Heart Attack and Returning to Cycling

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techsupport
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Heart Attack and Returning to Cycling

Postby techsupport » Sat Jun 23, 2018 7:45 pm

Hi,


I had a heart attack last week, an Angiogram was performed and they found my bottom artery in the heart was completely blocked. A stent was inserted and now recovering in Hospital, I should be out on Monday. I will wait a couple weeks before I get back on the road and thinking I should start on the Zwift Trainer for short rides before I return to the road. My question is will I still be able to ride as hard as I did before? I am no fantastic cyclist but always chased that EPIC suffer score and beating my PB's.

Has anyone else had a stent inserted and returned to cycling? What are the main things I should look out for when returning to the bike?
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Re: Heart Attack and Returning to Cycling

Postby Nobody » Sat Jun 23, 2018 8:29 pm

Sorry to hear you had such a serious problem. I suggest you have a close look at your diet since it will be more helpful than medication. The site below should demonstrate the power of diet for such maladies.

http://www.dresselstyn.com/site/articles-studies/
http://www.dresselstyn.com/site/

I'm confident the experienced in heart attacks will chime in. But I can't see why you couldn't eventually ride as hard as before, other than it could trigger another heart attack. If you've been riding a lot before, then it's clear that cycling isn't saving you from this condition. So there's no hurry.

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Re: Heart Attack and Returning to Cycling

Postby nickobec » Sat Jun 23, 2018 11:39 pm

techsupport wrote:Has anyone else had a stent inserted and returned to cycling? What are the main things I should look out for when returning to the bike?


Yes, heart attack while riding, two stents, returned to cycling and then took up racing.

I was lucky, the two stents were inserted within an hour of my heart attack, no serious damage.

You need to understand the medication you are prescribed and how it impacts on your body and the impacts on riding.

Beta blockers, lower your heart rate, how much power you can put out, but can be burnt off by hard riding.

For example while using beta blockers, early in race if my heart rate hit over 150 I would be out the back. After an hour my heart rate would hit 160 and peak at 170 in the final sprint.

5 years after heart attack, now off beta blockers, still racing, heart rate max is over 180 and beating all PBs (including pre heart attack)

Asprin (and other blood thinners) you bleed a lot, even from smallest scratch (live with it)

Ace inhibitors, lower blood pressure, but not real impact I can see.

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Re: Heart Attack and Returning to Cycling

Postby ValleyForge » Sun Jun 24, 2018 5:53 pm

Nobody wrote:I suggest you have a close look at your diet since it will be more helpful than medication. The site below should demonstrate the power of diet for such maladies.


Ahh, let's compare apples with apples. Diet is important in coronary artery disease risk reduction, but we are talking post-infact here.

The Anti-factor Xa agents you will no doubt be on now (Plavix, aspirin, et al) are life-saving and need to be maintained to keep the stent open.

The best thing you can find is a cycling Cardiologist or Physician (believe me there are lots) who will give you a sympathetic reception.
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Re: Heart Attack and Returning to Cycling

Postby mikesbytes » Sun Jun 24, 2018 7:56 pm

You should seek professional advice. Each experience with this situation is different so what has worked for someone isn't necessarily the right path for you
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Re: Heart Attack and Returning to Cycling

Postby ColinOldnCranky » Sun Jun 24, 2018 8:03 pm

I would think that in most cases you would be required build up as so many victims fall foul of bad overall health. HOwever I expect that there are many in this cycling demographic where they do not fit into "most".

In my case, and mine was a usually fatal heart ARREST compounded by a twenty minute delay in the defib, I left the hospital a week later with the blessing of my cardiologist and others, to exercise at the same level. But I showed up as very fit, and the stent was seen in my case sufficient to address the issue. It was that damned annoying bit of plaque.

I suspect that the common stereotype of having to build up in small increments is of those whose overall health was such that even before the attack the level of exercise undertaken was greater than their safe capacity to do. If you had a solid level of cardiovascular fitness before then, with the stent in place, it's not beyond the realm of possibility that you would pass a stress test with ease. But whatever, ask the question and go with the response from your cardiologist. If he/she gives you the tick of approval then you could probably feel secure, on the assumption that he/she would err comfortably on the safe side.

Ask. If the answer is yes then go with it. If not then take it easy, it's not like you HAVE to be doing criterions this very today.
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Re: Heart Attack and Returning to Cycling

Postby ColinOldnCranky » Sun Jun 24, 2018 8:13 pm

Nobody wrote:Sorry to hear you had such a serious problem. I suggest you have a close look at your diet since it will be more helpful than medication. The site below should demonstrate the power of diet for such maladies.

http://www.dresselstyn.com/site/articles-studies/
http://www.dresselstyn.com/site/

I'm confident the experienced in heart attacks will chime in. But I can't see why you couldn't eventually ride as hard as before, other than it could trigger another heart attack. If you've been riding a lot before, then it's clear that cycling isn't saving you from this condition. So there's no hurry.

