Tuesday, April 26, 2011

On the road again

The Heart of the Matter

I'm fine now. Yesterday I rode my bike 30 non-stop miles. Six weeks ago, though, I lay writhing on the ground, hands clutching my chest, in the midst of a serious heart attack. A blood clot was clogging one of my metal stents, which is a tiny tube that holds a once-clogged artery open. The clot was in my left coronary artery, also known as the "widow maker" artery.

As one health-oriented website puts it, "There is no term in the medical lexicon more ominous than 'widow maker.' This condition, a full and complete blockage of the left anterior descending coronary artery, is fairly rare but exceptionally lethal, having the ability to kill a patient in an instant."

Apparently, I'm tough to kill. My "widow maker" attack took about 20 minutes to almost kill me.

Earlier in the day, I'd pedaled my bike over to the base of the Baldwin HIlls Scenic, in nearby Culver City. The road that leads steeply to the top is about a half a mile long, always offering me a good workout and one of the best views of the city from on high. That day, I'd ridden to the top of the hill three times, and I felt stronger each time than I had in the past few decades on my bike. How that could be I could not explain. It was as if I'd reached a new level of physical fitness.

Fifteen minutes after heading back towards my home, I stopped to visit with a friend who lives a few minutes from my home. As we talked, I felt like I had a little indigestion. That feeling kept increasing, a feeling I knew was a potential sign of a heart attack. Surely that wasn't possible, for I'd just had my strongest bike ride in twenty years.

The feeling of indigestion wouldn't go away. As I left my friend's home, I thought, "If I'm having a heart, I won't last long on my bike." In fact, I lasted about a block, and admitted to myself that something was seriously wrong. I climbed off my bike and sat on the grass. I took my pulse, which was beating fast and beating erratically. There was no doubt, I was having a heart attack.

Still, I resisted the obvious: call 911. Instead, I called my wife, and asked her to pick me up and drive me a few blocks to the Kaiser Permanente hospital, just down the road. I knew I was supposed to call 911, in that way assuring a medical team would be waiting for me at the hospital. Instead, I then called my older daughter, who'd just stepped off the plane in New York, after her marriage in Los Angeles a few days earlier, and I left a voice message for my younger daughter. I told them both that I thought I was having a heart attack and that I loved them.

Then I swallowed some aspirin I carry with me for just such an emergency, and I put a nitroglycerine tab under my tongue, which brought no relief.

Kathy arrived shortly thereafter, and rather than drive me to the hospital, she commanded me to dial 911, and told me to tell the dispatcher to have the paramedics meet me at our house. At that point, I still felt reasonably OK. I put my now-disassembled bike into the truck of the car, and I climbed into the front passenger seat. Two minutes later we were at our home. When I opened the door of the car, my condition had worsened enough that I could only fall to the ground. Now my chest felt some pressure, a lot of pressure, and that feeling just grew, until I was gasping for breath and clutching my chest, which felt like an elephant was sitting on it.

I did have the presence of my mind to ask Kathy to pull my cell phone from my bike jersey pocket and make a photograph of me, in case I survived. I thought it would make for an interesting image for this blog. Kathy had the good taste to refuse my request. Anyway, I certainly I thought I could die, so I wasn't too concerned at the lack of documentation.

About 20 minutes had passed since I felt that first intimation of indigestion at my friend's home. I could hear the approaching siren of the ambulance, and by now several neighbors had gathered around to comfort me. Breathing was becoming more and more difficult. The rescue squad – an ambulance and a couple of fire trucks – arrived, the situation was quickly assessed, and I was loaded into the back of the ambulance, with Kathy ushered up front. We were off, not for the Kaiser facility, but to the highly regarded Cedars-Sinai hospital, also close by.

A paramedic said, "You're having a heart attack, sir." More nitro and aspirin did nothing to relieve the pain. Those drugs couldn't help because, while nitro and aspirin help thin blood and open up arteries, the blockage was in my metal stent, which was never going to expand.

