Angioplasty and Stent | Best Exercise Guidelines For a Safe Recovery

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I have received numerous requests for an article on exercise after angioplasty with and without stent placement after my other articles on exercise after bypass surgeryheart attackheart valve surgery, general open heart surgeryatrial fibrillation, and implantable cardioverter defibrillators.  Ask and ye shall receive!

What is angioplasty?

Before we get into what angioplasty is, you must first understand that coronary artery disease causes narrowing of the blood vessels that feed blood to your heart.

It can result in symptoms like pain and/or pressure in the chest, neck, back, jaw, arms (collectively called angina), or, if left untreated, a heart attack (myocardial infarction).

A cardiac catheterisation procedure is often performed to determine the extent of the blockages in your arteries and, if necessary, angioplasty may be performed with or without stent placement.

The term angioplasty comes from the Greek words angio meaning “vessel” and plasticos meaning “fit for moulding” but in very simple terms, it’s just another name for a heart plumbing job.

The full name for the procedure is percutaneous transluminal coronary angioplasty (PTCA).  Translation: percutaneous means they pass an inflatable catheter through the skin (at your femoral artery in your groin area) traveling through the lumen (the space within your artery), up into your aorta, and then enter into your coronary blood vessels (the arteries that serve blood to the heart). Another common name for the procedure is percutaneous intervention or PCI.

Once the blockage is visualised, the doctor then passes the catheter into the blockage and inflates a small balloon to widen the blood vessel and reestablish blood flow.

What is a stent?

A stent is commonly inserted during angioplasty.  A stent is a little wire mesh which keeps the artery open after the balloon has been removed and minimises the chance of the artery blocking up prematurely (restenosis).

The main types of stents include a bare metal stent and a drug-eluting (medicine-coated) stent, the latter of which helps prevent scar tissue from blocking the artery.

Angioplasty and stent procedure in images

Angioplasty procedure 1
Blocked artery visualised during catheterisation
angioplasty/stent
Catheter, balloon, and stent inserted into blockage
angioplasty/stent
The balloon inflates the stent, pushing the plaque off to the side of the arterial wall.
angioplasty/stent
The catheter and balloon are removed, leaving the stent in place with reestablished blood flow.
angioplasty/stent
Here you can see the artery in the middle of the image with blood flow reestablished. Compare to the first image.

Below is another example which prominently shows the difference in blood flow after arterial stenting.

Angioplasty Stent

Common medications

A number of cardiac medications are commonly prescribed to help minimise the risk of your artery reoccluding (blocking up again), as well as reducing cardiovascular disease risk factors (to prevent another blockage).

The thing you have to remember is that when it comes to coronary artery disease, it’s not always a case of the doctor “fixing it” with surgery. There is always a risk of blockages in other arteries.

So while I’m not a fan of pumping people full of medications, there are times where they can be a valuable adjunct to reduce your risk of a heart attack whilst making lifestyle changes.

Once you get your risk factors under control (i.e., lose weight, quit smoking, start exercising, reduce blood sugar (if diabetic), then you can discuss with your doctor the possibility of reducing or discontinuing some or all of your medications.

Beta-blockers

Beta-blockers slow down your heart rate which also helps to reduce blood pressure and, consequently, workload on the heart. They also help relax your blood vessels which can help improve blood flow and reduce or prevent chest pain (angina).

Blood thinners 

Blood thinning medications like aspirin and Clopidogrel (Plavix) reduce the ability of your blood to clot, making it easier for blood to flow through narrowed arteries and reducing your risk of a heart attack.

Nitrates

Nitrates (such as nitroglycerin) are a common anti-angina medication which relax and widen your blood vessels to allow more blood flow to your heart muscle.   Nitroglycerin comes in small tablets that you place under your tongue when having chest pain.

Statins

Statins are prescribed to lower your blood cholesterol.  They work by blocking precursor substances needed to synthesise cholesterol.  Statins can help reduce the accumulation of plaque in your arterial walls which may reduce the chances of another blockage forming.

Calcium channel blockers

Calcium channel blockers affect the muscle cells in your arteries which help the blood vessels relax and widen.  This results in increased blood flow through your coronary arteries thus reducing or preventing angina.  Certain calcium channel blockers slow the heart rate which reduces workload on your heart.

ACE inhibitors

Angiotensin Converting Enzyme (ACE) inhibitors block an enzyme that produces angiotensin II, a substance which constricts your blood vessels.  By blocking the formation of this substance, it helps relax your blood vessels to reduce blood pressure and workload on your heart.

Lifestyle changes

Most importantly, lifestyle changes are crucial after surgery.  A combination of regular exercise, a prudent diet, quitting smoking (if you smoke), stress management, and behaviour modification to help you stick with it are all key pieces of the lifestyle puzzle.

Angioplasty is not a “cure” for your coronary artery disease.  Like with medications, the procedure simply buys you more time to make important lifestyle changes which can reduce your risk of arteries reoccluding (blocking up again) or other arteries plugging up for a first time.

Healthy eating 

For more information on diet for people with coronary artery disease, please read Gabby Maston’s guest post on the paleo diet vs. the Mediterranean diet.

Benefits of exercise

It’s common sense.  We all know exercise is good for us, but here’s a laundry list of benefits to put you in an exercising kind of mood:

  • Reduced risk of a heart attack (or second heart attack if you’ve already had one)
  • Improved heart function (i.e., lower heart rate and blood pressure means less workload on the heart)
  • Increased anginal (chest pain) threshold.  The more fit you are, the harder you have to work to elicit chest pain (if there are blockages present)
  • Improvements in oxygen delivery (via the blood) and consumption (in your muscles)
  • Enhanced fuel selection with exercise (i.e., your body can tap into fat easier with better conditioning)
  • Body composition improvements (i.e., reduction in fat, particularly dangerous fat around the organs)
  • Improved blood sugar control and insulin sensitivity (if you have diabetes)
  • Increased functional ability (i.e., easier to perform activities of daily living like lifting boxes, gardening, cleaning the house)
  • Increased quality of life

When can I exercise?

After your surgery, you’ll probably feel great (provided you’ve not had a heart attack or other complications) because your heart muscle is now getting lots of oxygen through the newly reopened arteries. But you must remember, even if you’re feeling better, know that there IS still healing happening on the inside.

I recall a client I had back in 2007. He called me up and said, “hey, I hear you’re the heart exercise guru.  Can you start training me today?”

Me:  “Well, not sure about the guru bit, but maybe I can help you. When did you have your angioplasty?”

Client: “Two days ago.”

Me:  “Right, ok, I’m going to grab you by the scruff of your neck, pull you back down to planet Earth, and save you from yourself.  I’m glad you’re enthusiastic about getting back into exercise, but you still have some recovery and healing time ahead of you before we can work together.”

It’s important to give yourself at least a couple weeks of low activity recovery time after leaving the hospital.  This means you can get out and do walks around the neighbourhood on level terrain, but leave the steep hills and pumping iron to Arnold (for now).

If you’re planning on doing some hard exercise (aerobic or strength training), I’d advise you to ask your cardiologist if a post-angioplasty treadmill stress test is appropriate.  If you can tolerate high workloads without any signs or symptoms (ie., chest pain, shortness of breath) or unexpected arrhythmias on the electrocardiogram, then this is pretty good assurance that you’ll be able to push the higher exercise intensities on your own.

Whether or not you do a pre-exercise stress test, be sure to get your cardiologist’s approval before you get into any structured exercise (gym workouts, tennis, golf, etc).  Make sure you understand the effects of your medications on the exercise response.

Aerobic exercise guidelines

When you’re first released from the hospital, it’s important that you’re up on your feet and moving around a bit but keeping the intensities low to allow for healing.  Even if you think you can do a lot more, err on the side of caution and take it easy.

The following is an illustration of a sample exercise plan which may serve as a rough guide (provided your surgical team agrees).  The aim is to wean yourself from shorter to longer exercise durations by minimizing how many exercise bouts you perform each day.

 WeekMinutesTimes per Day
13-56-8
25-104-5
310-153-4
415-203
525-302
630-452
7601

 

How often can I exercise? 

Start off with 3 to 4 days per week and work up from there.  If you were previously active before surgery, then you do have the advantage of muscle memory and a residual training effect, but as I stated above, you need to “test out” your body during exercise and the effects of medication on your exercise response.  Once you establish your fitness foundation, gradually work up to daily exercise sessions.

How hard can I exercise?  

The answer is always the same:  it depends.  Exercise intensity can be a tricky one because depending on your current level of conditioning, you may be able to tolerate higher workloads than someone who was previously inactive before their angioplasty procedure.  If you had a heart attack, then this can further complicate matters.

If you’re looking for a training target heart rate, then here are some basic calculations you can do.  I’ll give examples below basing the calculations on a 50 year old man with a resting heart rate of 60 beats per minute.

Method 1: Straight heart rate calculation

1) Determine your theoretical max heart rate by subtracting your age from 220.  So:

220 – 50 = 170 bpm

If you have an actual MEASURED max heart rate from a stress test, then use that number instead.

2) Then calculate training percentages based on 170 bpm.  So if you wanted to exercise at, say, 50 to 65% of your max heart rate, you’d calculate it as:

170 x .50 = 85 bpm
170 x .65 = 111 bpm.

Therefore your training heart rate range would be 85 – 111 bpm.

For 60 to 75%, it would be:

170 x .60 = 102 bpm
170 x .75 = 128 bpm

Therefore your training heart rate range would be 102 – 128 bpm.

Method 2: Karvonen method (aka heart rate reserve)

The Karvonen or heart rate reserve method is a little trickier but I’ll do my best to make it clear.

1)  As above, subtract your age from 220 to get your theoretical max heart rate.  So it’s 220 – 50 = 170.

2) Then subtract your resting heart rate from the result of step 1.  So 170 – 60 = 110.

3) Now calculate your training heart rate percentages from this.  If we use the 60 – 75% range it would be calculated as follows:

110 x .60 = 66
110 x .75 = 83

4) Now add your resting heart rate to these numbers.  So:

66 + 60 = 126 bpm
83 + 60 = 143 bpm

Therefore, your training heart rate range would be 126 to 143 bpm.

I would advise starting at the lower percentages and see how you fare.  It’s not a perfect science so you may need to adjust them if the training ranges are too easy.

If you have a hard time finding your pulse, get yourself a heart rate monitor or a Fitbit (which also tracks your non-exercise movement habits). Click on each image to check out features and thousands of Amazon user reviews.

Also remember that if you’re taking medications that alter your heart rate (i.e., beta-blockers), then none of these calculations are going to be worth much.  In that case, you’ll need to rely on what exercise physiologists call the “talk test.”  If you can have a conversation with the person next to you while doing your exercise, then the intensity is probably sufficient.

