Heart Stents and IM Triathlon?

Triathlon Forum
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I’m fully aware that medical advise on such matter ought to come from a qualified Cardiologist. However, the fact is that my Cardiologist had for the past 20 years been dealing predominantly with patients with non-active life styles. To him, a 5km run within 30minutes is considered “intense”. Hence, I’ll like to seek broader views and experiences from this board.

A bit of background. I’m an age grouper 2 days short of 42 years old with some sports background in school and in the military. I started doing tri in 2008, trains about 8 hours weekly and had participated in four 70.3 races, 3 Marathons and several other shorter races. Last week as part of my annual medical check, some anomalies triggered a series of heart scans that revealed that my LAD Artery (one of the 3 main heart artery) is 70-90% blocked. This was confirmed by a 2nd opinion by another Cardiologist in another hospital. This caught me totally by surprise as I had not felt any discomfort during my training or races. Both doctors recommended an Angio Plasty procedure ASAP for stents to be inserted to address the blockage. Most likely, 2 to 3 stents will be needed given the length of the blockage. The procedure had been scheduled in 2 days time.

Its certainly a very disappointing news for me. I had just started a formal training program to do my first IM distance race in Arizona this November, and it seems like I may need to adjust that plan somewhat.

Can I check if any members of this forum have had heart stent(s) installed and had continued on training and racing for 70.3 or IM distance races? Any adverse effects from long term drugs such as Statin and Beta-Blockers? How soon after the procedure did you commence physical training and what was the ramp up schedule?

Thanks in advance.

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http://www.cyclingtipsblog.com/2010/10/qa-with-dr-andre-la-gerche/

I don’t have a current contact but Andre is multiple Ironman finisher at a high level in age groups and a Dr focussing on heart research. I would endeavour to get in touch with him.

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Beta Blockers are certainly not ideal and you should ask your cardiologist if they are necessary in the absence of an MI. What I can say is you are much safer exercising AFTER the stent compared to a 80% blocked LAD. You will likely be put on Plavix which will greatly increase the risk of serious bleeding if you were to have trauma (bike crash). Your cardiologist may or may not restrict your training or racing. But you dodged a bullet big time by them catching this when they did. They call the LAD the widowmaker for a reason. Focus on your health and happiness. And listen to your doctor.

:slight_smile:

Jodi

4

Thanks for the advise. Just completed the Angio this morning, finding was RCA 60% blocked, LAD and LCX are both 50% blocked, not as bad as exected. Doctor decided to delay the stent until after the Stress Echo result next week. When I asked him what are the chances that I’ll be able to race a Marathon on 28th May and IMAZ in Nov, his eyeballs looked like they were popping out. Looks like my 2011 race plan is out of the window…

5

I have a Cardio Seal MP35N cardiac implant installed about two years ago after suffering a stroke that resulted from a Patent Foramen Ovale (PFO).

When I had the implant installed in my heart doctors told me “Not to let my heart rate ever go above 120 B.P.M.” I told them I’ve spent over 10 hours with my heart rate above 150 BPM, and nearly two hours with it over 170 BPM.

My doctor was an Iraqi. He grew up in a tough place where life and loss of life were casual affairs. He was pragmatic about it. “Well, if that things comes lose in there, you’ll never know it.”

The product had to go through the requisite testing for such a surgical, cardiac implant. My guess is that, in order to get whatever approvals are necessary they had to depict performance parameters that feel well within safety limits. Also, as with your case, most of these cardiac appliances are installed in sedentary types.

Obviously I’m not a doctor so I’m not at all qualified to dispense medical advice. I can relate that my expereince with a cardiac implant has been entirely favorable. I still train and have raced with it at the upper end of age category in small, local events. My cardiac implant works fine. No complaints. I take a lot of aspirin for the lingering brain damage effects from my stroke (headaches) so my blood is probably pretty easy to move around.

On something like this, it’s always wise to get a professional medical opinion, which I’m sure you’re already aware of. Best of luck Sir.

