Just had a stent inserted, am I done?

Triathlon Forum
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Ok, just got out of the hospital after having a stent placed in the Left anterior descending artery…My question is, what’s the chances of continuing my tri lifestyle?

Of course the doctors are non committal on the future and I need some real life experiences.

I’m on the usual blood thinners and cholesterol blockers and understand the importance of dietary changes, considering the alternatives, not much of a choice 😐

One thing I will say, don’t ignore warning signs like breathlessness or unexpected jumps in heart rate on easy runs and even minor aches in chest. Making a next day appointment with primary care doc quickly followed by a 2 day followup by a cardiac doc saved my life.

Ron W.

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2 questions
How old are you?
How sh1tty was/is your lifestyle?

Imho yes you are done in triathlon, bit of cycling yes, bit of running yep, maybe the odd swim, but I would never be recommending you get into a race/open water situation again.
(I used to be an interventional cardiologist, in a previous life)

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Some background, racing since 1978 and I’m 71 years old. Fairly healthy history, although the last few years have noticed an uptick in both bph and cholesterol.

I had signed up for LP 2019 but noticed a drop in training performance, something didn’t feel right, no problem I deferred my entry to 2020. Sure enough when on an easy run I had a difficult time catching my breath and a jump in heart rate to 150 bpm. No diźzyness or pain just the feeling that if I pushed it one step further I’d fall on my face.

Easy for others to say call it quits but I’m looking for real life experiences to draw on.

Ron W.

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I will somewhat disagree with never racing again, but a lot of that depends on what you call racing. First things first, I am not your doctor. My background is a nurse who has 15 years of cath lab experience (where you had your stent implanted). Once again, I am not your doctor. Listen to him, first and foremost. Couple important questions…did you have a heart attack? And was there any heart damage? If there wasn’t any heart damage, living a healthy lifestyle is key. And lucky for you, triathlon can by healthy (to an extent). One kicker is going to be extra careful, especially on the bike. You are on blood thinners now. They are very important. Do not let anyone, with the exception of your cardiologist take you off them (Plavix, Brilenta, ASA, or Effient). That being said, a bike crash will be “bloodier” than normal. Without any further knowledge of your condition, I would venture to guess that you will be back to where you were physically in no time. Think of it this way, your heart is receiving a larger blood supply (aka oxygen) than it was before the stent. Take aways…1) Listen to your body and let your physician know of any cardiac symptoms. You have a history of coronary artery disease. It can reoccur. 2) Take your blood thinners. 3) Listen to your doctor! I am not your doctor. I am a nurse with experience with patients who have had angioplasties. Listen to your doctor! (I meant to say this again). 4) Enjoy life and have fun. Good luck to you sir.

Matt

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If you have to ask yourself, you probably know the answer.

More importantly - if there was even a 1% chance that racing would stop your ticker. Is it worth it to you?

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I will somewhat disagree with never racing again, but a lot of that depends on what you call racing. First things first, I am not your doctor. My background is a nurse who has 15 years of cath lab experience (where you had your stent implanted). Once again, I am not your doctor. Listen to him, first and foremost. Couple important questions…did you have a heart attack? And was there any heart damage? If there wasn’t any heart damage, living a healthy lifestyle is key. And lucky for you, triathlon can by healthy (to an extent). One kicker is going to be extra careful, especially on the bike. You are on blood thinners now. They are very important. Do not let anyone, with the exception of your cardiologist take you off them (Plavix, Brilenta, ASA, or Effient). That being said, a bike crash will be “bloodier” than normal. Without any further knowledge of your condition, I would venture to guess that you will be back to where you were physically in no time. Think of it this way, your heart is receiving a larger blood supply (aka oxygen) than it was before the stent. Take aways…1) Listen to your body and let your physician know of any cardiac symptoms. You have a history of coronary artery disease. It can reoccur. 2) Take your blood thinners. 3) Listen to your doctor! I am not your doctor. I am a nurse with experience with patients who have had angioplasties. Listen to your doctor! (I meant to say this again). 4) Enjoy life and have fun. Good luck to you sir.

Matt

You know it’s funny I didn’t ask if I had a heart attack ! I guess I was afraid of the answer, go figure. What they did say is that artery was 75% closed, and there was no damage to the heart muscle AND the no other arteries were effected. Plavic, Lipitor and baby aspirin are my new best friends.

YES, I have thought about a bike wreck and bleeding out on the road somewhere. Over the last few years I have leaned toward more Computrainer workouts, this will just make them mandatory.