The Borg rating of perceived exertion (RPE) 6 to 20 point scale is also quite useful.  The logic behind a 6 to 20 scale is that most people at rest or doing light activity have a heart rate between 60 to 90 bpm.  If you’re working very hard, then you’re going to be around 170 to 200.  So Borg decided to just drop the zeros and create a scale which is consistent with most heart rates at a given workload.  This is particularly useful if you’re taking medications that slow your heart rate.  There is a bit of a learning curve to it, so if you’re enrolled in a cardiac rehab program after your surgery, have the staff exercise physiologist explain the scale to you.

Borg RPE scale after angioplasty

How many minutes should I do aerobic exercise?

I suggest easing into it.  Start off with 10-20 minute bouts of exercise and then work up from there.  Also pay attention to how you feel both immediately after and the following day.  If you feel absolutely drained by doing 20 minutes, then perhaps scale it back a bit and build up your conditioning to longer durations.

If you need to do several small intervals to accumulate your daily exercise minutes, then break them down into small intervals you can tolerate. You might do 10 minutes, have a break, do another 10 minutes, have a break and then do a final 10 minute walking bout. You’ve just accumulated 30 minutes of activity.  I often suggest working up to longer durations of 45+ minutes as tolerated.

Which types of aerobic exercise are best?

There are not set in stone guidelines for this, but aerobic exercises that incorporate the large musculature of your body (i.e., hips and legs) will give you the most exercise bang for your buck.  Also be sure to pick exercises you enjoys since that will increase the likelihood you’re going to do it.

Aerobic exercise precautions

  • Get your doctor’s clearance to exercise first.  Ease into it and carefully work your way up to higher intensities and longer durations.
  • Perform a gradual 5 minute warm up to allow your heart and blood vessels to adapt to the exercise.  Jumping straight into high intensity exercise could potentially aggravate the stent and cause it to collapse (particularly immediately post-angioplasty).
  • While in the early recovery phase (1-2 days immediately post-op), avoid overexerting yourself with strenuous/vigorous exercise (unless advised to do so by your cardiologist or surgeon).  Pushing too hard can cause a sharp spike in your heart rate and blood pressure which might cause the stent to collapse (it can and does happen).  Use the ol’ KISS acronym:  Keep It Slow and Steady.
  • Walk or cycle on level surfaces to establish your fitness foundation. You’ll be able to handle the hills in due time. If you find yourself huffing and puffing, that should be an indicator to ease up on the accelerator!
  • Limit your exposure to environmental stressors such as extreme cold, heat, or strong winds. Any of these can make your usual exercise pace seem much more difficult.

Adverse signs and symptoms

Pay attention to any signs or symptoms associated with exercise. Stop exercise if you experience chest pain, tightness, or discomfort, pain radiating down the arm or jaw, back pain between the shoulder blades, or shortness of breath,  If it does not resolve by itself or continues to get worse during rest, seek emergency medical attention.

Resistance / weight training guidelines

One of the common questions I get from my readers is “can I lift weights after an angioplasty/stent?”  The short answer is probably yes, but how much weight you lift is going to depend on a number of factors that will need to be discussed with your cardiologist.

Here are some questions you’ll need to bring up with your medical management team (i.e., cardiologist, nurses, cardiac rehab team):

  1. Did you have a heart attack?
  2. Was there any damage to your heart muscle?
  3. Do you have any arrhythmias stemming from the heart attack?
  4. Do you have high blood pressure?
  5. Are you taking medications to lower your heart rate and blood pressure?
  6. During the cardiac catheterisation, did they note how widespread the coronary artery disease was (i.e., one artery, two arteries, triple vessel disease)?
  7. Did they stent all the offending arteries or were there still arteries with lower levels of plaque they chose not to stent?
  8. Were you a regular weight lifter before your procedure?
  9. How much weight were you lifting?

By no means is this an exhaustive list, but they are questions that need to be addressed.  If you had damage to your heart muscle, arrhythmias, or high blood pressure then high intensity weight lifting might be contraindicated (not advised).

If you had arteries with coronary artery disease which were not stented, then there is still a chance these plaques could rupture while lifting heavy weights.

If you were a weight lifter before the procedure then you might be able to tolerate weight training better than someone who is completely new to the gym.

How often can I lift weights after the procedure?

Consider starting off with 2 times per week and see how your body responds.  Then consider working up to 3 – 4 days per week as tolerated.

How much weight can I lift? Can I lift heavy weights?

The answer is:  it depends.  More than likely, you’ll be able to lift again, but how heavy you lift is going to depend on a number of factors.  Refer to the list above regarding weight training considerations.  You’ll really need to discuss this with your medical management team.

How long should my weight lifting sessions be?

There’s no resolute answer to this since it’s going to depend on how many exercises you do and how many sets and reps of each exercise.  This will be a bit of trial and error, but I would suggest paying attention to how you feel immediately after and the following day.  If you feel exhausted and run down, then you may need to adjust the training duration.

What types of resistance exercise is best?

Resistance training comes in all shapes and sizes.  You can lift barbells, dumbbells, body weight, cables, kettle bells, or get creative with set of TRX straps.

With the recent rise in high intensity training, I’m often asked questions like “can I do Cross-Fit after an angioplasty/stent procedure?”

Resistance exercise precautions

  • Like with aerobic exercise, get your cardiologist’s clearance for exercise.
  • Before you get into weight training, I would advise building a good aerobic base first.  If you can tolerate reasonably high workloads, then this will provide more assurance that you can tolerate weight training.
  • Perform a light to moderate 10 minute cardio warm up on the bike or treadmill to allow your blood vessels to dilate a bit.  Jumping straight into heavy weights with no warm up could cause a sharp spike in blood pressure which might affect your stent.
  • Following on from above, beware of weight lifting in very cold or hot climates.  If in a cold climate, be sure get in a warm up.  In a hot climate, be sure you’re wearing breathable clothing that allows for proper cooling.  Use a fan to help cool your body.  Environmental stressors (either hot or cold) can force your heart to work harder than it would at an ambient temperature.

Take home message

The bottom line is that you can exercise safely after an angioplasty and stent, but you do need to take some precautions.

Whether you’re into aerobic or resistance training, speak with your cardiologist about your particular medical and exercise history and ask lots of questions.

If you were a hardcore fitness nut before your procedure, ask about getting a treadmill stress test (if feasible) to see how durable your ticker is.

I would also recommend attending cardiac rehab, as this is another way to get some feedback on your particular condition.

Pay attention to how your body responds to exercise while on medications.

Once you adapt to the precautions, there’s no good reason why you can’t live a healthy and active lifestyle again.

Please share your thoughts, experiences, or questions in the comments section below.

136 COMMENTS

  1. Dear Dr Bill Sukala, thank you for your excellent and informative article. I recently had a 2nd stent fitted inside the original stent (70-80% blocked) in the LAD, because the 1st one developed excessive cellular growth over the stent (became 90% blocked with cells). I am a keen cyclist and resumed normal-strenuous riding after getting the clearance from my cardiologist about 6 weeks after my 1st stent (drug eluting). Have been on several typical medications after stent placement. I have been trying to find evidence that strenuous cycling after a stent may induce excessive cellular growth in a stent and may explain my situation. Would be interested in your thoughts. thanks Joe

    • Hi Joe,
      Thank you very much for taking the time to leave a comment. I am aware of this occurring in some cases, but I do not know the extent to which cycling would contribute to or hasten its development. Have you had a heart attack at any point or was it just coronary artery disease followed by angioplasty/stent? If you’ve not had a heart attack (and no resulting myocardial damage), then you’re mainly dealing with a “plumbing job”rather than a “heart job.” So this at least puts you in a better position. Have you had any follow up on the second stent? I think in your case you’d be well advised to pay special attention to any signs or symptoms which might be indicative of any subsequent blockage. Regarding in-stent stenosis, have a look at these articles which might provide a bit of scope and insight into why this happens: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1767562/ and http://circ.ahajournals.org/content/98/3/224.full and http://circinterventions.ahajournals.org/content/4/1/104.full Feel free to keep in touch and drop me a line if you find out anything. It is indeed an interesting situation and you are not alone in this happening. Kind regards, Bill

    • Respected Dr. Bill

      Would like to have your advice regarding start of Swimming after Angioplasty. Lvef is 55-60%, with no RWMA, 3 stents placed after atypical Angina in OM terminal, OM1/and LAD proximal with 50% stenosis in RCA. I would be pleased if u can give me ur email ID where I can send u the discharge summary and Angioplasty report for proper opinion.

      Thanks Dr. Jyotsna Verma
      Liver Transplant Consultant

  2. Hi Bill,
    I had a heart attack at the beginning of November, I has a stent to my LAD. although
    there was atheroma, it was diffuse and my cardiologist said for my age (45) that it
    wasn’t abnormal. What was abnormal was the size of my arteries, mostly they were
    very large apart from one place where they were naturally much smaller, (where they
    placed the stent).

    The heart attack came directly after a very intensive session with a personal
    trainer. I’ve been going about three months and being quite a competitive person I’d
    enjoyed being challenged by the PT to push myself as hard as possible. In my younger
    days I’d climbed mountains, sailed and biked, i was very active. In my later 30s
    work took over and I put on a far bit of weight, the PT was a way of fitting
    exercise into my life.

    Since then I’ve changed my life a lot, I’ve moved countries, from the UK to Spain,
    changed jobs. I walk every day for sixty minutes.

    My issue is weight loss and other exercise, my thoughts go from feeling like there’s
    nothing wrong with me to real anxiety that if I don’t do something that I will die
    an early death. I’m afraid of doing any exercise that significantly increases my
    heart rate, I feel paralysed by this… I’m stuck!

    Stew

    • Hi Stew,
      Thanks for your message. Just to reassure you, it is quite common to experience anxiety after a heart attack. Clearly you want to be out doing healthy things, but it’s always in the back of your mind that it could happen again.

      First, remember to deal with what IS rather than worry about something that hasn’t happened yet. If your doctor told you that your other arteries are clear and that your stent in the LAD is completely patent with no restenosis,then that is a good sign.

      Second, you also have to remember that most people who have heart problems usually have symptoms and, if you pay attention to them and get treatment, then you should be fine. It’s people who ignore signs and symptoms (i.e., crushing chest pain) that end up in the morgue.

      Third, exercise is supposed to cause your heart rate to rise, but you do have control over the intensity. If you’ve done a stress test with your cardiologist and he/she told you that you have a ticker the size of a thoroughbred racehorse with no abnormalities on the ECG, then that is good assurance as well.

      Fourth, I would also advise speaking to a counsellor with experience in helping people with medical issues. This is a sign of strength and not weakness. You clearly want to do the right thing by your health, but if you are physically well as confirmed by your cardiologist, then it may be time to get back on the horse. If a counsellor can help you work through a few sticking points, then perhaps that can get you back on the straight and narrow. It’s ok to be human. I have worked with a LOT of people over the years with medical issues and, if you’re getting back into your activity in a systematic way and ticking all the safety boxes, then you can say with reasonable confidence that you’ll be ok. But again, I want to emphasise that there’s no foul in speaking to a counsellor to work through any sticking points you might have.

