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THE MISTAKES THAT NEARLY KILLED ME  A staff artist's depiction of a heart catheterization procedure in progress, physicians watching the process on a TV monitor. |
Ignoring warning signs
led him to the brink
of TheColumnists.com
The first chest
pain came as I was biking up a steep hill. I ignored it. The
sensation went away as soon as I started pedaling on level ground.
Besides, I was put off by the fact that it wasn’t the sharp,
debilitating pain I thought you feel when you get a heart attack.
It was a kind of general discomfort or heaviness in the chest
area. And it didn’t last.
So I forgot about it. That would be the first of many mistakes
that would bring me to the brink of disaster.
MISTAKE TWO. Even when the discomfort came back the next day
as I jogged uphill, I did nothing. It vanished again soon after
I reached the top. So I didn’t call my doctor or even mention
it to my companion, Kay Kramer.
Two weeks later, I would be stretched out on my back at the Cleveland
Clinic with three heart doctors hovering over me.
They would find the problem in my main coronary artery—the
so-called left anterior descending (LAD) artery nicknamed the
“widow-maker.” It was the closure and rupture of this
artery that caused the death last year of TV journalist Tim Russert
at age 58.
I would be more fortunate. But the harrowing experience would
leave me with three lessons in health care that I wouldn’t
soon forget.
I am 78. I know age increases your risk of getting heart disease.
But one reason I failed to respond to my body’s warning
signals stemmed from the fact that I work out regularly.
MISTAKE THREE. Like many fitness buffs, I thought staying in
shape protected you from heart disease.
Regular exercise does reduce your risk. But I now realize that
jogging, biking, and swimming won’t always give you a free
pass.
You need to take into account risk factors that increase your
chances of falling prey to the nation’s number one killer.
Two applied to me.
Family history was my first risk factor. Your chance of getting
heart problems increases if your mother or father died from heart
disease. I was doubly at risk. Heart attacks killed both my parents,
albeit late in life. My father died at 72 and my mother at 82.
Risk number two applies to cholesterol, the fatty substance in
the blood that can gradually clog your coronary arteries. These
tiny but critical arteries transport life-sustaining oxygen to
your heart muscle.
I had borderline high cholesterol. My reading hovered around
the 200 level, making it likely that fatty deposits, called plaque,
were narrowing the opening in my coronary arteries.
There was one more bit of data I chose to ignore. Three years
ago, I took a high-tech test that uses a Cat Scan to measure
the calcium (or hardened plaque) deposits in coronary arteries.
To my surprise, I came out with one of the worst possible results.
I fell in the highest 75th to 90th percentage of men of my age.
That is, I was in the ranks of those with the most plaque build-up
in their heart.
Dr. Henry Saunders, my doctor in Conway, S.C. (where I spend
winters) put me on a statin drug to thin my blood. He did it
as a preventive measure to try to prevent a clot if blockage
developed. That action—and taking a baby aspirin every day
--probably saved my life.
But back to the issue at hand. Even though I was aware of my
poor test score, it still took me two weeks after I felt chest
discomfort before I went to my family doctor in New York (where
I am during the summer and fall).
He gave me an electrocardiogram (EKG) that showed I had a “circulation
challenge.” But that data was too vague. He scheduled me
for a stress test--a more informative exam that would xray my
heart while I walked and ran on a tread mill.
Meanwhile, I called Dr. Marc Penn, my cardiologist at the Cleveland
Clinic whose heart program is rated among the nation’s finest.
I told Penn about my chest discomfort and the EKG finding.
“Your story sounds like stable angina (chest pain or discomfort
triggered when you are active and your heart works harder),”
Penn said, “If you weren’t scheduled for that stress
test, I would have suggested you come right here for a catheterization.”
I was at Chautauqua in upstate New York, some 150 miles from
the Clinic. The stress test was at a local hospital only 15 miles
away.
MISTAKE FOUR. Geography ruled my decision. Instead of making
a bee line to the world famous Clinic, I took the stress test
because it was closer.
