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Avatar universal

Exercise prescription for bypass patient

   I am a 60 yo male who had a double bypass 5 years ago. I had no pain at the time nor exercise intolerance but since blockage was in LAD, surgery was virtually demanded by the doc. Now, mammary graft has been found to be flowing little if any, apparently due to "string phenomenon" where blood is finding alternative routes. Since I had heavy collateral network at the time of surgery, this may have been the internal bypass (my analysis).
   Anyway, I have always been a very heavy exerciser with long distance running, cycling, and triathalons. I continue all this at the previous levels with no apparent problem. I have perhaps rationalized that my 5 year usage of statins, excellent cholesterol profile (ldl 72, hdl 82, tri 50), 33 inch waist and low normal bp would protect me from a heart attack, even with intensive exercise. However, the recent Tim Russert tragedy has me somewhat concerned as he was apparently being well managed and had excellent exercise capacity. Most of the medical advice I have received is that "jogging"-as opposed to running or easy cycling are OK, but no racing or other max exertion.
   Is this a reasonable prescription for the rest of my life, after 35 years of the opposite? Or the larger issue, should any 60 year old man be doing intensive exercise? I think it is generally accepted that most men of this age have some degree of atheroschlerosis and may be completely asymptomatic.
4 Responses
242508 tn?1287427246
MEDICAL PROFESSIONAL
This is a difficult question to answer.  Given that you have established severe disease in the LAD that essentially has not been revascularized despite having had bypass surgery, there is a risk that you might become ischemic during exertion and suffer sudden cardiac death.  Some patients have no symptoms of angina so I wouldn't bet on that especially that you have severe disease in the LAD.  Collateral circulation is good for mild, maybe even moderate exertion but severe exertion should be avoided because of the risk of ischemia.
Avatar universal
   Thanks for the rapid response. I understand your thinking and have read where collateral circulation is not sufficient to take over from an open native artery. The thinking of my cardiologists I think is that I may have some sub-critical lesions that may rupture and cause an infarct. My thinking is that any early lesions I may have should have developed the fibrous cap or toughened by lengthy statin treatment and as such, be resistant to the rigors of maximum exertion. As to the lack of angina, I would think there would be some other clues to severe ischemia before it became critical enough to result in sudden death.
   As I mentioned in my first post, I may be rationalizing. However, when one has made intensive exercise a part of their life, it becomes a drug that is hard to quit.
Avatar universal
Tom, I to am a runner and cyclist. I agree with you exercise is a drug, I can't quit. I am 50 years old have CVD treated with a stent injuly 2006, I thought I ate wisely, and exercised a lot prior to my stent, so you can imagine I was shocked and fearful that this could have happen to me.I had previously been on medication for high blood pressure and anxiety with side effects tough to live with especially as a runner. I was also placed on a statin blood thinners etc after my surgery. I did not know what on earth I should do, which way to turn.I prayed and feel I was led to the web site of Dr Fuhrman.com , who Treats people who refuse cardiac intervention for blockages. It impressed me that in most of his patients the symptoms like angina and the likes ( which by the way I never had either) were relieved, and in most in just a few weeks. The other thing that caught me was that in over twenty years all his cvd patients  who adopted his advice have regained there health. The great part of this is he offers no magic pill or an exotic cocktail. Nutritional excellence, thats it . And I am living proof it works. His book is available on Amazon for as little as $6.00. called "EAT TO LIVE".
After my stent I was on drugs costing $4500 per year. I hear on TV advertising for statins that they slow progression of the disease. that means to me that over time things are not going to get better only worse.
In the two years since, I have strictly kept to Dr Fuhrmans advice and it has been equally as shoching but in a good way. My Cardio Doctor ( who is a fantastic marathoner) has had to lower and lower my meds as my numbers from blood work kept lowering. I was on two blood pressure meds , and now only a trace of what I was taking, which I think will be stopped in the near future . Drugs now cost me $200 per year . Started out on lipitor 80mg , now 10 mg total cholesterol 142, ldl 71, hdl 59. tryg 78. B/pressure this morning 114/63. which is slightly lower than my 122/70  that I average now.
Tom consider reading the book if you will, it sure is working for me,
                                                                                      Brian.
ps; Had cardio checkup last week Doctor only wants to see me in a year. Also forgot to say anxiety is no longer a part of my life, over time nutritional excellence has taken that from me too. Thanks to the Lord.
Avatar universal
Brian,
Thank you for your comments. Your post however just adds one more to the list of heavy exercisers I know who have fallen victim to heart blockages in spite of what they considered a healthy lifestyle. The phenomena is so perverse that I actually feel that my continued exercise is probably working against my ultimate survival. I found an article in one of the medical journals documenting a case study of a physician who was a marathon runner for many years that was found to have extensive calcification in all his coronary arteries. Further investigation showed that his blood pressure rose to high levels during his runs and left his arteries in inflamatory state for hours afterward. Vitamins C and E were found to alleviate the situation to a large degree.
   My own 6 year younger brother who exercises pretty much like me was also found to have a very high calcium score 6 years ago, although he hasn't had symptomatic blockages. He is a vegetarian, by the way.
   I have moderated my exercise routine somewhat favoring longer bike rides where my pulse may average 130 or 140 instead of hard runs that put it up to 170. I have also retired, partially because the opportunity presented itself but mostly because I think stress and my over-reaction to stress may be a significant player in my disease. Staying healthy is now "Job One".
   I enjoyed your comments and hope you continue to have good health.

Tom
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