      Feel free to leave me a comment or any other questions you might have. Happy to help where I can. Kind regards, Bill

  3. Thanks Bill, it took a few days for me to really process your response, I think part of the problem is that I wanted a “big bang” and that maybe I was also being paralysed by that. I think I need to make small changes more often rather than head for a long day in the hills or do a 50k day on my bike, that should reduce anxiety from not doing anything and the anxiety that i’d over exert myself

    Thanks for your help

  4. Greatly appreciate the exercise guidelines, precautions and contraindications. I am a personal trainer who just took on a client who recently got 3 stents put in. Confident I can now design a safe but challenging and effective workout regimen to get him back moving again.

    • Hi Dorian,
      Thank you for taking the time to leave a comment. As a trainer, you know the exercises but the real magic in training your cardiac clients is in knowing the signs/symptoms of when something’s wrong. In all honesty, if your client has been cleared by the cardiologist or, even better, has had a successful run through a cardiac rehab program, then you should be fine. Keep an eye on the heart rate and blood pressure, as well as understanding the impact of your client’s medications on the exercise response. How long has it been since the stents were placed? Happy to help if you have any other questions. Kind regards, Bill

    • Hi Dr I had a stent operation two months ago and up until now I still feel weak. I’m 60 years old and the daily medication I have now is Effient 10mg, Triatec 2.5mg, Salospir 10mg and Liptruzet 40mg. I did have my follow-up check up and my doctor says all is running smoothly. My worry is that I still feel very weak although I do some excercise/working every day for about 40 – 60 minutes. Pls your comments. Thanks

      • Hi Elias, I’m sorry to hear that you’re feeling weak. It’s difficult to say exactly why this might be, but would certainly be worthwhile speaking to your doctor about this. Looking at the medications you’ve listed, you are taking a platelet inhibitor (Effient), ACE inhibitor (Triatec), aspirin (Salospir), and a cholesterol med (Liptruzet). I don’t think the first three medications are unlikely to cause this side effect, but doing a bit of digging, the Liptruzet, as with any other statin medication, could plausibly cause your muscle weakness. Common side effects of Liptruzet include nausea, muscle pain, tenderness, weakness, increased fatigue, and dizziness (among others). Bottom line: it would be a good idea to speak with your doctor about this regarding the cause of your weakness and the possibility that it could be a side effect from your statin medication. Hope this helps. Kind regards, Bill

  5. Hi Bill, thanks for the article. I’m 56 and had a PTCA/Stent thing done almost 4 months ago here in Perth. I’m lucky that I had the opportunity to attend a rehab education class and a free 16 session rehab gym program at the hospital (thanks Fiona Stanley!). The thing that made a big impression on me was the “talk test” you mention. I’m on a raft of various pills, so it’s difficult to work out a true indicator of resting heart rate etc – but, I really took to the talk test after our exercise physio said to use it (at our education sessions). I’m a mad keen squash player and I set myself my personal goal of resuming squash after my “compulsory” 6 week period on the bench (my GP was very strict and brooked no argument!!). So, I started the gym sessions and then squash – AND I always kept the talk rule: if I couldn’t hold a conversation while working out, then I was risking a problem. So, maybe I didn’t startle anyone with my squash skills for a couple of months (after the 6 weeks), But I was playing, and I took it really easy. It helps if your squash mates are careful for you too! Now, I’m back to nearly full tilt on the squash court – I’m a terror for three 45 minute sessions a week! I’m even winning some games!! But, truthfully, I still monitor my progress, and I often just take a moment to re-gain my breath between serves. There’s no shame in being careful. I’ve got nothing to prove to anyone at my age.
    As for the gym, that’s been twice a week. It’s just finished at the hospital, and I’ve joined a 24-hour joint just down the road. I’ve never been to a gym before, but I’m enjoying that too. For those of us that get bored with long sessions on walking machines etc, I recommend an MP3 player/iPod or equivalent, loaded with podcasts or music or audio books. It’s amazing how easy it is to get through the boredom when your distracted by a good book!!
    Thanks

    • Hi Michael, I very much enjoyed reading your comment. You are a perfect example of someone who didn’t just throw in the towel and accept life was over after this little heart plumbing incident. Provided you did not have a heart attack and did not have any heart damage, not to mention an uncomplicated angioplasty/stent procedure, you’re clearly in a good place to heal up well and get back to living life to the nines. I also enjoyed that you bit the bullet and heeded the precautions during your recovery. I’ve seen people push it a little bit too hard during recovery and end up with a collapsed stent, although will admit this isn’t a common occurrence. I like that you’re back playing squash as well. I used to be a pretty hardcore racquetball player back in the US and I can see that, although the sports are different, they’re both pretty strenuous. Well done on an excellent recovery! Big fan of your work! Cheers, Bill

    • Dr. Bill,
      I have been reading information you have provided on heart attacks/problems.
      In particular the advice you gave Michael a 56 man from uk.
      I had a coronary heart attack on the 18 Nov 15, I basically ignored signs like pins & needles plus a heavy indigestion for 3 days.
      The medical services were great I had a stent put into the coronary artery, the angioplasty check up was perfect no bruising or damage whatsoever.
      I’m now attending the cardio physio team twice weekly.
      Like Michael I’m a keen squash player, thinking of playing again if safe but the cardio physios aren’t that keen on it because the BP & pulse goes through the roof they say.
      Normally my pulse playing squash & when running on the treadmill works upto 190ish , they are recommending about 90’s pulse, this might be too boring for me squashing. I noted your advice for Michael questioned whether he had a heart attack.
      Also mentioned was a stent could be damaged.
      I’m taking advice from the team so I will wait & see. Also thinking of using light weights..

      • Hi Tom,
        Thanks for your comment. First and foremost, remember that you’re pretty fresh from the heart attack and angioplasty/stent. Even if you feel great after your procedure (which is great), there is still healing happening on the inside. At this early stage, you do need to be careful and give your heart some time to recover. I will admit, I’m also a bad patient when it comes to injuries and I have a hard time not being active as well, so I can empathise with your situation.

        The questions that are important to consider here are:
        1) Did you have any damage to your heart muscle?
        2) Did they give you any indicator of how much damage? Any idea on an ejection fraction?

        If you’re working with a cardiac rehab them, then this is a very smart move on your part. They will be familiar with your particular medical history and surgical reports. Discuss those questions with them when you next see them.

        Also, if you’re on medications such as a beta-blocker, then this will reduce your heart rate a fair bit and “save you from yourself.” I’m not a fan of medications, but there are times where they can be beneficial particularly in the recovery phase after a heart attack/surgery in order to keep down the heart rate and blood pressure.

        Best wishes and feel free to report back here with an update so others may benefit.
        Kind regards,
        Bill

  6. Dear Dr Bill

    thank you for the article on exercising after an angioplasty, it has put me in a positive frame of mind.

    I am a 55 year old British man, working as a teacher in Taipei, Taiwan. I do not smoke, I eat sensibly and enjoy beer within government-recommended guidelines, I swim, cycle, and walk at least three times a week, and my BMI is around 23. My maternal grandfather died of a heart attack in his 50s, but my 80 year old father is as strong as an ox.

    About two months ago at the end of August 2015, I went to hospital feeling tired and breathless, and was rushed to the emergency room where I was diagnosed with unstable angina. I had to remain in the hospital for five days. This came as a a tremendous shock to me because the week before I started to feel unwell, I had been exercising as normal. Now I am waiting for an angiogram sometime in December. In the meantime I find I can walk steadily for about an hour, and I can do qi gong, but anything more leaves me breathless.

    I feel very frustrated because I obviously want to educate myself about atherosclerosis, but every time I get on the net to check it out, I read that I should ‘lose weight…’, ‘stop smoking…’ etc. etc. none of which applies to me.

    Something I should add is that for the past year I have been waking up at night with myoclonic jerks. This is a complete nightmare and I wake up most mornings feeling exhausted. I had a sleep study and was diagnosed with sleep apnea [in which you stop breathing in your sleep]. I am renting a CPAP [a kind of air pump and mask] for the time being, and the data from the pump tells me that I have central sleep apnea, that is to say the brain is not instructing the lungs to breath.

    The medical professionals I am dealing with here are all Chinese speakers but most of them speak English to a greater or lesser extent [far better than my Chinese…], and they are doing their best for me. However, there is an inevitable language barrier and comprehension gap.

    My question to you is this: is my atheroslerosis caused by my sleep apnea, or is my sleep apnea caused by my atherosclerosis? Furthermore, if I have a stent implanted will I be able to send the pump back to the distributor and get a decent night’s sleep again?

    Thank you in advance, best wishes, Dave

    • Hi Dave,
      Thank you for taking the time to write such a thoughtful and detailed comment. With regards to your questions, there is evidence that sleep apnea is associated with atherosclerosis in individuals without any other significant risk factors. Have a look at these two articles which might give you a few extra bits of information:
      1) http://www.ncbi.nlm.nih.gov/pubmed/19249446
      2) http://journal.9med.net/qikan/article.php?id=194146

      Regarding your second question, I’m not under the impression an angioplasty/stent will “cure” the sleep apnea, so your best bet it to speak with your doc about your treatment options for the apnea.

      Have you considered heading back to the UK for treatment (even if only temporary)? Perhaps find a specialist centre that deals with a lot of sleep apnea cases and get top notch treatment. Alternatively, since you’re obviously part of the commonwealth, perhaps a trip to Australia for treatment since it’s not too far away?

      Keep us posted on how you go, Dave.
      Kind regards
      Bill

  7. Dear Dr Bill, I am 48 and I was training for my first Ironman, (I´ve done several triatlones, couple of 70.3, lot´s of 1/2 marathons and three marathons) when I started feeling tire with pain in the chest and arms, I stopped and got my self checked, the result was 3 stents.
    At the beginning I was psicological destroy, and the first feedback was that I could´nt run marathons again needer 70.3… not to think on an Ironman, that hit me hard!!!, I am going to get a doble opinion but I would love to hear your thoughts. I just started after one month from the intervention to swim, ride the bike and run again, keeping good look at my heart rats and for periods not longer that1 hour. I would love to run a couple more marathon, I feel that without the challange of long distance races I would stop doing this….
    Look foward to your thoughts…
    Cheers

    • Muy buenos dias Carlos, Perdon la demora en contestarte pero estoy viajando al extranjero (de negocios) y no he tenido tiempo para responder bien. En cuanto a tu situación, legalmente no te puedo dar consejos específicos porque no se todos los detalles de tu condición.

      Primero que nada, recomiendo que hables con tu cardiólogo y si tu condición esta estable, preguntale si puedes volver a tu entrenamiento. O buscale a un cardiólogo que haga ejercicio (o tenga especialización en medicina de deportes) que realmente entienda tu pasión por ejercicio y deporte. Seguro te hicieron un angiograma. Visualizaron tus otras arterias para asegurar que no hay obstrucciónes en ellas?

