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when super fit should you reduce excercise after diagnosis
Hi my husband is 50 years of age, a pilot so does stress ecgs every 6 months always with excellent results, he has a low resting heart rate - 42 and cycles 2 hours for 4 times a week plus plays squash in league 2 times perweek.  However he has had high cholestorol which has been treating with crestor for 10 years - this is now under control.  However as his sister had a heart attack a couple of weeks ago he decided to go for the ct scan - his doctor said nothing would be wrong given all his ecg results but it came back with possible 60% narrowing of artery.  Then we went to cardiologist - after stress ecg with cardiologist he said he suspects nothing will be wrong as he is so fit and experiencing NO SYMPTOMS whatsoever - they did angiogram and it showed three blockages - one of 80% in LAD - with a length of 33mm - so he said it was too long to stent and would need a by-pass.  However given his ecg results and no symptoms he has decided to treat it medically with Pritor......  now all the literature says 40-45 mins brisk walk a day - so does this mean my super fit husband should reduce his excercise???  If so by how much as I am sure his fitness must have helped him....  sorry i just feel like it is a timebomb waiting to go off!!   thank you for any advice
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976897 tn?1379171202
I went through a very similar thing back in 2007 and I sincerely hope what I tell you from my own experience will help you to make the right decision. I had a heart attack and was sent for emergency stenting and it was my Circumflex artery which had the blockage. However, during the angioplasty, my LAD was seen to have a 40mm 100% blockage at the top, and my right artery was 100% half way down. I should have really been dead, but I had opened many collateral vessels (which we are born with), and these open up to form natural bypasses. This was proved by doing a nuclear scan. They expected to find lots of dead heart muscle, but the scan showed a very good feed getting to all the muscle. Natural bypasses form in most people, and the more you exercise, the more likely they are to open up. To have a 33mm 80% blockage and have no symptoms is a good sign such vessels have opened. I would ask for a nuclear scan before having a bypass, this shows how much oxygen is reaching all the heart muscle during rest and when the heart is working hard. Although my results were excellent, they convinced me to have a bypass, a triple. It took 12 months to recover fully, and yet the bypass failed after three months. I felt worse after the bypass failed than I did before the surgery. This is because the surgery caused the collaterals to close up, and not so many opened again after the bypass failed. This is because I wasn't doing the same level of exercise due to recovery. It is important to also realise that the 80% blockage didn't happen overnight, it has probably been building up over many years. They estimated mine was over a 10-15 years period. If I was in your husbands shoes, I would continue to exercise as before, giving his heart more reason to keep opening collaterals. His heart is not enlarged which is also a good sign he's developed collaterals. I would ask for a nuclear scan to backup the decision of a bypass. If the nuclear scan looks good, I would decline the bypass, definitely. In years to come, if he starts to feel shortness of breath, then this could be an indicator the blockage is worsening and needs intervention, but until that time (if it ever occurs), I would leave nature to cure itself.
There is also a lot of emphasis now on looking at diet, how it affects heart disease. For decades, fatty foods have been blamed but newer research is turning to products such as sugars. Japan for example had virtually zero heart disease with its high protein style diet, but with the scaremongering from other nations about fat, they switched to high carb diets. Now they are seeing heart disease increasing dramatically. Fatty foods can cause LDL to increase, but the large ones which are less likely to stick in arteries. Sugars cause the Liver to over produce small LDL which stick everywhere. Low fat foods are packed with sugars to make them taste better and many high carb foods are filled with sugar to stop them tasting like cardboard. The fashion of drinking soda pop hasn't helped and energy drinks.
I hope this helps and I hope your husband avoids going down the same road that I did. I would just like to add something. I was told also that stenting my LAD was not an option, it was too long and dangerous. Two years after my bypass failed, there was no other option and the leading stenting expert in the UK reopened my LAD with 5 long stents. An option which was supposed to be impossible.
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976897 tn?1379171202
I would just like to add, I think you are very wise to question these things, and you obviously think logically knowing exercise has been the big help. Keep following your instincts.
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thank you so much for your comments - i will definately look at the nuclear scan - think he might have done that already is it the ct scan or something different

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976897 tn?1379171202
it's different from ct scan and you are most welcome.

Nuclear scan sometimes called,  Thallium scan, nuclear perfusion scan.
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1862346 tn?1319967541
i have been living on collaterals for last 10 years, having refused a bypass for 100% occluded LAD and 80-90% occlusions in rca and circumflex, because i had no symptoms then. took niacin for 5 years but has skin rashes over the scalp which were a bit embarassing to explain.. exercise regularly 30 min, 5 days a week and eat fruits veg etc. the collaterals are doing great as the thallium scan shows. however whenever i eat a bakery product  like biscuits, cake patties or deepfried chips etc 2 hours before the exercise i feel angina and have to take a nitrate for relief. does anyone has a similar experience or is it specific to me? for last 6 months iam off all statins and my blood pressure has improved to 120/75 which is great and i feel lot energetic.however iam back to zocor 10mg and ace inhibitors and an aspirin. .
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976897 tn?1379171202
I think high fat foods can affect the heart. Whenever I've had a nuclear scan, I've been told to eat a very high fat lunch between the scans to push the medication around the bloodstream.
Just out of interest. Where are your collaterals coming from? If the LAD is 100% occluded then it isn't from there. If the RCA and LCX are 80-90% occluded then there isn't much flow or pressure from them either. There is nowhere else. Perhaps your collaterals are different from what mine were like. My collaterals fed from my healthy LCX into the RCA and LAD. Perhaps yours simply go around the blockages on the same vessels?
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