I'm not a doctor but…
Cycling injury, recovery and health issues.
The information / discussion in the Cycling Health Forum is not qualified medical advice. Please consult your doctor.
I have mentioned this a bit in the 6k Club thread but I thought I would go into a bit more detail here in case it helps someone.
Me: I'm a 45 years old healthy male, 46 in two weeks. I've been riding two years and have lost 10kg and got my fitness to a level I'm very pleased with. I commute to work most days and ride 50-100km on the weekend.
Two weeks ago i was riding 70km with 6 mates. This was a ride I had done before a few times and included some serious climbs. I felt strong and actually broke 3 PBs along the way. Towards the end of the ride I felt that I had indigestion after we stopped for coffee. I really felt nothing more than that and it did not slow me down.
When I got home the pain started to intensify fast. Within 10 minutes I had to go lie down. Then I broke into a cold sweat and I knew I was in trouble. My wife came to check on me and saw I was not well so she grabbed my mate who is a Dr. He checked my BP (which was normal) and decided it was best to call the ambulance. Next thing I knew I was in hospital on an ECG with all sorts of drugs going into me. The pain was really bad and the morphine only dulled it.
Soon I was transferred to the High Dependancy Unit and was given a life saving drug called Metalyse to rapidly break down clots. I could feel it going through my body like a wave and the pain subsided within 15 minutes. Life saved!
The next day I was sent for an angiogram where they shove catheters up your femoral artery via your groin, inject dye and x-ray your arteries. The short answer was that my arteries were normal with minor plaque. The Dr said sometimes "showtime happens".
I stayed in hospital for another day and sent home to rest with a bag full of tablets to take.
Two weeks later I was off to the cardiologist;
My arteries appear to have a minor amount of plaque or build up in them which is considered normal for someone my age. This plaque is like a thin, lumpy build up on the walls of your arteries. He said that these can peel away at the edges and sometimes form like an ulcer. Stress may increase the chance of this happening. In my case what he suspects has happened is that a part of the plaque in my LAD (left anterior descending) artery has peeled away from the artery wall and allowed the blood to flow behind it. This would have caused the initial discomfort that I felt on the ride. Once this happens the heart thinks the artery has ruptured and is bleeding so it forms a clot really fast. This clot then blocks the LAD which causes a Acute Myocardial Infarction or rapid and intense heart muscle death. This was the intense pain I felt when we called for the ambulance. The Metalyse drug they gave me in hospital dissolved the clot very fast and allowed the blood and oxygen to flow to the heart again. He thinks the site was near a bend in the artery which when exercising vigorously will be flowing more and cause the plaque to peel away faster. Maybe....
The cardiologist performed an ultrasound on my heart today and found that the residual damage at the site of the clot is minute. The bottom of the left ventricle is showing some damage from being starved of oxygen in that it is not moving as fast as it should. This may fully recover quickly or it may take time. The ultrasound also showed that I have developed a new clot near the base of the left ventricle which was not there last monday when I had the angiogram. He said that is caused by the stress of the events and may be because that part of the heart is a bit lazy.
He has given me Clexane which I have to inject into myself twice a day over the weekend to thin the blood fast and hopefully dissolve this clot. He also put me on Warfarin and was surprised they did not prescribe it when I left the hospital. This will also help thin the blood. I have a blood test on Monday to determine if the Warfarin has become affective so I can cease the Clexane injections.
He said I should make a full recovery and would like to get me back to full fitness in six weeks. This may take longer but he would like to work to this time frame. I will work with the Cardio Rehab unit at the Hospital during this time where they will perform measured fitness tests on me at intervals. The Dr said I should be able to get back on my bike next week and start slow.
In the long term I will stay on aspirin to thin the blood and some cholesterol lowering medication. This is not only about lowering cholesterol but it also conditions the plaque and makes it smoother and less likely to break away. My blood pressure is fine and my weight and general health is good so I should recover fully fast.
Seems that I was unlucky to have a heart attack when I am so young and fit but very lucky to still be alive and learn form this. The odds of it happening again now that I will be watched are greatly reduced.
Overal I am feeling fine. Still and bit shocked by all this but trying to stay positive for the future. I don't want to scare anyone with this but just be aware that live is a fragile thing. Enjoy it while you can and I hope you never have to go through this.
glad to hear you're mostly OK, must have been a scary time particularly thinking "but I'm fit" why?
had a mate who is about the same age as you and I (I just turned 46 myself) who had a similar situation (cyclist as well and very fit) except he stroked, just sitting on the couch watching TV with the family. within 24hrs he was fine (hospital an all that like you), but they found out he stroked through a possible dislodging of something (plaque maybe) that then went through a hole in his heart he did not know existed. he now has a Ti plug in his heart and is largely back to normal, I hope you end up the with a similar result, back to normal.
Life is not about waiting for the rain to pass.....it's about learning to dance (or ride) in the rain.
I should add that my cardiologist said that cycling regularly is a very good thing and I should back to it soon.
Thanks for sharing Dave, and be careful shaving
My father had a series of heart attacks and described them much the same as yours, although at the time he just thought he had a really bad chest cold. After the actual crisis and immediate treatment (warfarin was part of it) he was completely fine and never had any further cardiovascular problems.
