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From Out of Nowhere, a Heart Attack at Age 56

By vadkins on January 16, 2008 in

My husband, Jim, suffered an unexpected heart attack last week. I am writing this blog to detail and chronical what happened. Except for this post, which will remain at the top of this blog, the posts are in reverse chronological order-so the most recent posts are at the top, immediately below this post. Most of this blog’s readers will want to navigate around here using the categories which are listed in the right column. Jim’s heart attack occurred on January 8, 2008. I started this blog the same month..

It is our hope that the information here helps others.

vadkins

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Heart Attack: HDL & Cholesterol Levels 20 Months Later

By vadkins on September 2, 2009 in ,

Jim saw his cardiologist yesterday to see how his HDL level is doing since he stopped taking Niaspan two months ago. The blood test show that Jim's HDL (good cholesterol) level did drop from 48 to 43 in the last two months. That is a drop of more than 10%. So it does appear that taking Niaspan did improve Jim's HDL level. But Jim has had no stomach pains since he stopped taking Niaspan and Plavix. The doctor did not recommend going back on Niaspan though. But Jim does need to do all he can to raise his HDL level. The cardiologist recommends:

  • Drinking 6 oz. of red wine/day
  • Eating lots of salmon and other cold water fish
  • Increase intake of olive oil
  • Increasing the time spent walking on the treadmill from 20 minutes to 40 minutes/day, 5 days a week-at 11%-12% incline

The doctor did say that Jim's C-Reactive Protein level is not elevated, which is good news. That indicates that Jim does not have an increased risk of a heart attack in the next 5 years.

It will be two years since Jim had the heart attack in January. After two years the risk of having more problems related to the heart attack declines. Therefore, Jim will not have to see his cardiologist for a full year. He will have his cholesterol levels checked every 6 months though.

Jim's blood pressure was measured at the doctor's office yesterday at 128/64, and his pulse was 64 BPM.

vadkins

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Heart Attack: Improved HDL Number Is Great News

By vadkins on June 25, 2009 in

Jim saw his cardiologist today for his 4 month checkup. As usual, the doctor reviewed Jim's latest blood test/lipid panel/cholesterol results. His total cholesterol is 90, the HDL cholesterol (good cholesterol) is 48, the LDL (bad cholesterol) is 33, the triglycerides are 46 and the VLDL cholesterol is 9. These are very good cholesterol numbers for a heart attack survivor. The HDL has risen to 48 from 44 in 4 months. The month after Jim had his heart attack (February 2008), his HDL cholesterol was 27, which is very low. At that time the cardiologist prescribed Niaspan (500MG/day) to get the HDL cholesterol level up. (HDL needs to be at least 40 for a male, and 50 for a female.) Jim has taken Niaspan for about a year, and has had some problems as a result. A year ago he was diagnosed with stomach ulcers from the Niaspan and Plavix that he's been taking. And the Niaspan often causes flushing of the skin, which is irritating to live with. Other likely factors in the improved HDL number is that Jim has also lost 40 pounds since the heart attack, and he walks on a treadmill for 30 minutes 5-6 times/week.

Because Jim's cholesterol numbers are so good, the doctor told him to stop taking Plavix and Niaspan, to see how that affects his cholesterol numbers. Jim was told to take 1 low dose aspirin a day instead of Plavix. Jim will see the doctor in 2 months to check his cholesterol and see if he can continue not taking Niaspan.

Below the jump is a table of Jim's blood tests for the last 10 years or so.

All in all, Jim is doing very well.

vadkins

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Heart Attack: Blood Test Result Comparisons

By vadkins on April 21, 2009 in

Here is an updated table of my husband's blood tests going back to 1998. Jim's unexpected heart attack occurred on 1/8/2008. The test results taken before the heart attack have a shaded background. What is notable about these results to me, is the abnormally low HDL (good cholesterol) levels that Jim had back to 1998. From what I understand, HDL is the substance in our blood that transports plaque out of the arteries so that the body can dispose of it (known as reverse transport). Since Jim lacked HDL, his body wasn't able to get rid of the plaque in his arteries. So the one blockage in his coronary artery that caused the heart attack was able to get larger and larger because he didn't have enough HDL in his blood stream to carry (transport) the offending plaque away.

Since the heart attack Jim has been taking Niaspan daily to raise his HDL levels. The Niaspan plus the 40 minute aerobic workouts he does 6 times/week on the treadmill plus the 40 pounds of weight that he has gotten rid of have contributed to raising his HDL to 44-which is above normal and a vast improvement.