I’m willing to take my chances on race day.

Thank you for thoughtful reply.

Ron W

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My wife had two stints placed three weeks ago, so this has been an ongoing discussion.

The correct answer is ask your cardiologist and primary care provider and make an informed decision from those conversations.

For my wife, the blunt truth of it is that this is Coronary Artery Disease which is genetic. No amount of eating clean, maintaining correct weight, or exercise is going to change the genetics.

There are going to be medications that will help mitigate some of the risks that she will need to take for the rest of her life. There is also a piece that forced a look at mortality… genetics is always going to win out.

(Oh, expect that the blood thinners may make you feel like you are in the worst shape of your life…literally getting out of breath from talking.)

The discussion about training was that there was going to need to be a couple weeks of recovery (they couldn’t use the radial artery, so coming from the groin has a bit longer recovery time). After that, it is going to be a matter of training appropriately. She was able to train with restricted bloodflow to the heart, better bloodflow there should help things.

She is going to be easing back into things, starting with walking then some Z1 / (low) Z2 Zwifting, then adding in more and more as tolerated.

I sincerely wish you the best in your recovery
Scott

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I don’t know your details, but for me the answer is definitely not.

I’m 55, and earlier this week I celebrated my 23rd anniversary of having a stent inserted (1996). I had a 95% blockage of my right coronary artery, and like you I luckily went to the doctor at the right time. I thought I had a chest cold. At the time ice hockey was my sport. I didn’t get into triathlon until 13 years later.

I took it slow and over time got to where I had no restrictions. I just had an appointment with my cardiologist this week and she continued to encourage me to keep racing. I do sprints and 70.3s.

I can provide you with a lot more information if you PM me with your contact info. One thing I can tell you is it took me about 3 months to get through it physically, but about 4 years to get through it mentally. The anxiety I started experiencing was new to me, and it took a long time before I could really push myself.

My issue was low HDL cholesterol. At the time the HDL level was 28 with a total cholesterol of 170. I lost weight, started eating right and got on a statin. Now HDL is 55 with a total cholesterol of 108.

I had an angiogram in 2015, and after almost 20 years the original stented blockage site looked great with no significant blockages in any other areas.

Obviously there is a lot more to the story, but maybe I can give you some hope that you can stay active and get to where you are better than you are now. It just takes time, research, and listening to really smart doctors who deal with active people.

Rob

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Everyone is different so you will likely have to see how it goes and act accordingly. But if you would like to hear of a positive outcome, here’s my story:

This is about 3 years ago so I was 63 years old, had never smoked, cholesterol was a little high but within the normal range, no family history and I’ve never been overweight. In the morning I had been to my GP for my yearly exam, he gave me a good bill of health and that afternoon I did a 2 hour workout at the YMCA. At the end of the workout I was on the Concept 2 Rower just cooling down and felt pretty tired for the 2:15 pace that I was at. I got up to go to the locker room and collapsed with no pulse or breathing. 100% blockage of the LDA aka “The Widowmaker”.

I happened to in the company of an off duty EMT guy who administered CPR within a minute of my collapse and when I regained consciousness the official EMT’s were there and I was off to the ER. Two stents went in the next morning and I was released directly out of the ICU and walked down to the lobby and my wife drove me home. My only pain came from the broken ribs. Jason, my savior (who I didn’t know at the time) is about 235 and pushes a huge amount of iron. He can break ribs easily.

So a pretty dramatic event and there are some lessons in life that I can pass on…

Being in good robust physical shape to begin with is a huge advantage for recovery. I have zero lasting physical effect from my near death experience. I’ve since bested my PB on the Concept 2 and my 2K is down to 7:50. Not stellar but respectable for my age considering I don’t specialize my training for it.

You can give it about a year to feel confident about really ramping up your effort. Don’t be in a hurry and above all follow your cardiologists instructions. I see mine once a year now and I pointedly ask him if there is ANYTHING I shouldn’t be doing. I had just crushed the treadmill stress test so he says I can do what I want. That’s good because I love maxing out my effort and getting my HR up to about 180.

You may have to dial the risk back in regards to your blood thinners. I was on Brillinta which made me bleed like fucking crazy. You could bleed out from a bike crash so take a friend with you when you ride.

Again, everyone is different but the short answer to your question is hell no, you don’t have to be done. Work through the issue and get back to enjoying life. I’m also glad you didn’t have to go through the drama that I did. It wasn’t fun.