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Its actually the Left Main that is the “widowmaker”, which usually warrants a bypass and not a stent :slight_smile: either way, I would definitely discuss this with a cardiologist who is used to dealing with athletes, and not just the general population. You are pretty young, and likely have coronary artery disease for SOME reason (strong family history, bad cholesterol panels), as I doubt you are a heavy smoker. You are now risk-stratified to a much higher-risk group of athletes. Good points from previous poster about the aspirin/Plavix thing. You will most definitely have a tough time clotting if you have a crash and start bleeding. But, if you cardiologist states that your heart “plumbing” is as good as new after stent placement, then hard and lengthy exercise is not out of the question by any means. Best of luck to you!!

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Although not the same, I had an ASD closure in December 2008. I was on Plavix for six months after that. My only restriction was no biking or any exercise that could result in chest trauma for 2 weeks after the procedure. Being on Plavix while training wasn’t too bad - but there were a few memorable moments. After a minor fall on the bike, I kept bleeding for the next 20 miles. I also bruised pretty easily - I typically had a bruise somewhere during the six month period.
My doctor cleared me to run a marathon in May 2009 and for Ironman Florida that same November. Granted, this isn’t the same as a stent, some of the same aspects are there.

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100% blockage of the lad, heart attack…2 stents put in and I’m faster now. 508 half 13 months after the attack…plan on going 445 this year. 55yrs old this year.

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wow 3 vessel disease, are you going to get a bypass now?
keep us posted!
good luck

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You should talk to your doctor about possibly getting a bare medal stent (BMS) instead of a drug eluting stent (DES). AFAIK if you are on the DES you need plavix for the rest of your life where you only need it for 6 months with the BMS. The DES usually have slightly better outcomes though. I couldn’t tell you which way to go but might be worth mentioning to the doctor if the plavix and other drugs are going to be an issue with training.

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I had open heart surgery in 2007 to replace my aortic valve. I had a mechanical valve and thus am on coumadin as well as a Beta-Blocker. I completed a marathon 7 months post-op and IMW the following year. 4 weeks after Wisconsin I qualified for Boston. I can’t comment much on stents and agree with the advice to seek medical advice from a cardiologist who has experience dealing with active patients. I’d also recommend visiting Cardiac atheletes website. Many people on their forum that have started or continued after numerous types of cardiac issues. Including CAD, CABG, and Stents. All the best to you.
http://www.cardiacathletes.org.uk/forums/index.php

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Sabre, I don’t want to give any medical advice, but I’ll share my experiences as they may give you encouragement for your future athletic pursuits.

In June of 2009, at age 57, I had angioplasty and a stent to repair a 90% blockage in my LAD coronary artery. My blockage was apparently the result of the rupture of some plaque, since symptoms appeared suddenly and I had no other significant blockages.

I have been a competitive cyclist for many years. I began racing in 1978 and raced seriously through 1984 (cat. 2 for most of that time). I took a break from training and racing for about 20 years, but continued to ride and run for recreation and fitness. I began training and racing again in 2004.

I never considered myself to be at much of a risk for heart disease, but noticed some chest pain while doing some interval workouts in May of 2009. I couldn’t believe it was a heart problem, but after visiting a cardiologist, I was scheduled for an investigative cardiac catheter procedure a week and a half after my first symptoms. By the time of the procedure, I could induce chest pains by just walking across a room! I needed a wheel chair to get into the hospital. The angioplasty and stent were done at the same time as the investigative procedure.

The stent produced an amazing and immediate end to my symptoms. I began taking Plavix, aspirin, and a statin (Zocor). My stent was a medicated one. I’m not sure that some of the information given by one of the other posters is correct concerning the indefinite need for Plavix with a medicated stent - my doctor had me discontinue the Plavix after 18 months. I now take just aspirin (325 mg.) and Zocor.

After receiving the stent, my doctor enrolled me in a cardiac rehab. program, which I think was a good program, but I told the rehab. instructors that the time I spent in their program was getting in the way of my training. :slight_smile: They arranged a stress test and made sure it was a real stress test - one that had me exercise to exhaustion. This let me “graduate” from rehab. The stress test also gave me valuable information (H.R. at A.T., VO2 max, etc.) for training and racing. I was cleared to resume my previous training activities by the end of June and rode a couple of time trials by early July.