Dave, close call. Good luck with the rehab and return to fitness.
What was your diet like before? Smoking? Drinking? Sedentary? Cholesterol readings?
If you talk to 3 different cardiologists, they won't all say the same thing.
Some don't know enough about exercise or cycling to discriminate what is safe and unsafe.
The most switched on one I've consulted said middle aged and older guys who do HIIT like exercise are asking for trouble (high intensity interval training) for the exact reason of what happened to you. - emboli or thrombotic plaques break away and block circulation to heart muscle or the brain. We have to accept our bodies and all of its tissue is older and more fragile, and we should treat it more gently than in our teens and 20s.
Doing huge efforts whether on the flats or hills, is the same as HIIT.
In saying that, if you build up to this type of training over several years, eat a good diet, and do everything else right, you can re-engineer your arteries to tolerate higher pressures and more turbulent blood flow. But it is still not risk free. Personally, I take 100mg of aspirin every day now.
Today, I did a 45km handicap road race. I rode most of it solo, and pushed hard all the way. I've been a bit of a basket case since, with a couple of little aches and pains. It's reminded me to stop eating so much crap food.
The other thing that is really important to stop your artery walls being knocked around is to stay well hydrated, which keeps your blood a little thinner and the flow less turbulent.
Turbulent flow bad. Laminar flow good.
btw, one of the guys who trains with us sporadically had a heart attack shortly after the last session he rode with us (about 6 weeks ago). He pushed himself beyond what he normally does....which underscores the risks are not small.
Thanks Paw Paw.
My Cardiologist said much the same thing. He said constant exercise is great but binge exercise is very bad. I did have a couple of stressful weeks before the ride and I did push hard on some of the climbs. This is snot a good thing to do. Good lesson for all. He also said more people should be on cholesterol owe ring meds because even if your cholesterol is low they help smooth out the plaque.
i've never smoked, moderated drinker, normal Cholesterol and normal to high BP.
What a close call Dave. Lucky yes in reality ,but I guess you don't feel that way.
Not saying you went too hard, I guess that sometimes we test ourselves to the point that something gives.Thats how I found out about my health issues
I am certainly feeling like I have lost my invisible immortality cape.
Heal quickly mate best wishes.
"Motivation is what gets you started. Habit is what keeps you going."
Anual checkup as part of my motorsport license including full blood tests and ECG.
Yes, thanks for sharing.
A good mate of mine had pretty much exactly the same thing happen at the end of a 100km ride (Amy's Ride in 2010 I think) in 35 degree heat which is a distance he didn't normally do. Having an ambulance at the end of the ride saved his life as he literally got off his bike and fell over in front of them. A piece of dislodged plaque was the cause. He still did some riding afterwards but not to his previous level. He has passed away now of unrelated causes but I remember this episode caused a great deal of worry amongst his family and friends no matter how much he tried to shrug it off.
Glad you are on your way to a full recovery.
Glad you made it out of that one relatively OK Dave.
Another 46 yo thinking it might be time to let the doc have a bit of a poke around. 'Bout the only time I see him is for replacement Pariet scripts...
...whatever the road rules, self-preservation is the absolute priority for a cyclist when mixing it with motorised traffic.
London Boy 29/12/2011
Ouch. Glad you've come through ok Dave. It's always a shock to hear a fellow rider having an episode. Be happy that you don't have any significant disease and should see good recovery and be back on the back soon. Take it easy and recover well!
Bianchi, Ridley, Montague, GT, Garmin and All things Apple
Ouch! Nasty. Hope all goes well. Not thinking of pulling the plug on the CAMS permit are you? Motor racing is also good therapy.
Some days you are a big, strutting rooster, some days you are a bit chicken and some days you are just a complete cocque. Roger Ramjet: 2009 Giant CRX3 Spockette: 2009 Trek FX 7.3 (WSD, property of Mrs Monsoon) Lady Penelope: 2011 Avanti Cadent 1.0 TdF
No good mate... super glad you are ok.
One wonders what the outcome would have been if you weren't fit?
Once you can climb hills on a bike it's all downhill.
Hopefully I'll know what that's like..... one day.
Only one way to think about this - why not ? If you weren't that fit,
it would have happened much sooner, and you might not have lived to tell the tale.
You can't reverse what vulnerabilities your genes have given you, but you can do
a lot to minimize the impact of them.
WombatK - Jerry Garcia, Grateful Dead
One of worrying adverse effects is irritation (possible ulceration) of the stomach lining and being prone to bleeding, bruising. An over counter drug called Cartia is a smaller dose 100mg of aspirin with an enteric coating which inhibits clot formation stops some of irritation.As in most things medical talk to your Gp first it may react with other medications your on. Alternatively you could just have 2 -3 glasses of red wine weekly not daily and have the same affect with some fun. Most of Medical/Nursing people I know put themselves on Cartia/aspirin as they get older.
"Motivation is what gets you started. Habit is what keeps you going."
thanks and glad all is sorted.
the key point here is that no matter how 'good' you are, you cant escape genetic factors.
any chest pain that doesnt go away after 10min of rest should be considered as a heart attack. call 000.
oh, and it doesnt have to be chest pain ! arm, shoulder jaw can be involved, usually on the left side,
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