      Segundo, a ver si te pueden hacer una prueba del esfuerzo cardíaco. Si no hay irregularidades en tu ritmo cardiaco o el segmento ST en el electrocardiograma seria una buena indicación (echale un ojazo a esta pagina: http://www.my-ekg.com/como-leer-ekg/segmento-st.html).

      Tercero, si no tuviste un infarto y no hay daño al músculo cardiaco, significa que tuviste un problema de pipas tapadas y no del corazón.

      Quarto, de aqui en adelante, lo mas importante es estar atento a tus sintomas. Los sintomas que tuviste son relativamente comunes y si los tienes de nuevo, sabras que tienes que ir al hospital. Es importante no esperar porque “tiempo es músculo cardiaco.” Una arteria tapada, sin tratamiento, puede causar daño al músculo del muro cardiaco.

      He trabajado con pacientes cardiacos que hacen mucho ejercicio y con tiempo lograron volver a entrenar y competir. Es posible pero lo mas importante es mantener la comunicación con tu cardiólogo y respetar a los síntomas.

      Gracias por dejar un comentario y espero que esta info te ayude.
      Cheers,
      Bill
      PD, vivia en Mexico por eso te repondi en español.

      • Orale Guey…..Extraodinario!!!
        estoy siguiendo tus recomendaciones exactamente, fui a un cardiologo de deportes, y me pidio un test de esfuerzo con MiBi??, en fin me lo hago en un par de dias.
        lo mio fue afortunadamente un episodio que no llego a ser infarto … solo de cañerias.
        y el resto de las arterias estaban normal.. me dejaron con aspirina, brilinta, nevilet, crestol, omeprazol…
        ya estoy corriendo, nadando y pedaleando nuevamente manteniendo las pulsaciones en 135…
        asi que muchas gracias por responder!!!!
        saludos.

        • Sipo huevon! Jaja, buenas noticias! Creo que con esa información te dará más paz interior sabiendo que todo está bien. Me parece un buen cardiólogo también. En tu caso, creo que necesitas alguien que entienda la mentalidad de un atleta. Suerte matador! Manda notícias cuando tengas la medalla de oro en la mano!

  8. Dr. Bill,
    I had 5 stents put in to open 3 blocked arteries 8 weeks ago. Taking statin, Plavix, aspirin & beta blocker.
    I’m 50, triatlete, ultra runner, personal trainer and ice hockey player.
    Prior to my mild heart attack, my max HB was 185. I have been animal and dairy free since (almost no oils), following Esseltyn/Cambell diet and program. My total cholesterol is now 103 (179 before), LDL 53 (120 before) and HDL still in 30s.
    I am back to almost all of my previous activities (teaching Spin, aquavit, jogging, swimming), along with cardiac rehab with no problems at all (keeping hr below 140). My resting hb was below 60 before, and now is a bit lower. I’d like to go back to ice hockey, which is the only activity that raises my hb to around 160-170 in short bursts followed by recovery. I’d like to eventually be drug free, if diet keeps my #s low.
    Your thoughts on returning to ice hockey and necessity for drugs?
    Thanks,
    Leigh

    • Hi Leigh,
      Thanks for stopping by to leave a comment. At 8 weeks post heart attack and intervention, I’d say you appear to be doing very well. I can’t provide any detailed recommendations without knowing your entire medical history, but the things I would suggest speaking to your cardiologist about would be the risk of contact sports (I.e., hockey) while taking blood thinning meds. I’ll be the first to admit that while I’m not an advocate of pumping people full of meds, I think immediately post op they can be helpful to keep heart rate and blood pressure under control during the healing process. Speak to your doctor about your particular condition and if you can safely whittle down the dosages over time. You are clearly health conscious and this will certainly help your case. feel free to stop by and leave a follow up comment to let readers know how you’ve progressed. Cheers, Bill

  9. Hi,
    My name is Janine. My husband Mark had a major heart attack 3 weeks ago aged 55.
    For the 30 years we have been together he has been a health and fitness nut.
    He’s heart attack occurred after a workout. The main lower artery was 100% blocked.
    They were able to clear and put a stent in(thank god) and I do every day). He’s workouts were weight training running martial arts ( kickboxing) . He has mild to moderate damage to the front wall of his heart. My biggest concerns are- he was a man who rarely swallowed a panadol and now he is on 8 different medications inc beta blockers etc.
    – his workouts and fitness are part of his everyday life. I’m trying to get a handle on what will be best for him moving forward. Would you recommend an exercise bike or Pilates machine.
    His gym equipment consists of treadmill and weight machines .- Dumbbells free weights(long bar one not sure the correct name for that) I just want to see him happy and healthy and do whatever is best. He starts rehab next week. I would appreciate any advice.
    Kind regards
    Janine.

    • Hi Janine,
      Thanks for your comment. I can certainly appreciate your concern for your husband. He’s not unique in the sense that, yes, whilst exercise is important, it’s not a fix all that protects against all heart attacks. I’ve seen plenty of athletes show up at cardiac rehab with a heart attack and angioplasty/stent. In those cases, there might be a strong enough genetic link that can contribute to it. Thing is, had your husband NOT exercised, it’s also very possible his heart attack would have been much earlier.

      I’m glad to hear he’s going to attend cardiac rehab. THAT is a very smart choice. He will have an opportunity to exercise and push himself in a safe environment. Given his cocktail of meds he’s now on, he will need to be aware of both his heart rate and blood pressure response to exercise (and after). Meds that lower his HR and BP both at rest and exercise can sometimes lead to a significant drop in blood pressure after exercise, so tell him to be aware of “post-exercise hypotension.” He can discuss this with his cardiac rehab team.

      As for which exercise is best, he’ll need to find exercises that he likes and then test them out under the watchful eye of the cardiac rehab team. Based on your IP address, it appears you’re in Australia as well (Victoria?). Which hospital will he be attending?

      Provided your husband is diligent in watching for any adverse signs and symptoms, and if any symptoms do present, then he’d be wise to make sure he gets himself in for treatment asap. I think it’s important to remember that an angioplasty/stent procedure is NOT a cure, nor is open heart surgery. But with very strong lifestyle changes he can significantly minimise his risk of any future events. To be clear, I’m not saying he will have any future issues, but it is something to be vigilant of. As for meds, I admit, I’m not a fan of prescription meds, but when it comes to heart attacks and surgery, they can be helpful for protecting the heart against spikes in heart rate and blood pressure. Down the road, he can speak with his doctor about whittling down the doses as is appropriate.

      Hope this helps. Feel free to report back and leave a comment about how he’s going with his exercise regimen.

      Warm regards,
      Bill

      • Hi Bill.
        Thank you so much for your prompt reply.
        You asked which hospital he would be attending.
        Initial attack and 000 call we ended up at Jesse McPherson at Monash in Clayton. He had the heart attack late Monday night. He was released on Saturday. Myself I wasn’t happy. They had spent 36 hours draining fluid only to end up giving him a drip on the Friday night due to nausea. He was very pasty looking. When he came home we kept fluids up due to the nausea as they said he was probably dehydrated. Sunday he started with a cough and had a lot of trouble talking without being breathless. By late Monday evening he was getting worse(. I had had him at his GP late Monday arvo) who had given us ventolin. By 1am tues I called 000. He ended up with fluid around the heart and in his lungs and paramedics said he was having minor heart failure. This time he was rushed to Dandenong Valley Private. He has made the decision to stick with them as he found the cardiologist much easier to talk to and felt he was more thorough. (Dr Fernando) it is also closer to home. Myself I’m just scared this will happen again. It is definitely a life changing experience. In a way I’m lucky. My father died from a fatal heart attack at home , so when Mark told me he had severe chest pain I knew not to hesitate in calling 000.
        Your reply was very informative and his given Mark a lot to think about. He has always treat his body like a temple so had he not been so fit maybe it would of happened earlier.
        Thank you again. Your knowledge has been an immense help.
        Kind regards
        Janine

        • Thanks Janine,
          This is serious stuff, that’s for sure. Glad to hear he’s being well cared for and appears to be moving in the right direction. Bedside manner is important when it comes to getting a good doctor. There are lots of great doctors out there who are very competent in everything except people skills. Unfortunately, the people skills side of things isn’t a main topic at medical school! Feel free to drop me a line here in the comments section as Mark progresses through his recovery.
          Warm regards,
          Bill

  10. Hi Bill
    Very informative article, thank you.
    I have had diagnosed artery disease for about 14 yrs and had a number of procedures to keep me well.
    I have two questions :
    With a large number of stents can the fact that they are there cause discomfort during cardio exercise ?
    At what time do we call a halt to stenting in favour of a bypass ?
    Regards
    John G.

    • Hi John,
      My sincere apologies for the delay in responding to your questions, but I somehow missed your comment and am only just seeing it now!

      For the most part, I don’t believe the stents should cause any discomfort for you during exercise. It’s not to say that it’s not remotely possible, but I’ve never heard a patient say they could feel the stents in their arteries.

      As for whether you should stop stenting in favour of bypass surgery, this is generally determined by the surgeon and cardiologist. If you have diffuse coronary artery disease (i.e., lots of blockages) and those blockages are in locations that are critically located (i.e., near a bend in the artery) or they deem the plaque too hard to safely penetrate, then bypass surgery may, in fact, be a viable alternative. Whilst I’m not necessarily in favour of opening anyone up, there are times where it’s the most feasible option to effectively reestablish blood flow.

      Hope this helps.
      Kind regards,
      Bill

  11. Hi, Doctor Bill,
    Thank you for this excellent detailed article.
    I had my first attack in 2008 while watching a movie at home and one stent was placed. The attack came in March 2015 when I was sailing few miles away from shore on a small boat. The doctor said my first stent blocked 90 % and another artery blocked 75 to 80 %. Hence, first stent was inserted to open the earlier stent, second was placed next to this stent and third stent was used to open the second artery block.
    Since then my doctor says I am fine. Kindly guide me, if I can use a bicycle on a plain road (no hills) for small distances (3 to 4 KM) daily?

    Best regards,
    Sudhir
    India.

    • Hi Sudhir,
      Thank you for your comment. Your situation is not unique and I have seen this sort of thing before. It is frustrating, but the most important thing is to be aware of your signs and symptoms and get medical treatment as soon as possible. Time is heart muscle. The quicker you get attention, the better off your heart muscle will be (i.e., minimising damage to the myocardium).

      Whilst I cannot give you specific recommendations for your exercise since I do not know every detail of your medical history or your recent hospitalisation, I would suggest speaking to your doctor and asking him the following questions:
      1) Was there any damage to your heart muscle?
      2) If there was damage to your heart muscle, what is your current ejection fraction? This will give an indicator of your heart’s pumping ability.
      3) If you had a post-surgery treadmill test, what was your peak workload (speed and grade)?

