician to put the scan in perspective; it should probably be done in the context of a larger exam/tests for blockages which most insurance will cover. He also noted that some positive results may raise an unnecessary alarm about something that doesn't need treatment leading me to conclude that they be performed and interpreted by professionals and not an algorithm.

 

[Puma concolor]

It’s a good and interesting topic for sure and one I find myself thinking about with increasing frequency (still only 49, but that’s old enough).

Specifically, I wonder who is more at risk. Is it the guy/gal who has had an only mildly active (or even sedentary) early life and decides somewhere around midlife that he/she wants to get “out there” more and takes a cautious, non-aggressive approach to it all? Or is it the guy/gal who has been “out there” since early in life, always pushing him/herself and taking on big challenges ... and then just doesn’t know when it’s time to back off a little or a lot?

Increasingly, I think it’s the latter group at the most risk for heart attacks when engaged in vigorous outdoor activity. People who could just stop entirely if they so chose and live many more years if only they were so inclined. Except they’re not so inclined. Of course, there are genetic and specific other heart factors at play. But when measuring all of this, I think it’s important to establish which risk group you’re in.

 

[Hillwalker]

About eighteen months ago, my 66 year old younger brother Dan Wheeler died while skiing at Gunstock Ski Area in March. An autopsy showed 90% blockage. I immediately went in for an evaluation and was stress tested and given an Echo cardiogram which showed nothing really scary. About ten years ago I was given am Angiogram which showed nothing abnormal. I haven't smoked since 1976, and never was much of a Cholesterol consumer.

When I used to hike with Dr_Wu years ago, we would joke about me needing to carry a toe tag and ultralight body bag on my hikes. One never knows....

On my last five summer hiking trips to Spain I have carried a notarized and laminated set of instructions in the event I expire on the trail, and always carry repatriation insurance for hiking trips.

John was one of my volunteer AT Corridor Monitors working with me and Dartmouth Outing Club/Appalachian Trail Conservancy a few years back. He was responsible for the corridor section that runs around Smart's Mountain. I have included the only picture of him I have whilst digging out an AT Survey Monument on Smarts. RIP John



When I go again this coming summer I will do the same. I will be 79 in a few days and I think I can see the exit.

I have lived alone since I lost my wife in 2002 so there are no spousal issues to be concerned with.

My two grown children are up to speed with my lifestyle and decisions. I'm ready

 

[DayTrip]

Specifically, I wonder who is more at risk.

I think genetic predisposition/make up play a far larger role in this then activity level. Specific factors make arteries clog, many factors of which have nothing to do with activity level. Activity level and diet just seem to exacerbate existing problems with poor habits or make them less of an issue with healthy habits. It seems we all know someone who is the model of health and physical activity that has had a major heart attack. I also know many people who have horrendous eating habits and activity levels with zero cardiac issues. I think knowing your family history and getting regular blood work and check ups is the way to prevent disaster.

 

[Quietman]

Great info here. 10 years ago my father had 6 bypasses done at the same time and he is still doing good at 86. I never realized that genetic predisposition is such a large factor. Thanks for all of the information.

My stress test is scheduled for the 24th. Hoping that a stent or 2 will fix me for now. Good to know about the issues with statins as I'm sure that that topic will come up shortly!

 

[peakbagger]

That's the genetic and now epi-genetic lottery. Everyone thought that once the genome was decoded cures would be easy but now there is epigenetics and "junk DNA" that may not be junk that further confuse things. One thing pretty apparent is as folks get older if they don't use it they lose it. My father used to do talks for AARP and he had his standard " there are young "old people" and old "old people" and the young "old people" are not necessarily young and the old "old people" are not necessarily old. Depressingly I am starting to notice in folks my age the consequences of poor health decisions made years ago. I expect there are joint replacements for me in the future but no plans to give it up. Just running out of folks my age especially women who still want to hike and camp.

 

[Quietman]

So I had the stress test and nuclear imaging done, and I have one partial blockage. Went back and forth with the cardiologist and decided that since imaging doesn't show all potential blockages, we will go ahead with the cardiac catheterization and if there is only one blockage, he will insert a drug eluding stent.

Just took my 1st 10mg of Atorvastatin and will see how that goes, glad I'm starting with a low dose.

 

[Finnski]

So I had the stress test and nuclear imaging done, and I have one partial blockage. Went back and forth with the cardiologist and decided that since imaging doesn't show all potential blockages, we will go ahead with the cardiac catheterization and if there is only one blockage, he will insert a drug eluding stent.

Just took my 1st 10mg of Atorvastatin and will see how that goes, glad I'm starting with a low dose.

Good luck. Are you doing the procedure at Monadnock?

 

[Quietman]

Good luck. Are you doing the procedure at Monadnock?

Thank you Finnski! And your 1st post at that! Nope, I'm having everything done at New England Heart Institute at CMC in Manchester. From what I've been able to gather, they are the best in the area. I know that CMC has a satellite office at Monadnock, but if something goes south, I want to be at CMC. I have a friend who is a local EMT who says that whenever they have a patient with serious heart issues, they drive past Monadnock and go straight to CMC.

 

[Finnski]

Thank you Finnski! And your 1st post at that! Nope, I'm having everything done at New England Heart Institute at CMC in Manchester. From what I've been able to gather, they are the best in the area. I know that CMC has a satellite office at Monadnock, but if something goes south, I want to be at CMC. I have a friend who is a local EMT who says that whenever they have a patient with serious heart issues, they drive past Monadnock and go straight to CMC.

Your welcome. First post but maybe one of the longest lurkers on record. Been reading threads for years and years.
CMC sounds like a very good choice. I live in the Monadnock region and my wife is an RN of 33 years and I think she would agree with you!

 

[Quietman]

I arrived at CMC yesterday at 9am, was taken down to the procedure room at 12:30, was back in my room at 1:30, and was home at 7. They found that my main(right) cardiac artery was almost completely blocked, but were able to place a stent and open the artery back up. The xray images are cool and scary at the same time! They were also able to do the procedure through my wrist which was nice. Now I'll be on blood thinners for around a year to prevent clotting, and statins and new BP meds for life, which I am hoping is a long time.

Again, I was very lucky as the cardiologist stressed that most do not get the warnings that I had, and those who do don't always get attention quick enough. I was really stupid & lucky as I waited over a week after the 1st warnings.

Hope to be back out on the trails soon!

 

[Hillwalker]

Here's wishing you Happy Trails for lots of years. Good job.