I nearly couldn’t complete it. I huffed and puffed mightily
as I struggled to keep up with the treadmill as it raised my
pulse from 60 to 160 beats a minute.
The test showed I had a serious problem. There was a blockage
in my heart. But the test didn’t tell where it was or how
extensive it was.
MISTAKE FIVE. Still, I downplayed my situation. I felt discomfort
only when I was exerting myself. So I thought I could wait before
going to the Clinic.
I called Penn back and told him I was about to take a long-planned
vacation to Canada. “Let’s do the cath test when I
get back.”
Looking back, I realize how foolish I was. But I was to get a
second chance.
Penn called back. He said he had talked to Dr. Irving Franco,
one of the Clinic’s senior “interventional” cardiologists.
These specialists use non-surgical techniques like catheterization
and angioplasty to clear heart blockages.
Penn asked if he could take a patient with an urgent problem.
Franco, who has been at the Clinic since 1971 and does about
300 catheterizations a year, said his schedule was full. But
he said he would work me in the next day.
“There’s a cath opening tomorrow,” Penn told me.
“You would need to be at the Clinic at 11 a.m.”
“I’ll be there,” I said. Finally, I made the right
call.
The next day, my companion Kay drove me to the famous Clinic.
It was here that the coronary artery bypass operation was pioneered
and first performed in 1967. Today, almost 2,000 doctors and
scientists work at its sprawling campus that attracts patients
from all over the U.S. and from 80 nations.
I got to the Clinic at 11 a.m. I felt no discomfort on the ride.
But during a six-hour wait before my turn came in the cath lab,
chest pains started. It was the first time they had come at rest.
A nurse gave me a nitroglycerin pill to take the pain away as
she prepared me for catheterization, considered the gold standard
for investigating heart pain.
In the cath lab, one of six in the Clinic, Franco inserted a
catheter (narrow tube) through a vein in my thigh and threaded
it up into my coronary arteries.
After squirting contrast dye through the catheter, he studied
a TV monitor showing xray movies of the dye’s path. He looked
for any blockage the dye would show up.
There were two options.
If the blockage was scattered and located in three or more arteries,
Franco would refer my case to an open-heart surgeon who would
do a bypass operation.
If the blockage was confined to a small area in one or two arteries,
Franco would do a simpler procedure called angioplasty.
In that case, he would open the artery by flattening the plaque
with a tiny, inflatable balloon at the tip of the catheter. If
the blockage was severe, he would implant a stent, or metal mesh
tube, to act like a scaffold and prevent the artery from closing.
What would it be—surgery or angioplasty?
The answer came from one of Franco’s assistants. “There’s
a blockage in your main artery,” he said. “The good
news is we’re putting in a stent.”
The whole procedure took only about 45 minutes. In the waiting
room, Franco told my companion Kay that plaque buildup had blocked
95 per of my main coronary artery.
With only a 5 per cent opening left, I was at risk for a heart
attack and the stress test had been a questionable choice because
it by itself could have brought on a heart attack
.
“He’s a very, very lucky man,” Franco said.
Penn said that one reason I escaped the ruptured artery--that
ended TV newsman Russert’s life--was the fact that Dr. Saunders,
my family physician, had put me on a blood-thinning drug regimen.
I stayed overnight at the Clinic and then was told to take it
easy for two weeks. After a month, I resumed normal activity.
So what was the take-away message? It breaks down into three
parts. If your heart sends you a warning by giving you chest
pain or discomfort:
1. Listen to your body.
2. Then, do something about it. And do it without delay. If you
err, err on the side of caution. Go straight to a doctor or an
emergency room.
3. If the doctor or the ER find a life-threatening problem, get
the best medical care you can--no matter how far you have to
go. Major illnesses should be treated at major hospitals. You
have only one life to live.
©2009 by David Zinman. The Zinman caricature is ©2001 by Jim Hummel. The illustration is a staff artist's conception of an internet photograph. This column first posted Nov. 9, 2009.
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