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There’s a Documentary on Amazon Prime called “Flatline to Finishline” about team Iron Heart which is made of all heart disease survivors who still participate in Ironman. It’s an extremely well done documentary and very engaging. I’ve watched it twice.

http://flatlinetofinishline.com/ . You can watch the trailer on their website. I recommend all triathletes watch this movie. Great stuff.

Here’s a link for the trailer: https://vimeo.com/157327880

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Bleeding out due to a bike crash while on coagulation inhibitors…? Hmmm. It’s likely happened, but it would not be something I’d worry much about. You need to lose 20-30% of blood volume to be worried at all (if you can get reasonable medical care in a reasonable time - not an emergency). That is a lot of blood! An average male has 5 L of blood, so more than one L of blood is worrying, but not life threatening. Take a L of water and throw it out on you patio. There is little chance that you generate that amout of blood loss from road rash - you’ll need to cut more tissue with bigger arterioles/arteries. If you want to get into real trouble, blood-loss-wise, it more like 40-50%. Now you are spilling more than 2 L of blood. Do you have any idea how much blood this is? A nasty cut while shaving - a lot of blood - is probably 1 mL - 1000-2000 times less than we are thinking about. Listen to your real doctor, but even with aggressive anti-coagulation, you are not going to bleed out unless your bike crash is significant enough to cause other potential co-morbidities.

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Your clinical analysis is probably correct as far as actually bleeding out. However there are all sorts of related issues to consider such as brain and internal organ bleeding. Not to mention the bruising you get from just normal day to day activity is pretty scary and frankly unnerving. It’s a day to day reminder that you’ve been broken and you are still healing. I may have been only fooling myself but knowing that I’ve taken the steps to mitigate the risk somehow helps.

Keeping your spouse on an even keel is part of it too. And as others have mentioned, managing your emotions after a heart attack (or surgery in this case) is tough. I was still prone to breaking down in tears well after I had physically recovered.

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Op back,

Great reading all these replies and good info.

I’m in no rush to start pushing the training envelope, I always enjoyed the slower walk/runs and the no interval approach to swimming and biking when recovering from a serious injury. It’s nice to smell the roses.

As far as the bleeding issue, according to my heart surgeon i could be off Plavix in six months with this stent. But I will be checking with my heart doc and the rehab group when I start the recovery process.

Thanks again people for the feedback.

I will post back time to time to share my recovery experience.

Ron W.

Ron W.

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If you didn’t have any “heart muscle damage” then you did not have a “heart attack”, AKA myocardial infarction. I would think that if you have clean coronary arteries aside from your stent, and you begin exercising again and feel fine, especially if your ejection fraction is normal, then you will be fine if you want to race. It certainly is not risk free, but nothing in life is…

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Here are my two cents. It depends… mostly on your personal health situation, and risk benefit analysis.

Evidence is that physical activity will lower cardiac risks post mi for example (arguably better than any one single therapy), if you can tolerate it. However, much of that data is based on your more average joe/jane who probably needs to get off the couch more anyway. There are no large randomized controlled double blind studies of the risks of triathlon participation post stent in people over 70. Case studies and isolated examples, (some recorded in documentaries) at best. You are the 0.0001%, and i bet your need for a stent was 99% not due to poor lifestyle. I am making big assumptions, but we are in a tri forum…

But I agree with others that the bigger issue here is one of risk of bleeding. Mainly, bleeding in an accident. I also cringe at the thought of endurance running/biking on pressure points on significant blood thinners. It makes my “t’aint” squirm.

But the bleeding risk very much becomes personal. Kind of like concussion. Yes, in an accident, your risks may go up. But do you stop driving, skiiing, cycling, etc? That is a personal choice. No exercise may make tou depressed. That could be a far worse outcome for quality of life. Just be ready to live with the consequences of your decision one way or another.

Baby steps, go from there. Your body, time, and good medical info will help guide you.

If i could give general wisdom that will probably work for 90% of people, irrespective of diagnosis or question; it would be that the answer is usually in between. The people that gravitate to extremes for an answer are the people that generally get in trouble. That being said, you are already 0.0001% (ok, i made that number up), so what may be extreme for someone else, may not be for you. Your bar will be different from grandpa-off-the-couch.

But the bleeding risk… that is up to you to decide what you are willing to risk. Just be sure to get informed medically so that you can make a decision with the best info possible (realizing that no one has a crystal ball).

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Former CTICU RN here (now ER), and I’m totally with you, Matt.