      The other thing is that you are nearly a year post-stent. This is a good thing because you have had time to heal and recover. Provided you do not have any issues with your blood pressure going too high (are you on beta-blocker medications?) or other medical issues which might affect your ability to exercise, then doing light cycling probably won’t hurt you and will, in fact, likely be good for you. But ultimately the final approval must come from your cardiologist who is familiar with your specific medical history and surgeries.

      Hope this helps.
      Warm regards,
      Bill

  12. Hi Doctor Bill,

    Thank you for your quick response and sincere reply.
    I will surely follow your guidance and seek my cardiologist advice by asking reply to your question before deciding for light bi-cycling.

    Kind regards,
    Sudhir Sharma

  13. This is so thorough and excellent. Much appreciated on day 6 after stent placement and early mild heart attack. I could find nothing near this much help and it will be so very helpful. Thank you Dr. Bill. Thanks again.

    • Thanks for your comment Su. I really appreciate the feedback. If you think there’s anything missing or any ways I can improve on it, always feel free to write me or leave a comment. Best wishes for your recovery! Kind regards, Bill

  14. Bill,

    Great article, thanks much for writing it. Quick background — 52 years old, minor heart attack a month ago, 3 stents, post stress test last week my cardiologist said I was an excellent candidate for cardio rehab, have no apparent heart damage. My question is, do I really need to go through the hand holding of cardio rehab or can I just start going back to the gym? Hell, I know what I have to do — eat less, exercise more, and drink much less beer (yes, I know to start back slowly at first, but unlike your other readers I am by no means a fitness enthusiast, I just plug away because it has to be done). I really don’t need (or want) the remedial nutritional advice based on 20 year old guidelines, happy/sad faces to describe my emotional well being, etc. My biggest concern was another heart attack, but according to my doctor that is not very likely and if it does happen it will be massive and thorough. Somehow that is very liberating, not having to worry about trivial aches and pains. Anyway, so doesn’t it make more sense to invest my copay in a good personal trainer and get on with things? Or is there really value in going through a three month program?

    Best regards,
    Dave

    • Hi Dave, You sound like you’re doing great! Congrats! As for cardiac rehab, I’ll say this. If they use telemetry monitoring, then that will be VERY helpful for you to check your heart’s response to different types of exercise at different intensities. Sometimes the heart is on its best behaviour when the doc is there, but it can do funky things at other times when nobody is looking. So let’s say you do 6 sessions of cardiac rehab. That should be enough to know if your ticker is going to be cooperating with different types and intensities of exercise. If you’re going to hire a trainer, make sure they have experience working with people with heart conditions. I train personal trainers on how to work with people with heart problems and most of them at the beginning of the seminar look at me like “oh sh*t, what do I do with this guy who’s had a heart attack and surgery?!” I would strongly encourage you to do your diligence with finding the right person (or hire an exercise physiologist with experience with cardiac clients).

      Bottom line: I think a cardiac rehab program for at least a month could give you a lot more confidence and knowledge about your heart and ways to keep it strong (plus finding any potential arrhythmias or other hidden stuff that might not have shown up during your stress test).

      Hope this helps.
      Cheers,
      Bill

  15. Dr. Bill,
    Thank you for the helpful information. I’m 64, eat healthy, have never smoked and am somewhat of a workout nut with cardio and weightlifting and won a few bodybuilding contests at 63. Low body fat, 5’7″ and 168 pounds. Since I was adopted I know nothing about my birth parents other than my birth father died of a heart attack while waiting at a bus stop when he was in his 60’s. He smoked and was overweight.. Eleven days ago I had two stents put in the LAD and went into cardiac arrest during the procedure. I was told the LAD was 80% blocked but the other arteries were “normal.” I didn’t ask what “normal” was. Not sure how much damage there is to the heart yet, because I’m with Kaiser and my cardiologist there was not the doctor who put in the stents at another hospital and I was probably too out of it to ask all the right questions. My assigned cardiologist spoke with me briefly before discharge but I won’t be seeing her for two more weeks. I’m on a beta blocker, a statin and blood thinners. I’m anxious to get back to the gym. Do I start with the cardio and wait for the weights? How would I know if I’m doing too much? Any advice?

    • Hi Howard,
      Thanks for taking the time to leave a comment and share your story. The biggest thing that sticks out to me is that you are only 11 days post-op since your cardiac arrest and surgery. You still have some healing to do on the inside, particularly if there was any damage to your heart muscle. Did they give you any troponin numbers? Any echocardiogram reports that state anything about wall motion abnormalities? Provided you have clearance from your cardiologist, you should be ok to do low level activities like walking until you go back for your check up (usually after a month). At that point, you might consider requesting a treadmill stress test to see how your heart looks on the ECG under high intensity exercise. If that comes back normal then your doc might give you the clearance to get back to weight lifting and higher intensity cardio.

      As for your meds, whilst I confess I’m not a fan of pumping people full of drugs, in this case, the cocktail of meds they have you on are quite common after heart attack/angioplasty/stent. What blood thinner are you on? Clopidogrel (Plavix)? As for the beta-blocker, remember that it will lower your resting and exercise heart rate so even if you’re working at higher intensities (once given clearance to do so), then your heart rate probably won’t climb to it’s usual rate that it was when you weren’t on the meds.

      As for knowing if you’re doing too much, make sure you’re paying attention to any signs or symptoms like I listed in my article (shortness of breath, tightness in the chest, pressure, etc). If you had symptoms during your last episode, there is a possibility future symptoms could be the same.

      The bottom line at this point is to give yourself an opportunity to recover. Even if you feel well, there is still some healing happening on the inside. Once you get the final clearance from your doc, it might even be a good idea to do cardiac rehab for at least a month. They can put you on a telemetry monitoring system and see if anything is happening with your ticker whilst doing exercises consistent with what you’d be doing on your own at the gym. Remember, when it comes to the heart after angioplasty/stent, you have to train smart and be on the look out for signs and symptoms. If you do that, you’ll probably be ok.

      Hope this helps.
      Best wishes,
      Bill

      • Thank you very much. I haven’t heard the word troponin before so I will ask. I had many echocardiograms but nobody told me of the results which I take to mean there was nothing abnormal. I am on Plavix, Lopressor, Lisonopril and Lipitor. Your site is quite helpful. My checkup is set for a month post op.

        • Hi Howard, it seems like they’re doing everything right. I would suggest googling “ejection fraction” too. If you had any myocardial damage, it may be reflected in the ejection fraction, but hopefully all good. Feel free to drop in and leave another message as you progress.
          Cheers
          Bill

          • Dr. Bill,
            I saw my cardiologist and asked about the ejection fraction. What I recall her saying was that “normal” is 60 and I was between 40 and 50. Not really sure what that means. She also told me the heart repairs itself over time. She cleared me to start weight training again but not skiing right now. I had this fleeting thought of entering another national bodybuilding competition in July, but don’t know if with the loss of muscle weight I should bother trying! Whereas I had problem getting from 160 to 155 to make weight last July, today I’m 157.

          • Hi Howard,
            Thanks for getting back to me. Good to see you followed up with your cardiologist. Regarding your ejection fraction, the norm ranges between 55 to 70% on average so if you’re between 40 and 50% then that means you had some mild damage to your heart muscle. You can read more on this here: https://my.clevelandclinic.org/services/heart/disorders/heart-failure-what-is/ejectionfraction
            Your heart will remodel to some extent but it’s different for every person. If you had what’s known as “stunned myocardium” then it can regain a fair bit of its contractile abilities. If you had a massive heart attack that blew out most of your heart muscle (which it doesn’t sound like applies to you), then it will be difficult to regain much function.

            I can’t advise you on the bodybuilding decision, but hey, it would make a great comeback story!

            Kind regards,
            Bill

          • Dr. Bill,
            New inquiry that may be a bit “off topic” but it’s relating to rehab after heart attacks.. Since my heart attack 6 weeks ago my libido has completely disappeared. Being aroused is not only difficult, it messes up my head. I was on testosterone replacement therapy under a doctor’s supervision for four years. It improved my mood, my sex life, my body fat and overall sense of well-being. I had my blood and levels monitored and donated blood twice a year so that the blood would stay thin and to avoid the risk of a stroke. I stopped the weekly injections right after my heart attack on January 24 and only recently started resistance training again. So now I wonder if the lower testosterone level and the meds I’m on have doomed me from one of the great pleasures of life at 64. Do you have an opinion about that or resuming the TRT. There are different opinions on the subject.

          • Hi Howard,
            Thanks for your comment. You’re definitely not on an island all your own. I’ve heard of this sort of thing before. Remember that it’s still early days and your body is going through some adjustments. I would suggest speaking to both your doc that prescribed you the TRT and your cardiologist (and perhaps try to get them communicating so they can work together on getting your meds right). You might also find that over time you’ll be able to whittle down the dosages on your meds (as your doc’s discretion). Sorry I can’t be of more help, but I do think you raise an interesting point from which others might benefit. Please stop back and give us an update as things transpire. Best wishes, Bill

  16. Dr. Sukala,
    Thanks for your column. I had two stents in my heart in 2013(within 30 min.) after I had a heart attack. I was wondering if there is a maximum amount of cholesterol (bad) that a person’s heart can tolerate. My weight is close to my BMI range, and I exercise two to three times a week, plus practice Martial arts (no sparring), plus I eat a light breakfast, and lunch, and more at supper time. I am currently taking a b/p med, and an anti-cholesterol med. I love to jog in warmer weather, and hike when I get the chance.
    Thanks, MH

    • Hi Mark, Thanks for taking the time to leave a comment. Cholesterol is one of those “it depends” sorts of things. There are some people with anomalously high amounts of cholesterol that do not have any vascular problems (be it the coronary or carotid arteries). Then there are people with low to normal cholesterol that still manage to have heart attacks or stroke. There is a genetic component and lots of factors and meta factors that can influence what constitutes a dangerous cholesterol level for an individual. There is a lot of debate on cholesterol and its role in the development of atherosclerosis. One thing we do know is that it’s at the scene of the crime, but we can’t necessarily say we 100% understand its role in the process. Best bet for you is to keep up with your healthy lifestyle. Cholesterol is only one piece of the puzzle. But we know that people who have a healthy lifestyle have lower blood pressure, better blood sugar levels, and a reduced overall risk of health problems. Keep up all the good work you’re doing and pay extra special attention for any signs or symptoms like those I highlighted in my article. I don’t want you to have any further problems, but if for any reason you do, you’ll be wise to get treatment asap. Hope this helps. Kind regards, Bill

  17. Dr. Bill S.,
    Thanks for the information. I had an MI in 2013, and in 30 min. had two stents put in. I take b/p med, and anti-cholesterol med. I was wondering if there is a maximum amount of bad cholesterol I am allowed? i eat a light breakfast, and a light lunch, and eat more in the evening. I exercise 2-3 times a week, and practice martial arts once a week (no sparring).
    Thanks,
    Mark

    • Hi Mark, Thanks for your comment. Sorry for the delay in responding. Your comment ended up in the spam folder for some reason. Nevertheless, I have rescued it and am responding below.