I haven’t noticed any loss in performance due to the heart episode and last summer I even had my best result since 2005 in my club’s TT. I continue to race cyclocross, which, you may know, can be very intense. In cardiac rehab. I learned the importance of a careful warm up for someone with heart disease. This is especially important in cyclocross, since, instead of the sprint being at the end of the race as in road racing, the sprint in cross is at the beginning.

So far I remain symptom free.

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RobH, Your historey is almost the exact life I lived, except I did suffer the heart attack. What is your current dose of Zocor? My Internist and my Cardiologist can’t seem to agree on either 20mg or 40mg.

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I take 40 mg. of Zocor. Before taking Zocor my total cholesterol was 139 and the Zocor didn’t change that. It did improve my ratio of “good” to “bad” cholesterol and I’m told it has other benefits for me, like making the arterial plaque less brittle.

Apparently I didn’t suffer any heart muscle damage, but that could have easily been otherwise.

Congrats, Sage, on your recovery!

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Hi Rob H
I am a 53 year old cross rider from the U K.
I was very interested to read your post about your heart problem.
As i had a heart attack after doing a good ride in a cyclo x 3 weeks ago,i was taken straight to hospital where i got 2 stents fitted.I had been wondering if any one had raced after Angioplasy so was quite pleased to hear you are doing well with the x.i know that you will know what ‘intense’ means,'in the red ’ from the start of the race so that gives me hope that i can race again.Previous to this i had had no signs of a heart problem,my cholestrol level was fine,normal blood pressure,never smoked and havent drank for 10 years but its in the family so must have been genetic.
The way i look at it is that i am in better condition after the stents than before, as long as there is not much,if any heart muscle damage and as soon as soon as your heart is healed i cant see any point in resting as everything is surely as good as its going to get,in theory ,your arterys could be in worse condition in a years time than they are straight after the procedure.thats just my theory.
I logged in to your Nationals today live on Cyclenews,that Jeremy Power was impressive
Regards Pete Wilkin

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See this blog from a friend of mine for information you might find useful. Having a stent hasn’t stopped him. http://olddogsintraining.com/

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Thanks ,I’ll take a look.

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lunesdale, my cardiologist insisted on a stress test as a condition of my return to my previous activities. As I mentioned, this gave me valuable information and more importantly eased some of my fears about participation in sports. I have modified some of my behaviors, particularly, I’m very careful about doing a proper warm up before a race. In cyclo-cross this means that I continue to ride around behind the start line while everyone else tries to get a good start position near the line. I have just resigned myself to have to start near the back and spend the early part of the race passing people.

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My friend, who got me started in the sport of triathlon, had some bypasses put in and set PR’s in every race afterwards. He was in year 18 of his tri career and I was in year 2. After a half marathon one cold day, he had trouble catching his breath once we entered a warm building just minutes post race. A Dr visit the next day, with treadmill stress test revealed issues. Thought to be mild enough for stints, the cardiologist ended up placing 6 bypasses to correct 4-90% blockages and a couple more that were in the 80+% range. This was done in February. In May, we raced a 1/2 IM where he Pr’d his last effort on the same course by over an hour. Later that year, he PR’d the Great Floridian Full in October. That was his 8th time around that course. His cardio doc encouraged him to return to the lifestyle and sport that he loved to do. His doc understood athletes though. He was 46 at the time. He has since retired from long distance triathlon to pursue motocross racing. Was National Champ in his AG and Division a couple years ago. I would find a cardio doc who works with athletes for a second opinion if you want to keep racing.

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Sheesh!

You guys have succeeded in scaring the crap out of me. I’m 69 and both my father and grandfather died at 69 and 65 respectively of heart disease. My last thallium stress test was about 9 years ago. Someone please tell me I’m turtle slow because I’m old and untalented and not because I have C.A.D. I have very occasional chest pains but nothing intense. 160 cholesterol and 37 bpm rhr. Low bp.

Robert