With respect to cholesterol problems, the advice has shifted some time ago from change in diet to statins, diet proving to not be very good at reducing those nasty little deposits of fat and glug.

However, wrt diet, diet aimed at bringing in a healthy weight IS still considered to be the right approach.

So, control weight AND take statins if cholesterol is an issue.

But importantly, talk to your cardiologist before you act on advice from me or anyone else on this forum.
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Re: Heart Attack and Returning to Cycling

Postby ColinOldnCranky » Sun Jun 24, 2018 8:15 pm

ColinOldnCranky wrote:
Nobody wrote:Sorry to hear you had such a serious problem. I suggest you have a close look at your diet since it will be more helpful than medication. The site below should demonstrate the power of diet for such maladies.

http://www.dresselstyn.com/site/articles-studies/
http://www.dresselstyn.com/site/

I'm confident the experienced in heart attacks will chime in. But I can't see why you couldn't eventually ride as hard as before, other than it could trigger another heart attack. If you've been riding a lot before, then it's clear that cycling isn't saving you from this condition. So there's no hurry.

With respect to cholesterol problems, the advice has shifted some time ago from change in diet to statins, diet proving to not be very good at reducing those nasty little deposits of fat and glug.

However, diet aimed at bringing in a healthy weight IS still considered to be the right approach.

So, control weight AND take statins if cholesterol is an issue. (And any other meds prescribed.)

But importantly, talk to your cardiologist before you act on advice from me or anyone else on this forum.
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Re: Heart Attack and Returning to Cycling

Postby Nobody » Sun Jun 24, 2018 8:47 pm

Sorry for not being more concise. I assumed that someone would listen to their doctor's advice first, since there is this sticky at the top of the Cycling Health topic which explains that clearly. Assuming is obviously a mistake.

Just trying to help. I'm out. :arrow:

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Re: Heart Attack and Returning to Cycling

Postby nickobec » Mon Jun 25, 2018 12:29 am

As the other have said, speak to your cardiologist and your GP. From my experience they are supportive of getting you back riding, not only from my personal experience but from friends and other racers who have stents, valve replacements, pacemakers and triple bypasses.

There should be no reason why you can't get back to riding at the same level (or even higher) you did prior to the heart attack. The stent is not going to restrict you, the medications as I stated earlier can, but you can learn how to deal with that.

Post op, I had access to a specialist physio who started me on very light exercise on a trainer. In 6 weeks and I was back on my semi regular 42km commute, it was low intensity and slowly built the volume up over pre heart attack as I need to shift a few kgs. Cardiologist was very supportive, we did talk bike and training, as he was a triathlete. Did a stress test, then got the ok to up the intensity, never looked back.

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Re: Heart Attack and Returning to Cycling

Postby uart » Tue Jun 26, 2018 11:45 am

techsupport wrote:Hi,
A stent was inserted and now recovering in Hospital, I should be out on Monday.

When you are discharged from hospital they will probably give you instructions to build up your exercise over a number of weeks. For example, starting with easy (10 to 15 minute on level ground) walks twice a day, and building up from there. They will certainly want you to be exercising regularly, but not too high intensity too soon. Talk to them about including some easy bike rides in the recovery schedule, and also about the time required to get back into moderate intensity riding (which from memory was about 6 to 8 weeks for someone I know).

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Re: Heart Attack and Returning to Cycling

Postby CKinnard » Tue Jun 26, 2018 3:32 pm

It's been several decades since I worked at Brisbane's leading cardiac hospital (TPCH).
We used to ramp people up in the rehab phase following very objective protocols, down to using watts on stationary bicycles (while connected to ecg).

From my understanding of current trends, things have evolved but general principles are similar.
- Low intensity at first in shorter blocks
- develop lower limb cardio first (walk, exercise bike), delay strength ex (stairs, squats)
- keep upper limb and trunk exercise/activity very light for the first months. delay heavy lifting for 4-6 mths.

You definitely want to take on board the effect of diet.
If you had a 100% block of ?LAD, then your diet and lifestyle must have been sub par previously.
And if you had silent ischaemia prior (no angina symptoms), then you may also NOT get sufficient indication of when you are overdoing the exercise moving forwards.
And you want to talk to your doctors about the risk of reblocking the same artery, or another artery developing a block. It would be a mistake to think your other coronary arteries, or your carotid and vertebral arteries are hunky dory.