      I think it’s important to note that the great cholesterol debate is not a clear-cut one. I’ve seen people with normal cholesterol have heart attacks and people with bad cholesterol get away with no heart attack. There appears to be a genetic component to cholesterol levels where they tend to gravitate in a certain range which can vary from person to person. With lifestyle changes (i.e., diet, activity, etc), cholesterol levels can improve but will likely still hover within that range (unless artificially manipulating it with meds as appears to be your case). The threshold at which blood lipids cause health problems will also vary from person to person. We also understand that inflammation plays a factor in atherosclerosis too, so this could be a contributing factor that partially explains the variance from person to person. Also consider your HDL cholesterol and the protective role it plays. I wish it was a cut and dry case, but unfortunately it’s not.

      In answer to your question, I would suggest that you have a talk with your cardiologist regarding your LDL cholesterol profile and ask him/her what he/she thinks would be a suitable upper level for your individual situation. I cannot be more specific since 1) I’m an exercise physiologist and not a cardiologist; and 2) I’m not familiar with your entire medical history so could not legally give you any advice beyond general info that you can discuss with your doctor.

      Kind regards,
      Bill

  18. Dear Dr. Bill
    I am 59 now. I am a very happy and joyful person as told by my friends and family. I had a chest pain in right side of my chest during April 2006 and after angiography I was told that my two arteries i.e LCD & LCX are blocked upto 70 & 90% respectively. As per advice of my cardiologist I had got two stents on 10.05.2006. Since then I am regularly doing my morning walk upto 45-60 Minutes at least 6 days a week. Now for last 4 months I am doing some aerobic exercise for about 30 minutes before morning walk. I am getting regular check up with my doctor at Kolkata, India. I was a smoker before April,2006 but after that I left smoking completely. Now for last one year I do take two three cigarettes daily. Please suggest me to do still better in my life and lead a healthy life.
    Thanking you.
    Krishna Pratap,
    Kolkata, INDIA

    • Hi Krishna, you sound like you’re on the right track. But if you can find a smoking cessation provider to help you stop smoking, that will help you significantly. Keep up with your exercise. That is a step in the right direction! Cheers, Bill

      • Thank you Dr. Bill for your kind reply of my query. I shall definitely try to reduce the habit and bring it to zero through my conviction. God bless you for your such a noble care of heart patient.
        Krishna

        • Dear Krishna, thank you for your kind words. You’re on the right track. I believe working on strategies for quitting smoking will greatly protect you and reduce your risk of having any future heart problems. Remember life is a marathon and you just need to take small steps each day to win the race. Keep smiling ☺
          Warm regards
          Bill

  19. Hi Dr Sukala great article wish more cardiologists would do this So my story is i’m 42 and I too had a HA in sept last year. Had 2 Des stents in my RCA. Cardiologist said i possibly caused it through cycling with a 70% plaque which ruptured due to the extreme intensities during cycling, dehydration etc. Had a Bruce protocol stress test 1 month later where i achieved 15.5 mins before i got nervous and stopped. Was on a 2.5mg of bisoporol then but now am off them as cardiologist says no real need as no damage and excellent LVF. Always played sports(football, martial arts, tennis, running, cycling, weight lifting) and always very competitive which they say helped me live due to the collaterals but i also question did it also do the damage in inflammation as i tried to train almost eveyday ? Now though i am nervous to perform any strenuous activity but was thinking about just doing weights? Lost over 10kg in a couple of months due to change of diet to Dr esselstyn’s. All of it is driving me and mrs nuts as so many conflicting things out there. On ramipril atm and about to start 10mg of simvastatin both low does just for protection. I’ve been discharged from rehab although they didn’t like my HR going as high as it did and not come back down but a lot of that was anxiety which I’m having counselling for and its really helped.
    I still struggle about beginning the statin since my levels are good now and I’m still working on getting back to exercising. One thing though after my HA I started hearing my heart beat in my left ear and it’s worse after I take my plavix and aspirin and whenever I eat a meal. Any thoughts my doc says ignore it ?

    So thats my story and really glad all the people above posted their stories they are very encouraging and wish them all the best.

    • Thanks for your comment Rav. I’m not sure about hearing your heart beat in your left ear. I know what you’re talking about but not certain it would have any relationship with your ongoing cardiovascular risk. I think from here on out, your best plan of attack is to work together with your cardiologist and keep up with your healthy lifestyle. Thanks again for sharing your story! Kind regards, Bill

  20. Hi Dr Bill! I had a major heart attack 3yrs back. Got an angioplasty done with one stent in my left main artery. Currently the right main artery is still blocked 100%. My ef went down and is now 35%. I walk daily for 45 min. Do some body weight exercise for 5 to 10 min. I wish to practice martial arts. Is it advisable? I am now 32 years old.

    Regards,
    Mithil

    • Hi Mithil, thanks for your comment. If your right coronary artery is 100% blocked, I’d strongly recommended that you speak to your cardiologist about your exercise limits (in terms of intensity) and perhaps participate in a guided cardiac rehabilitation program. As you’ll notice from many of my responses, I cannot provide any specific recommendations to anyone since I’m not familiar with the fine details of each person’s health history. The big question in your case is if you’re symptomatic given your RCA is 100% blocked as you say. The other question is if you have collateral circulation around the blockage. Are there any plans for doing another angioplasty? The bottom line is that you need to be working closely with your doc regarding possible treatment options and safety limitations on your activity levels. Hope this helps give you some guidance.
      Kind regards, Bill

  21. Dr. Sukala

    I had two heart attacks two years ago as a result I have two stents. I am 41 years old I have been weight training religiously three to five days a week for the last 22 years. After my heart attacks I lost 60% mass and 75% of my strength. I went through rehab and got cleared to workout but they do not want my heart rate going above 120. Which is 5.0 on the treadmill and they don’t want me lifting heavy. When I asked how heavy they really didn’t have a clue and told not to lift more than 65% of my max 10yrs ago EVER. Most of the questions I ask my cardiologist he can’t answer because he has admitted he does know how to answer them. I am his only patient under the age of 60 and non of his patients are a gym nut like me. I have looked and looked on the net to find answers for my training question, like how to weight train without over stressing my heart and will I ever be able to run and get my heart rate higher than 120bpm. I can’t find anything, everything is gear to the 65+ who are not gym nuts. I am not on beta blockers anymore and haven’t been for 4 months. Can you help me or point me in the right direction?
    Thanks Matt

    • Hi Matt,
      Thanks for your comment. I can certainly understand your frustration and, trust me, you’re not the first person to have this issue. Whilst I can’t necessarily give you any specific advice since I’m not familiar with every nuance of your particular medical history, there are some things you can discuss with your cardiologist in hopes you can get back to exercising at higher intensities.

      1) You state you had two heart attacks. Was there any damage to you heart muscle? Did they run any tests on you to determine what your ejection fraction is? If you had a lot of damage to the heart muscle, then this can work against you. If you had no damage to your heart muscle, then you’re far better off than someone who had a full blow-out. A normal ejection fraction is around 50 to 75% but if you’ve had some damage and you’re down in the low 40s or less, then that could pose an issue with your ability to perform high intensity workloads (i.e., your heart is not as effective as a pump and it could plausibly lead to symptoms like shortness of breath).

      2) Have you had a full treadmill stress test? In your particular case, you are used to living an active lifestyle and doing higher intensity exercise. I’d suggest speaking to your doc about arranging one of these to see 1) how hard can you exercise; 2) does your heart rate and blood pressure rise normally with graded exercise, and how high do they climb? If you’re on beta-blockers or any other meds that affect your HR and BP, then you might have a blunted response; 3) are you symptomatic in any way shape or form during high intensity exercise? and 4) how do you fare in recovery? Does your HR and BP gradually decrease back to resting levels in a reasonably short period of time (within a few minutes)?

      3) You might also discuss with your doc whether or not there are certain meds that could make it safer for you to tolerate higher workloads. I’m admittedly not a fan of pumping people full of meds, but I do recognise that there are times where it’s medically warranted. For people with high HR and BP, exercise can send them both off into the stratosphere which can increase the risk of having another heart attack.

      I think the bottom line for you is 1) can you do high intensity workloads without any abnormal responses (HR, BP, or any signs or symptoms); and 2) are there any specific reasons in your case, having a history of regular exercise, why doing high intensity exercise is medically contra-indicated?

      I have worked with patients who had really bad congestive heart failure yet were still able to tolerate some pretty gruelling exercise due to peripheral adaptations. In other words, their hearts were badly damaged and had a low ejection fraction, but the rest of the body was very fit and efficient at extracting oxygen and nutrients from the blood (to compensate for the heart).

      There is hope, but I think you just need to work with your medical management team to discuss your particular situation.

      Hope this helps.
      Kind regards,
      Bill

  22. Dr. Sukala,
    After showing signs of a low risk abnormality on a stress test on 2/5/16, my cardiologist performed an angioplasty on 3/3/16 and placed 4 stents in my heart. I am 68 years old and have never had a heart attack or any angina pain. At first I was thankful for the stents but after reading several articles on the internet maybe they were not a good idea. (too late now) My doctor said that I was a prime candidate for the “widow maker” event.
    Below is the summary from my cardiologist.
    1. 90% proximal to mid left anterior descending stenosis successfully stented.
    2. 90% proximal and 70% mid vessel stenoses in the right coronary artery successfully stented.
    3. 90% distal right coronary artery successfully stented.
    4. Normal left ventricular systolic function and wall motion with ejection fraction of 70%.

    DISCUSSION: The intermediate ventricular branch may cause some difficulty in the future. I would recommend following it by serial myocardial perfusion imaging studies, since he has remarkably silent myocardial ischemia even with near global ischemia.

    Can you reassure me that the stents were a good thing?
    Thanks,
    Bill

    • Hi Bill,
      First thing I’ll say is you have to be very careful with generic info from the internet. I’m sure you can find articles that would scare the heck out of you or reassure you. I think to put it into perspective, every person’s clinical picture is different and must be treated individually. Based on the info you’ve provided, you certainly did have a lot of blockages in key arteries. The good news is that they were all found in time. For many people, the first sign of heart trouble is sudden death. So in your case, you didn’t have a heart problem. You had a plumbing problem. Your options would have been angioplasty with stents or open heart surgery. The first option is the least invasive and has a quicker recovery, not to mention less trauma on the body. The fact that you still have an ejection fraction of 70% is excellent. Without knowing all the nitty gritty details of your medical history, I think what the doc did for you seems consistent with what I’ve seen for other patients in similar situations. Honestly, you’re a very fortunate man that they found all this when they did. It was only a matter of time til the volcano erupted. Hope this helps. Kind regards, Bill

      • Thank you very much for your response. I have learned how fortunate I am and will enjoy each and every day of my extended life.
        Thanks again and great site!
        Bill

      • i am 65 yrs male,i under went angioplasty 2 years back and doctors fitted 4 stents…i do walking evryday,i also do yogaasanas for 30 mins…i am 183 cms tall and weight is 83 kgs…can i take viagra once in week.thanks

        • Hi Subhaschandra, Viagra can cause a reduction in blood pressure by making your blood vessels dilate. If you’re taking other medications that lower blood pressure, then you’ll need to be careful. I’d suggest speaking to your cardiologist about this as he/she will be familiar with your entire medical history and can properly advise you on this.