On a more personal note, 2.5 years ago I ended up finishing a triathlon and then performing CPR on a fellow athlete who was about 25 meters away from crossing the finish line. The athlete didn’t have a history of heart disease, but had been getting random chest “niggles” while training for this race, was short of breath as soon as he got off the bike, and ended up in full blown cardiac arrest in the finish chute. Dude ended up getting intubated on site, was defibrillated multiple times due to persistent V-fib, and they were able to achieve ROSC. By the time they got him to the ER he’d coughed up his ET tube, was awake, alert, and able to talk to his wife in the ER. Ended up having a CABG, reoccluded a graft, got a stent placed, and recovered to the point where he did the race again LAST YEAR and finished. Now, is this a common scenario? Absolutely not. But having a stent place does not mean it’s game over for you. That doesn’t mean you should go against medical advice from your doctor, but I would just make sure that you have an open and honest discussion with your cardiologist regarding triathlons and training.

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The LAD (left anterior descending artery) is a branch of the Left coronary artery also called the “Widow Maker”. If that one blocks up the chances of death are high. The LAD supplies blood to the front left side of your heart…the anterior side of the left ventricle. That’s the part of the heart that does the real work. Listen to your MD(s) and do what they say but from what you posted if it was me………………

Stay out of the water
Blood thinners and bike crashes don’t mix well.

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Former CTICU RN here (now ER), and I’m totally with you, Matt.

On a more personal note, 2.5 years ago I ended up finishing a triathlon and then performing CPR on a fellow athlete who was about 25 meters away from crossing the finish line. The athlete didn’t have a history of heart disease, but had been getting random chest “niggles” while training for this race, was short of breath as soon as he got off the bike, and ended up in full blown cardiac arrest in the finish chute. Dude ended up getting intubated on site, was defibrillated multiple times due to persistent V-fib, and they were able to achieve ROSC. By the time they got him to the ER he’d coughed up his ET tube, was awake, alert, and able to talk to his wife in the ER. Ended up having a CABG, reoccluded a graft, got a stent placed, and recovered to the point where he did the race again LAST YEAR and finished. Now, is this a common scenario? Absolutely not. But having a stent place does not mean it’s game over for you. That doesn’t mean you should go against medical advice from your doctor, but I would just make sure that you have an open and honest discussion with your cardiologist regarding triathlons and training.

I think one needs quite a bit of medical training or experience as a patient to fully understand this.
CTICU? RN? CABG? reoccluded a graft? ROSC? ET tube? V-fib?

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In 2013, at age 51, I had a stent inserted for the LAD “widow maker” being 85-90% blocked. I was signed up for Ironman Lake Tahoe (the cold one) 7 months later and my doctor said I could do it. It took about 2 months to get back into training due to bad reaction to the statin medicine. We ended up severely reducing the statin dosage, as my total cholesterol is normally below 150. I was racing just to finish and did finish feeling great, since I did not try to race it.

It was a year later when someone told me that the bleeding possibility from the blood thinners from a crash could have been risky. Ignorance about that issue I guess helped me train without worries.

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CTICU: cardiothoracic intensive care unit-basically our team took care of all the people post-heart attack who either had a stent placed, or had a CABG-coronary artery bypass graft, AKA open heart surgery/cardiac bypass surgery. What you need when you have a lot of arteries blocked off by clots/cholesterol deposits and your heart isn’t getting oxygen to its muscle since the arteries are blocked. Also used when placing a stent just isn’t possible due to the location of the blockages/advanced degree of blockages. We also got a lot of people who went into cardiac arrest in the field (outside of the hospital), and ROSC (return of spontaneous circulation) was achieved. AKA they went from dead to not dead because they got a pulse back after CPR and such. We had very specific protocols for how to care for these patients.
RN- registered nurse.
Reoccluded a graft: the graft they placed during open heart surgery got clogged back up again essentially causing the beginning of a heart attack. This is important for you, OP, because once you get those pipes back open, they can clog up again. It’s quite common. Take the meds they prescribed, especially blood thinners and cholesterol meds.
ET-tube: the tube they put down your throat and into your lungs if you’re not breathing on your own. So in reference to my story, the guy went from very dead to very alive to the point where he wasn’t breathing and then was alive enough to cough the tube up out of his lungs and be breathing on his own quite well.
V-fib: ventricular fibrillation. You don’t want your heart to be in this rhythm, it’s very bad and not compatible with life. Requires defibrillation/lots of shocking. Google it if you want to see what it looks like in comparison to what your heart rhythm should look like.