Chronicle of My Husband's Heart Attack

On Wednesday evening my husband, Jim, had a few dizzy spells beginning at about 10:15 PM. He had about 4 dizzy spells that lasted only about 30 seconds each. The spells were about 10 minutes apart. One time he got dizzy when he stood up from a chair. During the other dizzy spells he was sitting in the living room and using his laptop computer.

This was the first time that Jim has felt dizzy since his heart attack on January 8, 2008. We had no idea why this was happening. He called his cardiologist’s office and the doctor who was on-call for his cardiologist said that the dizziness might be caused by one of the heart medications that he is taking. Jim’s pulse was running between 55 and 85 that evening, which is normal for him. His blood pressure was the usual 100/60. That’s what his blood pressure has been running since the heart attack when he was put on a 5 mg dose of Lisinopril to lower his blood pressure. (Before the heart attack Jim’s blood pressure had been running about 120/80, so high blood pressure has not really been one of his problems.) The doctor said that the dizziness could be caused by his medications. That was probably the case since his pulse was normal and steady. He said that a low pulse was about 40 bpm. The doctor told Jim that he could go to the Emergency Room and have his heart checked, but that it probably wasn’t necessary, and that he should call his cardiologist the next day. If Jim felt anymore dizziness that night, he should go to the ER.

About an hour later, Jim felt dizzy again for about 30 seconds. At that point we decided that he’d better go to the ER to get checked out. The hospital is only about 5 miles from our house, so we drove there.

Within only about 30 minutes after arriving, Jim had been admitted and was in an examining room. The hospital had none of Jim’s medical records since his heart attack occurred while he was traveling on business in Massachusetts, and he was treated at Boston Medical Center. So we verbally gave the ER doctor Jim’s heart attack history and how that had been treated. The doctor ordered blood work for Jim, a chest x-ray and an EKG. All were normal. But the doctor told us that he would probably admit Jim so that they could measure the troponin levels in his blood for the next 12 to 18 hours. (Troponin is an enzyme in the blood that, if elevated, indicates that the patient has had heart damage, usually from a heart attack.)

After about 2 hours in the ER, one of our primary care physician’s partners came by to examine Jim. He was especially checking to see if Jim had any signs of having had a mini-stroke. Thankfully, Jim did not. And Jim had not had any more dizzy spells in about 4 hours.

At 4 AM I went home, confident that Jim was really OK and in very good hands. By about 1 PM the next afternoon, all of Jim’s blood tests had normal troponin levels, so he had not had another heart attack. Jim’s cardiologist came by and said that all of Jim’s tests were fine. He said that the dizziness could have been caused by the blood pressure lowering medicine, Lisinopril. He told Jim to stop taking that medication, and to keep an eye on his blood pressure. If Jim’s blood pressure rises above 120/80, then he should call his cardiologist.

Today was Jim’s first day since the heart attack when he did not take the Lisinopril. Tonight his blood pressure is 115/65, so it is a little higher than it had been when he was taking Lisinopril. But Jim has had no more dizziness either.

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One of the most important action items from my husband’s cardiologist appointment last week, was to follow the doctor’s prescriptions for getting Jim’s HDL levels up. Here’s what cardiologist says to do to get the HDL cholesterol level increased:

• Decrease the Crestor (cholesterol reduction medicine) dosage in half, to 20 mg
• Take 400 mg daily of Niaspan. Niaspan is said to be very effective in raising HDL cholesterol levels. But many people have had problems taking Niaspan because it often causes flushing. The doctor’s nurse told Jim that he should take the Niaspan at night, and with applesauce. She said that something about the pectin in the applesauce helps prevent the flushing. And it’s very important that Jim take his daily aspirin 1/2 hour before he takes the Niaspan. Jim took the Niaspan as the nurse directed, and he has had no flushing at all-except for the one night that he decided to take Niaspan without eating the applesauce. Sure enough, a couple hours later he flushed-and he described the flushing as fairly obnoxious.

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At the time of my husband’s heart attack on January 8, 2008, he weighed 225 pounds. Jim is 6’2" tall and now 57 years old. Last week his cardiologist said that he needs to weigh 190 pounds. But the doctor encouraged Jim to lower his weight to 170 pounds, which is what Jim weighted as a young man. 170-190 pounds is the healthy body weight range for a person of Jim’s height, according to the BMI (Body Mass Index) calculation.

Jim has been making great progress with his weight loss by using the Weight Watchers point system to determine food portions, and the cardiac diet to determine what foods he eats. Along these lines, we find that the Heart Association cookbooks is tremendously helpful.

Here’s how Jim’s weight loss progress is going:

Week 1: 220 pounds
Week 2: 216.5 pounds
Week 3: 215.75 pounds
Week 4: 213.8 pounds
Week 5: 214 pounds
Week 6: 210.5 pounds
Week 7: 210.5 pounds
Week 8: 207.8 pounds
Week 9: 207.8 pounds
Week 10: 206.2 pounds
Week 11: 205.8 pounds
Week 12: 206.4 pounds
Week 13: 206.6 pounds
Week 14: 205.5 pounds

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Jim’s cardiologist told him that ingesting more folic acid would decrease the level of homocysteine in his blood. Last week the cardiologist ran a lipid panel blood test and the test result indicated that Jim’s homocysteine level was high. There is evidence that a high homocysteine level may increase the risk of heart attack. So what is homocystiene:

Folic acid and folate are forms of the water-soluble vitamin B9. These occur naturally in food and can also be taken as supplements. Folate gets its name from the Latin word folium ("leaf").

The cardiologist also told Jim to take a vitamin B6 and B12 supplement to lower his homocysteine level:

Vitamin B6 is a water-soluble vitamin. Pyridoxal phosphate (PLP) is the active form and is a cofactor in many reactions of amino acid metabolism, including transamination, deamination, and decarboxylation. PLP also is necessary for the enzymatic reaction governing the release of glucose from glycogen.

Vitamin B12 helps maintain healthy nerve cells and red blood cells. It is also needed to help make DNA, te genetic material in all cells. Vitamin B12 is also called cobalamin because it contains the metal cobalt. Vitamin B is bound to the protein in food. Hydrochloric acid in the stomach releases vitamin B12 from proteins in foods during digestion. Once released, vitamin B12 combines with a substance called intrinsic factor (IF). This complex can then be absorbed by the intestinal tract.

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At the cardiologist appointment last week, the doctor reviewed my husband’s blood test results with us. One of the factors tested was VLDL. But what is VLDL?

Very-low-density lipoprotein (VLDL) cholesterol is one of the three major types of blood cholesterol combined with protein. The other two are high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) cholesterol. Each type contains a specific combination of cholesterol, protein and triglyceride, a blood fat. VLDL cholesterol contains the highest amount of triglyceride.

Like LDL cholesterol, VLDL cholesterol is considered "bad" cholesterol because elevated levels are associated with an increased risk of coronary artery disease. There is no simple, direct way to measure VLDL cholesterol. So it is usually calculated as a percentage of triglyceride levels.

Fortunately, Jim’s VLDL level is normal.

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