  23. Dear Dr. Sukala

    I am a 53 year old male. I had 3 stents placed in January of 2015. Two in the LAD and one in the OM. Lad was 90% blocked. I have a third small artery that is less then 50% blocked. I exercised for many years prior mostly weight training pretty heavy right up until I had an episode, bench press 280 plus ect. I went through 6 months of Cardio rehab heavy cardio only training and I am still on a maintenance at the hospital rehab 2 to three days a week. Have a great new diet and life style lost 30 lbs. and all meds bata blocker, Benicar, cut in half still on Effient, and Aspirin. I developed a good case of anxiety for 6 months made me have multiple false alarm cardiac symptoms that sent me to ER. Was given multiple types of stress tests and finally a second cath. to check stents after 9 months. Given clean bill of heart health for my exercise and I see a Therapist for the anxiety which is under control. Never had a heart attack no muscle damage.
    I have started to weight train again my questions is what effect does this have on my heart has I train. How does it differ from my heavy cardio in terms of effect on blood pressure and on the stents. I am cleared for 140 to 145 heart rate. I use moderate dumbbells as compared to prior to stents. Occasionally I feel a little light headed but not dizzy towards the end my strength workout at the last set ect. It does not happen all the time. I have no chest pain or shortness of breath and heart rate does not peak above 110 during lifting mostly stays in low 100’s or below. Heart rate recovery is excellent.

    Thank you

    Jerry

    • Hi Jerry,
      Thanks for your comment and for providing a lot of detail about your medical history. As I say in nearly all of my responses, I cannot give you any sort of absolute “do this or do that” sort of advice, but I can give you some things to consider which you may wish to discuss with your cardiologist.

      First and foremost, you pointed out that you did NOT have a heart attack so this is a good thing. Basically it means you had a plumbing problem and not a heart problem. If you had a heart attack with damage to the heart muscle itself, then you’d be in a different league altogether (depending on the level of damage).

      Second, you mention that you had your angioplasty/stents done back in January of 2015, so you’re well over a year post-op now. It also sounds like you’ve been pretty active with your cardiac rehab program. THAT is the single most important thing you could do. In fact, I recommend cardiac rehab to fit people with heart problems because they WANT to get back to their routines asap. Having the close guidance of the cardiac rehab team gives you lots of specific information on your individual response to exercise. Having a good idea about your habitual heart rate and blood pressure response to exercise can be very valuable.

      Third, you mention that you have a long history with resistance exercise so it’s not like you’ve been flat on your butt doing nothing for 40 years and then decided to go all out and get on a health kick. The fact that you have a good cardio base and experience with weight training puts you at an advantage over those who are completely inactive and have no experience with exercise. You are probably more in tune with your body and this can be valuable for gauging intensity and knowing when to cool your jets (from a safety standpoint).

      Fourth, both cardio and weight training will increase your heart rate and blood pressure. Though you mention you’re on a beta-blocker. This will help keep your heart rate and blood pressure down a bit, depending on the dosage of course. I think if your cardiologist has run you through multiple stress tests and you are a year post-op, AND you have his full consent to return to reasonably strenuous exercise, then that is a good sign. Without saying “yes, go do this or that” I think that the weights you’re talking about (moderate dumbbells) and the heart rate limits you have set are all pragmatic and reasonable and do not appear to be too “out there.” If you’re still going to the cardiac rehab and they have weight training equipment there, perhaps you might like the team to check your blood pressure immediately after a set of, say, bench press. Heart rate is one piece of the puzzle, but it would be good for you to know what your individual blood pressure response is to a given resistance in both the supine and upright positions (i.e., a bench press on your back vs a chest press in the upright position on a machine). I would suggest trying to avoid any max lifts or extreme lifting where you’re only squeezing out a few reps. Those sorts of maximal efforts can potentially spike your blood pressure.

      Bottom line: I’d say to speak with your cardiac rehab team and get specific advice from them regarding exactly how much you can or should lift and your individual blood pressure/heart rate response to given resistances.

      Hope this helps. Thanks again for your comment.
      Kind regards,
      Bill

  24. Hello Dr. Sukala,

    Your articles are very helpful.
    My name is Manjiri. My age is 39 years. I had a massive heart attack on 8 September, 2015 (early morning). It was 6 months back. I had a severe chest pain and then I fainted. My husband did pumping and I came to my senses. Still severe chest pain and breathlessness was there. I was immediately admitted and angiography detected only one block of 99%. Angiplasty was done immediately and I was saved by God’s grace.
    Before this, I did not have any problem of high cholesterol, high BP. I was very active. I was taking walk and doing Yoga everyday. My 2 deliveries were normal. My weight was 55 kg. Doctor was also surprised that a person with such a good life-style can have this problem. My cardiologist said that it might be a genetic problem.
    1.5 months after the angioplasty, my stress test was done and cardiologist said that I am fine and can go ahead with a regular walk (not running and jogging). Damage to heart is 10%. But my weight is reduced to 51 kg.
    My questions are:-
    1. What is a genetic problem?
    2. 6 months before the heart attack, I had taken Ayurvedic treatment for migraine in which they made me drink half glass of ghee for 3 days. Could it be because of that?
    3. My father is taking mild blood thinner since he had a chest pain some years ago.
    4. My brother is also having a problem of deficiency of protein C and taking a mild blood thinner .
    5. Is there any connection with this?
    6. My pro-thombosis test is done and it is negative.
    7. My weight of 51 kg is okay or I have to gain some more?
    8. Which are signs that I should worry about?
    9. Sometimes there is a tingling sensation in my both legs. I have a problem of vericose veins.

    I still have some anxiety. While taking a walk, I am still not confident that I can walk more than 15 min. But I am doing my regular kitchen work and I am able to do it for an hour continuously without a break.
    Back of the mind, there is always a fear that anything can happen to me at anytime. My cardiologist says that these are psychosomatic symptoms and I should just ignore them.

    3 days before the heart attack, there was sudden pain in chest and left arm. But I thought that it might be because of indigestion. Which are symptoms I need to worry about? Should I go for another stress test?
    Please advise.

    Thanks in advance.

    • Hi Manjiri,
      I’m sorry to hear you’re having anxiety after your heart attack. But rest assured, you are not alone. This is a very common reaction and in time you will probably start to feel comfortable again, but it takes time. In answer to your questions below:

      1. What is a genetic problem?
      Your cardiologist just means that your heart problems might be related to genetic factors. You are clearly doing your best to live a healthy lifestyle, and this is a good thing, but our genes cannot be directly controlled. The good news is that no matter what your genes are, you can significantly help yourself by keeping up your healthy lifestyle.

      2. 6 months before the heart attack, I had taken Ayurvedic treatment for migraine in which they made me drink half glass of ghee for 3 days. Could it be because of that?
      I can’t say exactly what caused your heart attack, but it’s improbable that something you did one time 6 months ago contributed directly to your heart problem.

      3. My father is taking mild blood thinner since he had a chest pain some years ago.
      4. My brother is also having a problem of deficiency of protein C and taking a mild blood thinner .
      5. Is there any connection with this?
      It is highly probably that you have a family history of heart problems if your father and brother are taking heart meds.

      6. My pro-thombosis test is done and it is negative.
      7. My weight of 51 kg is okay or I have to gain some more?
      I can’t tell you what your ideal body weight should be since body composition is more important. If you can get a DEXA scan, then that will tell you how much fat you have and where it is located. That is more valuable than just a body weight on the scale.

      8. Which are signs that I should worry about?
      The main signs and symptoms you need to be aware of include chest pain, chest tightness, shortness of breath, pain in your back, jaw pain. These are your standard angina symptoms related to your heart. Everyone is a little different, but it might be worth speaking to your cardiologist for more specific information on your unique condition.

      As for getting another stress test, you’ll need to speak to your doctor about this to see if it’s appropriate for your individual condition. If you’ve had one already and it came back looking normal (after your surgery) then this is a good sign. Your doctor would also have more information regarding your other arteries if he did an angioplasty on you.

      9. Sometimes there is a tingling sensation in my both legs. I have a problem of varicose veins.
      It’s hard to say what this is. I would suggest speaking to your doctor about this to get a proper diagnosis.

      I’m sorry I can’t be of further help, but I cannot provide any specific advice or recommendations over the internet (ethically or legally).
      Kind regards,
      Bill

  25. Hi Doc,
    your article was informative and helped me to become relaxed …….unfortunate I did not get a lot of discussion before release….but I was told to do some life stile changes and to resume exercise……But not a lot of time was spent making me feel comfortable (that I did not have to be scared to move are lift my infant grand kids) after returning home…However after reading your article I feel empowered in my recovery and much more confident… I did not have a heart attack but my CIRC. artery was blocked and a metal stint was placed.

    Thanks for giving me clearer insight and ammunition to assure I ask the right questions and observe the right warnings,

    Thanks, Andrew M.

    • Hi Andrew,
      Sorry for not responding til now. I’m only just seeing your comment. Thanks so much for the kind words and feedback. I really appreciate it. Just stay aware of any signs and symptoms and be sure to seek a consultation and treatment if something doesn’t feel quite right. People who pay attention to the signs and symptoms generally tend to have better prognosis than those who live in denial (that river in Africa!).

      Kind regards,
      Bill

    • Hi Abdullah,
      Thank you for taking the time to leave a question. I think it’s important to note that the flu is dangerous to everyone at any age. I recently lost a dear friend to the flu who was only 35 years old and in excellent health. However, it’s important to note that, when looking at the statistics, the flu generally tends to be more dangerous to children and older adults who may be comparatively more physically weaker than healthy younger adults. If you have any underlying medical conditions that have weakened your immune system, then the flu could pose a greater risk.

      In regards to your question, I have not heard a lot about a connection between the flu and angioplasty. For the most part, it may still be a case of having to consider the individual and his/her health status. But I did do a bit of digging and did come across something that might be of interest to you. Here is an article that discusses the importance of flu vaccinations in people who have recently had angioplasty.

      And here is another general article on the flu and heart disease which might also provide some insight.

      The bottom line: you should discuss this with your doctor to see if a flu shot is something that might be appropriate in your case.

      Kind regards,
      Bill

  26. Re: Cost of Stent and Angioplasty

    Dear Doctor
    My name is Muhammad and I am age 59 years with the following illness:

    1 Diabetes – 12 years
    2 Paralyzed – 8 years
    3 Kidney checkup quarterly – 4 Years
    4 Angiography – Recently diagnosed ( But not yet )
    5 Angioplasty – Next step
    6 Heart bypass – Last step

    So my medical history is above. Please advise me of the approximate cost of treatment and admission time. Thank you.