This is where changing to a healthier diet can make a lot of difference, and weight loss if overweight (even by 5kg).

Either way, if you want the best outcome, definitely see a cardiac rehab service and their dietitian.
If the dietitian hasn't heard of Caldwell Esselstyn (who Nobody linked to), Neal Barnard, or Dean Ornish, find another.
Your rehab may be very differnet to others depending on how long you were suffering the heart attack, and how much coronary muscle or nerve was compromised.

As for ongoing medication, saying they help keep the stented artery open is a misrepresentation.
The stent is a stiff wire tube! The meds actually help prevent plaques re-develop or emboli to lodge. Diet has a very significant role in doing the same. (How do you think your artery blocked in the first place?)
Many people on the meds have difficulty getting the dose right, and can have dangerous fainting episodes, sluggish energy, and poor blood clotting ability.

It is possible to reduce meds significantly if you clean the diet up and other lifestyle factors. But the two need to be adjusted ideally by a doctor experienced and understanding of how to do so....which is very few.

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Re: Heart Attack and Returning to Cycling

Postby ValleyForge » Tue Jun 26, 2018 4:09 pm

CKinnard wrote:As for ongoing medication, saying they help keep the stented artery open is a misrepresentation.
The stent is a stiff wire tube! The meds actually help prevent plaques re-develop or emboli to lodge. Diet has a very significant role in doing the same. (How do you think your artery blocked in the first place?)
Many people on the meds have difficulty getting the dose right, and can have dangerous fainting episodes, sluggish energy, and poor blood clotting ability.

:roll:
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Re: Heart Attack and Returning to Cycling

Postby CKinnard » Tue Jun 26, 2018 9:41 pm

:shock:
Best practice is for post stent procedure cardiac rehab programs to make permanent dietary recommendations to delay stent complications or failure:
i.e.

https://www.svhhearthealth.com.au/rehab ... y-stenting
"After your angioplasty/stenting, you should focus on eating a healthy diet. This will help your body to heal, reduce your risk of complications and enable you to recover well. A healthy diet will also reduce the risk of plaque building up in your arteries again."

https://www.svphm.org.au/our-services/l ... ab-program
https://www.mayoclinic.org/tests-proced ... c-20384761
https://my.clevelandclinic.org/health/t ... it-include
http://www.dresselstyn.com/site/success-stories/

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Re: Heart Attack and Returning to Cycling

Postby ValleyForge » Wed Jun 27, 2018 11:31 am

CKinnard wrote::shock:
Best practice is for post stent procedure cardiac rehab programs to make permanent dietary recommendations to delay stent complications or failure:

Compare apples with apples.
Early post-procedure stenosis or early stent blockage may well be fatal. This is not influenced by diet nor rehab programs. It is prevented by aspirin and anti-Factor Xa agents.
Current literature leans strongly toward agressive lipid-lowering medication rather than diet manipulation as being more effective in the medium to long term.
And a stent isn't stiff. :wink:
And coronary artery occlusion isn't embolic.
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Re: Heart Attack and Returning to Cycling

Postby CKinnard » Wed Jun 27, 2018 2:20 pm

ValleyForge wrote:
CKinnard wrote::shock:
Best practice is for post stent procedure cardiac rehab programs to make permanent dietary recommendations to delay stent complications or failure:

Compare apples with apples.
Early post-procedure stenosis or early stent blockage may well be fatal. This is not influenced by diet nor rehab programs. It is prevented by aspirin and anti-Factor Xa agents.
Current literature leans strongly toward agressive lipid-lowering medication rather than diet manipulation as being more effective in the medium to long term.
And a stent isn't stiff. :wink:
And coronary artery occlusion isn't embolic.


Yes the early days rely most on drugs to stop blockages from bleeds, and AF related embolic coronary artery occlusion.

The medium to long term scenario is diet intervention specific.
Some dietary interventions are a one page handout with drawings on it, given at discharge.
Many diet vs drugs studies are funded by pharmaceutical companies who select diets known to have minimal effect.
More impartial diet studies improve a greater range of markers that impact outcome - cholesterol, inflammation, insulin resistance, and oxidation.
Clumping all diet interventions together is bad science, bad clinical practice, and favors pharmaceutical companies. i.e. it isn't apples vs apples.

Either way, I didn't imply drugs OR diet intervention, but rather diet intervention can reduce drug dose...which is a good thing if you read the side effects carefully and understand long term effectiveness.

A stent has enough radial stiffness to keep an atherosclerotic artery open. It does little to stop plaques forming again. Diet does.

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Re: Heart Attack and Returning to Cycling

Postby CKinnard » Fri Jun 29, 2018 7:31 am

rotten apples


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