Date of test Feb 2009 Jun 2008 Apr 2008 Feb 2008 Jan 2008 Nov 2006 Mar 2000 Nov 1998
Cholesterol 90 82   96 169 143 <100 159
Triglycerides 51 59   109 93 108 176
HDL Cholesterol 44 40   27 41 38 33 30
LDL Cholesterol 36 30 45 47 109 83 95 95
LDL/HDL Ratio 0.8 0.8   1.7     3.0 5.4
Hemoglobin A1c 5.5 5.5      
Lipoprotein (a)   3      
Homocysteine   18.9      
C-Reactive   0.18      
Hemoglobin 5.5 5.5     16
Glucose 111 109   117 104
CK       240  
Platelets       172 166
Troponin 0.01 3.4

Jim, fortunately, is doing very well.

vadkins

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Heart Attack: Recurring Heart Attacks from Drug Interactions

By vadkins on February 8, 2009 in ,

Previously, I posted that my husband (who is a heart attack survivor) had developed stomach ulcers that were caused by the Plavix, aspirin and (probably) Niaspan that he has taken since his heart attack on January 8, 2008. His gastroenterologist prescribed Pantoprazole to heal the ulcers, to be taken twice a day until the ulcers heal. Once the ulcers are healed he will have to take Pantoprazole for the rest of his life to prevent recurrence of stomach ulcers. After the ulcers were diagnosed, Jim saw his cardiologist who changed his heart medications because of the ulcers. The cardiologist cut Jim’s Niaspan dose in half and took him off aspirin all together.

The Heart of the Matter blog, which is written by a cardiologist in Malaysia, notes that recent studies show that heart attack survivors who take PPIs have a significantly increased chance of suffering a repeat heart attack. PPI stands for Proton Pump Inhibitors which is a class of drugs that reduce stomach acid production. PPIs are used to heal/prevent ulcers. Pantoprazole, which my husband takes to heal the stomach ulcers he has, is a PPI. But fortunately, Pantoprazole is one of the exceptions to this. Pantoprazole has so far been shown NOT to increase the risk of another heart attack.

vadkins

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Heart Attack: Blood Test Results

By vadkins on November 18, 2008 in

This is a table of my husband’s blood tests going back to 11/10/2006. Jim’s unexpected heart attack occurred on 1/8/2008. The test results taken before the heart attack have a shaded background.

Date of test 6/18/08 4/2/08 2/26/08 1/8/2008 11/10/06
Cholesterol 82   96 169 143
Triglycerides 59   109 93 108
HDL Cholesterol 40   27 41 38
LDL Cholesterol 30 45 47 109 83
LDL/HDL Ratio 0.8   1.7    
Hemoglobin A1c 5.5 5.5      
Lipoprotein (a)   3      
Homocysteine   18.9      
C-Reactive   0.18      
Hemoglobin 5.5 5.5     16
Glucose 111 109   117 104
CK       240  
Platelets       172 166

Jim is currently taking Crestor (lowers cholesterol), Coreg (betablocker), Plavix (prevents blood clots), Niaspan (raises HDL level) and PantoPrazole (to heal ulcers and protect stomach from Niaspan and Plavix) daily. His blood pressure runs around 105/68. He walks a treadmill for 40-50 minutes 4 times/week, walks or swims or bikes 3 days/week. He is doing very well.

vadkins

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Heart Attack: Which Type of Exercise Is Best?

By vadkins on October 1, 2008 in

When Jim and I met with his cardiologist last week, I asked the doctor if taking spinning classes would be as good for Jim’s cardiac fitness as walking on a treadmill. The doctor replied that walking on the treadmill at a 10-12% grade at 2.7-3 miles/hour is one of the best ways to strengthen the heart. So clearly, it is best for Jim that he keeps on walking the treadmill, which Jim does for 50 minutes 3-4 times/week.

I also mentioned to the doctor that we were swimming 1/2 mile each Saturday and Sunday. The doc was impressed, and he told us that swimming is almost the perfect exercise for the heart. It may be a little better for Jim because the upper body is strengthened with swimming, more than it is on the treadmill.

