Bicycling saved my life. More accurately, leading an active lifestyle significantly contributed to a positive outcome from a major heart problem.
Thanks to my parents’ interest in the outdoors, I grew up attracted to outdoor fun. My teenage years were focused on sailing and mountaineering. As a young adult I added telemark skiing, ski mountaineering, whitewater kayaking and sea kayaking to my adventurous lifestyle.
Six years ago, when I started raising children, professional activities and child rearing took a front seat to outdoor activities. My transition to bicycling as a primary outdoor endeavor began when, three years ago, it dawned on me that the two cars that my wife and I owned were never moving simultaneously. While we often used them both on the same day, inevitably one was parked somewhere while the other was being driven. This struck me as insane, so we sold one vehicle, and for a year I took a bus to work.
Two years ago I bought a Surly Long Haul Trucker touring bicycle and became a passionate bicycle commuter. For winter commuting, I rigged up an old mountain bike with studded snow tires. My ten-mile round trip bicycle commute, complete with 400 feet of elevation gain to my South Hill home, became a pleasurable and positive habit.
In early June, while starting my bike ride home from work, I experienced chest pain. I seriously considered calling 911, but kept pedaling. I then considered stopping into the emergency room of the hospital that I bike by everyday. Although the chest pain continued, there was no sharp or spreading pain. Feeling strong as ever, I continued biking up the hill to my home. As soon as I reached home, the pain went away. Thinking I experienced a cramp, I probably would not have thought about this event again.
The next day, a 46-year-old friend of our family died of a heart attack. This tragic event, combined with the knowledge that my father died of a heart attack at the age of 53, gave me pause for concern.
In mid-June I met with my doctor, who administered an electrocardiogram (ECG), which did not indicate any heart problems. However, she wisely suggested that I schedule an exercise ECG test, which took place in late June. While I scored very high for “exercise tolerance,” the cardiologist detected an “ST change,” an electrical finding that suggested an abnormality in cardiac blood flow. Given my family history, he suggested I schedule a cardiac catheterization for diagnostic purposes.
This coronary angiography involved threading a catheter into my heart via the artery in my groin, injecting dye into my heart, and taking an x-ray. The outcome of the test was shocking. The angiogram detected a 100 percent occlusion of the left anterior descending (LAD) artery, one of the three major coronary arteries that provide blood to the heart muscle. The cardiologist suggested an angioplasty procedure to attempt to open the blocked artery and place a stent. Alternatively, he said I could consider single-bypass open heart surgery.
I spent the next several days obsessing over my heart condition, and fearing that I might keel over at any minute. I went for walks in neighborhoods that I knew well, and continually focused on the nearest intersection so that when I called 911 to request assistance for my impending heart attack I could inform them of exactly where I was lying.
Fortunately, a friend of mine, who is a young medical doctor, took an interest in my treatment dilemma. He kindly spent an evening educating me in the pathophysiology of heart disease. He even brought over medical journal articles for my edification. He explained that there is a significant difference between a condition that often causes a sudden catastrophic heart attack and a condition such as mine, where I have a “stable” and probably longstanding blocked artery. Sudden heart attacks often occur when there is “vulnerable” plaque buildup in an artery that suddenly ruptures causing a total occlusion of an artery. This sudden occlusion can be fatal.
My friend suggested that my condition may be very different: a slowly developed “stable” plaque buildup that eventually caused a total occlusion that couldn’t get any worse and was unlikely to cause a sudden catastrophic event. He explained that some research studies indicated that neither a stent nor surgery may be the best choice for preserving life. Instead, drug therapy, diet and exercise may provide the best solution. He recommended another cardiologist for a second opinion consultation.
In early July I met with this new cardiologist for a second opinion. He suggested one last test: a cardiac stress nuclear procedure. This involved the injection into my circulation of a radioactive tracer dose followed by x-ray imaging both before and after exercise on a treadmill. This test determined that, at exercise, there is an adequate amount of blood reaching the heart below the occluded LAD, although it is less than the normal amount.
I decided to follow the advice of my new cardiologist. He concluded that I have a stable blockage of the LAD, with significant blood being provided to the heart below the occlusion from two collateral flows from the right coronary artery. No heart muscle damage had occurred. He said that there appears to be no health risk from this occlusion itself and did not believe that a stent or surgery is necessary unless the chest pain persisted. He stated, if you are going to have a heart problem, this is a good problem to have.
The ability of the coronary vessels to compensate for a problem is truly amazing. A network of collateral branches that interconnects the three major coronary arteries can provide for perfusion to the heart muscle beyond an occlusion. There is tremendous individual variability in the function of coronary collaterals, and exercise has much impact upon developing collateral flow. In my case, an active lifestyle with lots of regular exercise, including daily bicycle riding, contributed to adequate collateral perfusion of my heart beyond the occlusion.
My cardiologist encouraged me to continue to be as active as I currently am, and to continue my healthy diet. He suggested medical therapy consisting of a daily statin and aspirin. The goal of this medical therapy is to get my low-density lipoprotein cholesterol level to a low level in order to safeguard my remaining coronary arteries.
As I write this article, I am vacationing in Port Townsend and paddling my sea kayak every day. When I return to Spokane, I will gladly and gratefully continue my daily urban bicycle riding, which really did save my life.
