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Year 2 After an MI

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Year 2 After an MI

Post by pjs74 on Thu Sep 24, 2015 10:00 am

Hi All,

I just wanted to pitch something to the group. I have a meeting with the heart doc in a week and was wondering what questions a recovering athlete should ask in terms of guidance for their second year post MI recovery.

So as a quick reminder, I had a 100% blocked LAD in August 2014 at aged 40. This was 2 hours after a monster 30 mile bike ride on my race wheels (I am a triathlete) preparing for the Atlantic City triathlon. I hit several PR's on the ride.

After getting 3 stents in the LAD and hearing that I did have a reduced EF in my left ventricle, my main goal was to get back to what I enjoyed safely, say yes to the doc for a year and not ask too many hard questions. Over the year I built up to running 4 miles at 10 minute pace, biking 20 miles and swimming 2500 yards at a time. I have reduced my Metoporol from 50 mg/day to 25 mg/day since my resting HR was in the low 40's. I am currently restricted to a heart rate of 130.

Anxiety has been my biggest battle, but is improving with time. Anything new/different always has the worry triggers, but I am learning to calm these.

My other meds are rapamil, effient (soon to be stopped), asprin, lipitor and some fluoxetine.

My EF is back from 45 to 50 by January this year, so I hope it may have improved from there. My ECG still looked abnormal in June, so there must be some damage remaining.

Question I want to know is when can I race again at full tilt or even 80 or 90% tilt? What is reasonable. I feel I can do more, but have been conservative until now. Would appreciate any of your thoughts about this second year and questions for the cardiologist.

Appreciated,

Phil.

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Re: Year 2 After an MI

Post by Tom price on Thu Sep 24, 2015 2:31 pm

I did not have an MI, so my thoughts are a bit more general....you will most likely never get a doctor to say ok to 80-100% effort.....they are just too conservative.  You have to ask enough questions to be able to make your own informed decisions.  Always ask WHY? (Why the drugs, limitations, etc.).   What could go wrong?  Then make a decision......
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Re: Year 2 After an MI

Post by twal on Thu Sep 24, 2015 8:12 pm

If they tell you that you can't push yourself, try to get them to specifically say why not. If they don't have a good reason other than being cautious, then the decision is up to you.

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Re: Year 2 After an MI

Post by Dave Tuttle on Fri Sep 25, 2015 6:32 am

The only thing I could add to the previous comments is that it seemed like after a few years and a lot of miles my Cardiologist became comfortable with my running and then he was very supportive of it.

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Re: Year 2 After an MI

Post by jerseyguy on Fri Sep 25, 2015 3:35 pm

Hey Phil,
Our medical histories are strikingly similar albeit I am a little older - 49 now, 47 at the time of the infarct. I had an LAD infarct as well. Stents in my proximal LAD, 1st diagonal and 2 in my obtuse marginal. My two year anniversary is in 3 weeks.

Medication profiles are similar except my cardiologist is keeping me on Effient indefinitely (apparently there is a new school of thought emerging that platelet inhibitors have a role in secondary prevention after the first year post stenting). Caveat is risk of bleeding must be carefully weighed. I have also been told I will be on a beta blocker and ACE inhibitor for the rest of my life. I don't think there is a single person on this forum that would argue that beta blockers are the bane of our running existence. I have come to terms with this though.

Post infarct EF was 40% and is now up to 50%. Check with your doctor on this point but your EKG may never look "normal" again. If you think about it your left ventricle took a direct insult. I can tell I don't dwell too much on my EKG's so long as there are no NEW ischemic changes which I think is far more important.

In terms of your first paragraph, I would want to know when my activity restrictions will be lifted. What is my expected target heart rate? 75%...85% of maximum? When does my doctor expect me to reach my target heart rate? If you don't know your maximum heart rate, ask him.

It certainly sounds like you are doing everything right. I do believe the more you do and accomplish, the more confident and less anxious you will become. Keep up with what you are doing and in time I think your own potential will surprise you.

Phil

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Re: Year 2 After an MI

Post by bsegall2 on Sat Sep 26, 2015 8:56 pm

Hi Phil,

My history is also similar to yours. I had stents at age 44 and had an MI at age 54 due to a very late and unusual stent thrombosis. This occurred just after a sprint triathlon. My EF improved from 31 after the MI to the mid-to-late 40's two years later.

Since the stress of the triathlon may have played a role in my MI, I've decided to focus elsewhere besides races, mainly on my biking - distances and exploring new routes/experiences. I'm up to 40-50 miles rides, and 98% of the time I can stay under 130 heart rate.

Regards, Bruce Segall

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Re: Year 2 After an MI

Post by pjs74 on Wed Sep 30, 2015 2:18 pm

Thanks all for the feedback, we are an experiment of 1.

I will also see what my docs latest thinking is on continuing DAPT for longer than 12 months. I am tolerating effient well, couple nice hematomas from banging my leg hard that was the worst of it. Otherwise, no problem shaving!

I will ask the why's and what's and report back.

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Re: Year 2 After an MI

Post by EugeneRunner on Fri Oct 09, 2015 2:33 pm

I had an MI and stent at age 43, with a 100% blockage of my circumflex.

For me, 2 years was a key milestone. The medical folks wanted me to be pretty limited until that point to allow everything to settle in and the statins to do their work. After 2 years, the limitations were mostly lifted. My cardiologist has said 95% effort is fine, meaning there is some risk but not enough to offset quality of life improvement by being able to do what I love. He is also a former elite swimmer, so he is aware that 95% effort for a highly competitive guy like me likely exceeds a perceived 100% effort for a recreational athlete.

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Re: Year 2 After an MI

Post by pjs74 on Mon Oct 12, 2015 9:41 am

Thanks for the note Eugene.

I bended my docs ear for an hour last week. His case was you have scarring, we lost one of the branches off my LAD that supplied the scarred area. Your ECG shows that you look like you have had a prior MI. To get a legitimate stress test you need to go to 85% max HR. If there is any crap (his words) that is when you are most likely to see it above 85%. It is likely that nothing will happen, but that 1 time in a hundred I could risk an issue. He prefer I do not do a stress test on myself without being hooked up for now.

Bottom line for him is continue to 70% maybe 75% max heart rate. I am doing just about everything I wanted to do. He was ok with me increasing duration at this intensity to whatever was comfortable.

My next stress test is end of 2016. Next cardiology appointment in 6 months.

I also talked to him about some of the newer medical approaches in the pipe. I am interested to see how the ventrigel trial goes.

So for now, will keep chugging along. I plan to go longer and add more resistance work (still no push-ups).

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Re: Year 2 After an MI

Post by EugeneRunner on Mon Oct 12, 2015 1:11 pm

In my case my EKG looked pretty clean after the stent (not before!), so that makes a big difference. In cardiac rehab they gradually worked me up to 85-90% on the treadmill with an EKG going and attempting to take my blood pressure as I ran. I didn't get a full stress test until about 2 1/2 years later, but I was already well tested without it.

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Re: Year 2 After an MI

Post by jerseyguy on Tue Oct 13, 2015 7:34 am

It sounds like it was a pretty successful meeting with your physicians. Personally I will take endurance (duration) over speed any day of the week. I hope things continue to go in your direction.

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