The doctor told Jim that his weight is no longer too high. (Jim now weighs 186 pounds in the morning.) Now Jim needs to develop more muscle tone and to have his body fat measured. His body fat needs to be less than 18%.

vadkins

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Heart Attack: Cardiologist Changes Meds to Help Heal Ulcers

By vadkins on September 26, 2008 in

About 2 weeks ago, Jim had an endoscopy which confirmed that he has 3 partially healed stomach ulcers. His gastroenterologist doubled his dose of pantoprazole to 40mg twice a day, instead of once a day. Jim is to take the increased dose until the ulcers are healed. After the ulcers are healed, he will then return to the 40mg of pantoprazole/day for the rest of his life. Jim will have to continue taking the pantoprazole so that the ulcers do not recur. The doctor is convinced that the ulcers have been caused by the heart medications that Jim must take for the rest of his life.

On Tuesday we met with Jim’s cardiologist to see what he has to say about the ulcers. As usual, the doctor was extremely helpful, here’s what he had to say:

  • Aspirin and Niaspan are the 2 heart medications that Jim takes daily, that are most likely to have caused the ulcers
  • Jim was taken off of aspirin all together. Because Jim’s stent is a bare metal stent (as opposed to a drug eluting stent aka DES), he could have been taken off of aspirin 6 weeks after the stent was inserted in his heart via angioplasty.
  • Niaspan dosage cut in half. Niaspan also tends to cause stomach ulcers. Jim began taking Niaspan a few weeks before he started to have the chest pains which turned out to be ulcer symptoms (that was in June). Jim has been taking 1000mg of niaspan a day, so he will now take 500mg of niaspan a day. The reason that Jim began taking niaspan was because his HDL cholesterol (the good cholesterol) had dropped to 27 because of the statin drug (Crestor) he’s been taking. After taking niaspan for 3 months, the HDL level rose to 40, and 40 is the minimum acceptable HDL level for a male.
  • Pantoprazole can negate/lessen the effectiveness of Plavix if taken at the same time of day. Fortunately, this is easy to fix – Jim just needs to not take the two doses of pantoprazole at the time that he takes Plavix each day. (Plavix is the medicine that keeps the stent in Jim’s heart clear of obstructions and he must take it every single day for the rest of his life.)

P.S. Jim’s blood pressure was measured as 104/64. His weight was 5 pounds less than it was 3 months ago when he last saw the doctor.

vadkins

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Heart Attack: Plavix/Aspirin Cause Ulcers

By vadkins on September 18, 2008 in

On the drive to the airport to leave on our family vacation in June, Jim tells us that he has chest pains. Since my husband, Jim, had had a heart attack on January 8th, this was very serious. While walking to the airline ticketing counter and rolling our luggage behind us, Jim spoke to his cardiologist’s office. The cardiologist told him that he should go to an Emergency Room to have the chest pains checked out. One family member decided to go ahead and fly to our vacation destination. The rest of us, drove Jim to the local ER.

One thing we have learned, if a heart attack survivor goes to an EM with chest pains, they will have to spend at least 12-18 hours in the hospital. It takes that long to check the troponin blood levels, to see whether there has been a heart attack. Jim’s troponin levels were not elevated which confirms that his chest pains were not the result of another heart attack. Jim spent the night at the hospital so that he could have a echocardiogram stress test the next morning. (That evening, I flew to our vacation destination, since it looked like Jim’s chest pains were the result of acid reflux.)

The next morning, Jim passed the echocardiogram with flying colors. Jim was able to exercise on the treadmill for 8 minutes with his pulse at 165 beats/minute. The doctor prescribed a PPI (proton pump inhibitor), Protonix (the generic name is pantoprozole), to reduce the amount of stomach acid and thus reduce Jim’s pain from acid reflux. Jim then flew to Williamsburg to join us on vacation. Over the following weeks and months, Jim continued to take Pantoprozole 40mg daily. He also took Tums as needed to reduce the pain. The acid reflux pains subsided somewhat.

We saw our primary care physician when we returned home from vacation. She ordered an endoscopy, to confirm whether Jim’s esophagus showed signs of irritation from acid reflux.

Last week Jim’s gastroenterologist did the endoscopy. The doctor saw 3 small non-bleeding ulcers in Jim’s stomach. The biopsy indicates that the ulcers are partially healed, and are non-cancerous. The pantoprozole that has been taking, is probably the reason that the ulcers are partially healed. These stomach ulcers need to completely heal, because stomach ulcers are more likely to become cancerous than duodenal ulcers are. (2% of stomach ulcers become cancerous.) To heal the ulcers, the doctor told Jim to double his dose of pantoprozole – to take 40mg in the morning and 40mg at night. In 3 months, she will perform another endoscopy to see if the ulcers have completely healed.