When I arrived at the hospital, the cardiac team was waiting for me. It was a "Code White" situation, that is, I was in serious distress. The team cut off my bike jersey, ironically one I'd purchased after riding the Solvang Century, a 100 mile ride each March that raises money for cardiac rehabilitation programs. As I lay on a gurney with most of my clothes off, in a cool hospital room, my body started to shake a little. I thought it likely I was going to die. I felt no conscious fear, though; I wasn't praying to God or the doctors to save me. I wonder, though, if that shaking didn't come from an unconscious fear of death. Or maybe it was the cool room, the drugs that were now inside me, and the heart attack that caused the shaking.

This happened way too often

A few minutes later I was in the "cath lab," still shaking, despite my efforts to control it, and a few minutes later a catheter had been inserted into my femoral artery, in my leg, via a small incision in my groin. The catheter was then guided up my body, towards my heart. Real-time X-ray showed the cardiac team where my blockage was. The doctors quickly removed the clot, and inserted yet another stent. I went from a state of semi-consciousness to a vast sense of relief, as blood once again reached my heart.

Apparently not many people survive when the left descending coronary artery is completely blocked. That artery supplies blood to an extensive area of heart muscle. Collateral circulation, where other blood vessels are formed and branch out over time, suppling extra blood flow, probably helped keep me alive. Where did those extra blood vessels come from? Probably my years of cycling.

One of the doctors who's operated on me came by my room. "You were maybe five minutes from death," he said. "Worst case scenario," he said, "you need a pacemaker. You did some serious damage to your heart." Indeed, my heart rate was still somewhat irregular, it was 50 beats above normal, and occasionally the beats would shoot up to about 145 for a few moments.

The lack of blood had shorted out the finely-balanced electro-chemical reactions that allow the innumerable cells that make up the heart to beat in tandem. Instead, chunks of my heart were operating independently of each other. My heart wasn't pumping blood to the rest of my body very well; I was pumping out less than half the normal volume of blood with each beat.

A few days later, I left the hospital with some special medication to help keep my heartbeat under control. A few weeks later I was back on my bike, riding slowly around the block at first, and then on longer rides (in fact, I had a six mile ride with Lance Armstrong, chronicled earlier in this blog, less than a month after my heart attack; yes, I probably overdid it a little, but what a great way to go).

Yesterday, I had a visit with my cardiologist. My heart is apparently almost back to normal, with only slight damage: an echocardiogram showed that one of my heart valves is a little sticky, and it might fully recover in time.

Meanwhile, I've ridden up that hill in Culver City again – slowly – pedaled to the top of the Santa Monica Mountains – slowly – and sprinted along the Ballona Creek Bike Path. With my easy exercises, and walking our new dog, who arrived a week after my heart attack, all over the neighborhood, plus attending a few sessions of cardiac rehabilitation, my heart seems to be working more efficiently than ever. My wake-up heart rate is 43 beats per minute most mornings now (down a few beats from before), and I feel as good as I did before my heart attack, on and off my bike.

I am very lucky. Or hard to kill. Or both.

As to why I had that clot form in my stent, I'll save for another blog entry.

Three terrific nurses. No wonder my heart was in afib.


christopheru said...

What an inspiring story. I am pleased to hear that you are recovering well.

Christine Krieg Photography said...

I'm glad you survived Dave. But honestly I don't understand your reaction and POV. Why didn't you call 911 at the first sign of trouble?

Dave said...

Christine, denial is a powerful force. As in, "It can't be happening again!"

Plus the symptoms of my second heart attack were a little different from my first, so I had some hope that something else might be going on, like arrhythmia, rather than a full blown heart attack.

In retrospect, yes, once I felt my erratic heartbeat, I should have called 911. Still, denial is a powerful force.

Christine Krieg Photography said...

Well okay, yes, denial is a powerful force, but more powerful than the threat of death? I wonder, in retrospect, do you feel like you acted a bit like one of the guys from "The Perfect Storm"? with the only difference being you were damn lucky to survive?

Peter said...

OMG - this sounds like me all over again. I was riding up a hill with my wife in tow and starting to get sharp pains. I was determined to be a silly macho and ignore it but my wife nagged me like hell to see a doctor; and to cut a long story short, it was that same left anterior descending artery, 90% blocked. I now have a stent in there, and am eternally grateful to my loving wife's female commonsense. And I'm also grateful to you Dave for reminding me that those stents can get blocked again and I need another checkup.
And by the way Dave, I think you should stay off the pizzas - that cheese is a killer too!