Because these ulcers were most likely caused by the Plavix and aspirin that Jim must take daily (since he is a heart attack survivor and has a stent in his heart), he will have to take 40mg pantoprozole for the rest of his life so the ulcers don’t recur. She recommended that Jim take Malox for stomach discomfort through the day. When Jim needs to take a pain reliever, he will need to use only Tylenol, not Motrin or Ibuprofen.

As far as lifestyle/diet changes, the doctor told Jim that he can continue to eat as he normally does but that he might want to eliminate citrus juices and raw vegetables from his diet until the ulcers are healed. Citrus juices can cause acid to enter the esophagus. Raw vegetables cause a lot of gas when they are digested.

At the doctor’s office Jim’s blood pressure was 110/70, his pulse was 64 and his weight was 187.5 lbs.

I have posted all of Jim’s test results from his hospital stay in June below the jump.

vadkins

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Heart Attack: 9 Predictive Risk Factors

By vadkins on September 16, 2008 in

A recent study of 29,000 people from all over the world, half of whom have previously had a heart attack, lists 9 risk factors, in order of importance, for heart attack:

  1. Increased LDL/HDL ratios (i.e.,, elevated LDL and low HDL levels)
  2. Smoking
  3. Diabetes
  4. Hypertension
  5. Abdominal obesity
  6. Psychosocial (i.e., stress or depression)
  7. Failure to eat fruits and vegetables daily
  8. Failure to exercise
  9. Failure to drink any alcohol

Now let’s compare these risk factors to my husband, Jim’s, situation at the time of his heart attack on January 8, 2008:

  1. Increased LDL/HDL ratios – At the time of the heart attack, Jim’s total cholesterol was 169 which is considered low risk. His HDL (the good cholesterol) was 41 which is considered low risk. His LDL (the bad cholesterol) level was 109 which is considered low risk. Doing the math, Jim’s LDL/HDL ratio = 109/41 = 2.65. This result is low risk for heart attack. So Jim did not have increased LDL/HDL ratios.
  2. Smoking – Jim has never smoked anything in his entire life.
  3. Diabetes – Jim was not, and is not, diabetic.
  4. Hypertension – Jim’s blood pressure was not high at the time of the heart attack, and he has never been diagnosed with high blood pressure.
  5. Abdominal obesity – Jim’s waist measurement at the time of the heart attack was 42".
  6. Psychosocial – Jim was not in a stressed or depressed state at the time of the heart attack.
  7. Failure to eat fruits and vegetables daily – Jim has always eaten lots of fruits and vegetables.
  8. Failure to exercise – Jim had been living a sedentary lifestyle at the time of the heart attack.
  9. Failure to drink any alcohol – Jim has never drunk alcohol.

So, of these 9 heart attack risk factors, Jim had 3 at the time of the heart attack: abdominal obesity, failure to exercise and failure to drink any alcohol. Of these 9 risk factors the first 2 are the most significant:

The first two of these risk factors (bad lipid readings and smoking) predicted 2/3 of all heart attacks.

But this does not apply in Jim’s case.

Jim has reduced his weight from 225 lbs. to 188 lbs. since the time of the heart attack in January. His waist has reduced from 42" to 35". He also exercises daily. The only risk factor he now has is the failure to drink alcohol, and that’s not going to change, because Jim just doesn’t like it.

vadkins

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Heart Attack: Exercise at High Altitude

By vadkins on August 24, 2008 in

My husband. a heart attack survivor, was in Denver on business last week. He was exercising on the treadmill at his hotel fitness center as usual. Jim wears a heart rate monitor when he exercises. About twenty minutes into his workout, his pulse suddenly rose from 120 bpm to 155 bpm. Jim stopped exercising and cooled down. His pulse returned to normal. Why had his pulse shot up so quickly? He called his cardiologist back home and was told to continue monitoring his heart rate. If his pulse stayed normal, then he was safe to fly back home the following day. Jim’s pulse has remained normal since. The morning after he returned home, he went back to the cardiac rehab center for his monthly maintenance workout session. He was monitored for the 50 minute workout as usual. The results of this exercise session were excellent. Jim’s heart stayed in his acceptable target heart rate range, and the monitors indicated that his heart had strengthened since he had graduated from the cardiac rehab program the month before. And Jim’s pulse did not race during this workout session.

The nurse who leads the rehab staff told Jim that his racing pulse rate in Denver was most likely caused by the high elevation of that city. She says that it takes a full week to acclimate to a rise in elevation. He should have exercised at only an 4 percent grade on the treadmill instead of his usual 8 percent grade.

vadkins

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