    • Hi Muhammad,
      Thank you for your message. The cost of angioplasty with a stent is going to vary significantly from country to country and medical system to medical system. You’ll also have to consider that your individual health status could also play a role in how long you’ll be in the hospital and what the final cost might be. For example, if there are any complications due to other underlying health conditions, then this might keep you in the hospital for an extra day in order for the doctors to stabilise you and ensure you are safe to be discharged.

      In general, and angioplasty might keep you in the hospital for 1 – 2 days. Every doctor is different and some will try to get you discharged as soon as possible where others might keep you in for observation for 2 days (or longer if any unforeseen complications).

      The bottom line on cost is that you’ll need to discuss this with your local doctor and other relevant hospital administrators. Sorry I can’t provide a dollar figure for you.

      Kind regards,
      Bill

    • Hi James,
      Thanks for your comment. The question of “how soon can I fly after angioplasty” is quite common. Ultimately you’d have to ask your cardiologist for a specific time frame since he/she’d be familiar with your particular situation. The wait will also depend on other health conditions related to the angioplasty/stent such as if you had a heart attack, have high or low BP, the medications you’re taking, etc. There is no cut and dry cookie cutter answer to this since there are so many mitigating factors around heart health and air travel. There are pressure changes in the cabin that could ultimately cause changes in HR and BP which might affect your body, but in my experience, cardiologists I’ve worked with have (generally) made sure patients waited at least a week, sometimes two weeks, depending on their particular health conditions. But again, I do need to reiterate, I cannot give anyone specific advice here on this topic since it genuinely does depend on the individual and their health issues. Hope this helps. Cheers, Bill

  27. Hi Dr Bill, I’ve found your forum very informative, many thanks for putting people’s minds at rest.
    My story is that I’m 48 years old and had a stent fitted in early January 2016. It followed a heart attack that felt more like a fever than any actual pain in the chest. The blockage was in a back artery but a scan done the next day showed no muscle damage done.
    I have recovered well, I haven’t had a cigarette since it happened but have vaped when feeling stressed.
    I know this is wrong and will try to stop inhaling completely. My stress hales from not being able to lose any weight. I feel enormous and believe I have low testosterone and high estrogen. I would like to know what I can do about this? I’ve started cycling and am finishing my cardio rehab shortly. I am going back to work next week and hope the extended working will burn more calories.
    I really want to know if I can increase my testosterone by visiting the gym more. I know that if I could shed the weight my stress would diminish and my confidence (which since the heart attack had been seriously affected) would definitely increase.
    Would really appreciate your view.
    Many thanks
    David A

    • Hi David,
      Thanks for taking the time to leave a comment. A few things caught my attention here:
      1) You state that there was no damage to your heart muscle. This is a very good sign. If you had damage to your heart muscle, then your recovery time and process would be a bit different.
      2) You’re participating in cardiac rehab. This is another excellent sign. I would encourage you to take advantage of the staff and ask them as many questions as you can, given they are more familiar with your complete medical history than I am.
      3) Cigarette smoking. I would encourage you to speak with your cardiac rehab team to see if they can refer you to a certified smoking cessation provider. Avoid all the quick-fix gimmicks out there that will likely not work in the long-term. If you continue to smoke, then it can increase your likelihood of having another heart attack.
      4) Testosterone and estrogen levels. I would suggest getting a referral to an endocrinologist for further workup to measure your testosterone and estrogen levels. It might intuitively seem the case that your levels are low, and you could be right, but I would suggest having them properly measured to ensure that, in fact, the levels are off. Exercise can increase your testosterone levels, but I don’t think by itself it will be a large change. Nevertheless, it IS still a step in the right direction and will have a number of benefits that will improve your overall health and well-being (and give you more energy by default, independent of testosterone levels). I would suggest speaking to an endocrinologist about this and get as much reliable information as possible.

      The other thing I noticed is that you mentioned your stress would diminish and your confidence would improve IF you lost the weight. I believe this is a piece of the puzzle, but it also opens you up to the tyranny of “I’ll be happy when…..” And then when you lose weight, you might find that things are not a whole heck a lot different. A lot of our happiness stems from our beliefs, some of which are true, and some of which deceive us. Does your cardiac rehab team have an on-site counsellor or social worker? It’s a good idea to sound off to someone with proper training in this area to help keep you on the right track.

      Thanks again for taking the time to leave a comment, and i hope some of this was helpful in getting you back on track!
      Kind regards,
      Bill

  28. Dr. Bill,
    I’ve corresponded before but have new questions. Had the heart attack on 1/24. The LAD was 80% occluded and the others were clear. I had two stents. I’m on metoprolol, clopidogrel, lisinopril and baby aspirin. I’ve been doing resistance training cardio daily, initially for 30 minutes and now two sessions of 45 minutes daily as I’m preparing for a bodybuilding competition. I’m 5’7″ and 157 and age 64. I had an echocardiogram yesterday, am between 60 and 65 now and my cardiologist says I’m healed. I was on TRT for four years and stopped abruptly after the heart attack. Had my T tested and it’s now low at 185. I want to go back on it. My cardiologist won’t say yes or no but my out of network “anti-aging” doctor is currently out of town. I have done a lot of reading and the studies show no link between TRT and heart attacks. Strokes are something else, but I’m on a blood thinner. What is your opinion about resuming TRT?

    • Hi Howard,
      Thanks for coming back and leaving another comment. Based on what you’ve provided, I take it your echo showed you had an ejection fraction between 60 and 65%. That is pretty darn good! Regarding your testosterone levels and the question of whether or not to go on replacement therapy, I will confess I haven’t done a lot of digging on this particular topic, but I did come across something that is relatively recent and might be worth discussing with your doctor: https://www.sciencedaily.com/releases/2015/11/151109160558.htm This study was based on 1472 men who were apparently healthy and found that TRT did not increase their cardiac risk. In all fairness, this is a single study, but I think it would be worth your while discussing this in depth with your anti-aging doc and cardiologist. It would be good to have some sort of convergence of opinion and something with which you feel comfortable. Sorry I can’t be of further assistance, but am hopeful this is helpful to some extent. Kind regards, Bill

  29. Hi Dr Sukala

    Great article and outstanding effort in answering all the questions out there. I am male , 42 and from the UK. I had a heart attack on 7 Sept 2015 had 2 stents in my RCA, with no apparent damage shown in echo. I had a stress test 1 month later bruce protocol in which I achieved 15.5 mins and given the all clear to participate in what i wanted.

    I have always been very active, diet was bad in my younger years although last 5 years it has been fairly clean so came as a big shock when this happened. I had symptoms that something was wrong only through Jaw pains but neglected to correlate them to a heart problem since they only occurred when i was doing high intensity exercises. The pain was so mild and would subside instantly as i slowed down. However one day the plaque broke and occluded the artery. There was alot of emphasis on my cholesterol which was TC 5.2, Ldl 3.5 and Hdl 1.3 at the time which i think is average but i’ve read so much about statins and diet that I am convinced no one really knows what to say at this present time. Is it sugar, Saturated fats, too much exercise, Stress, genetics, Omega 6 vs 3 the list goes on with so many knowledgeable people and so many differences in opinion. I took myself off the statins as I became Vegan which kept the numbers very low and i’m experimenting with what i can add to keep them within the levels suggested by my Drs of Ldl < 2.4. I loved my sports but since the stents ive been scared to go back to what i did before, just in fear of damaging the stent. What kind of sports would you advise against ? I like football, Tennis, cycling, running and weight lifting. Should I fear high heart rates given the all clear? My medication today are baby aspirin, clopedigrel, Ramipril 1.25. Appreciate any advice or info you can give. All the best to everyone its a tough time but dont be afraid to ask questions and get help from a counsellor if you need to. I did and it made a huge difference to my life.

    • Hi Rav,
      Thanks for taking the time to leave a comment sharing your story. It looks like some of those bad habits from your earlier years caught up to you, but this doesn’t mean it’s the end of the game. Far from it. You do have a lot more that you can control (i.e., lifestyle) than what you can’t control (i.e., genetics).

      I’ll point out a few things here for you and other readers which I think might be helpful. I certainly understand your point regarding all the confusion about cholesterol, statins, and all the other factors that contribute to health. When I hear people ask, “why can’t you experts all agree on one thing?” Actually, the truth is that most legitimate experts DO agree on the same thing, but we now have a massive proliferation of pseudo health “professionals” spouting off all kinds of rubbish on social media yet they have no health qualifications and are unable to read clinical research reports to inform their opinions.

      To settle this, cholesterol is indeed a fickle one, but probably not as fickle as everyone might think. I have seen people eating extremely clean yet still had high cholesterol due to genetic influences (i.e., familial hypercholesterolemia). I have also seen people who eat complete rubbish diets that still managed to have low total and LDL cholesterol and high HDL cholesterol, the latter of which is protective. On that note, cholesterol levels tend to fall within a certain range for people and can be mildly influenced for better or worse through all the lifestyle factors (i.e., diet, exercise, smoking, background physical activity, etc).

      Looking at the list you’ve provided (sugar, saturated fat, too much exercise, stress, genetics, omega 6 vs omega 3 etc), it is fair to say that the devil is in the dose for most things. If you overdose on all these things on a regular basis, it will obviously pollute your health in many ways not just related to cardiac health, but can impact your risk of cancer among other things.

      You mention that you took up a vegan diet. If that works for you and it is sustainable for the long-term, then that’s a good thing that’s right for you. Not everyone wants to go that route, and that’s ok for them, but the biggest thing is each person finding strategies that work for them. I also recommend a Mediterranean style diet for people after they’ve had heart troubles, as it is a nutrient-rich diet that is recommends good quality veggie intake and monounsaturated fats.

      As for what you can and can’t do, ultimately the best person to discuss this with would be your doc. If you are around 8 to 9 months post stent, then I can’t imagine you would damage the stent at this point. I’ve never heard of it being an issue in any of the patients I’ve worked with in cardiac rehab. However, I think if you were still pretty fresh out of your surgery and were back at the gym pumping iron and doing high intensity exercise, then the rise in blood pressure could create some instability and possibly cause trouble for that stent (as it wouldn’t be fully set yet).

      If you’ve had a stress test and tolerated 15.5 minutes, then that is a good sign that you should be able to get back to doing most sports. Plus that, you are taking aspirin, a blood platelet inhibitor, and an ACE inhibitor. The combination of all this information should be viewed as reassuring, plus if your cardiologist has cleared you for exercise then you should be ok. I would recommend just being vigilant about any signs and symptoms in the future. So if you have any other indicators of jaw pain, chest pain, etc, then you need to get to your doctor as soon as possible for further work up.

      In closing, you’re going to have a pretty hard time killing yourself if you’ve ticked all the safety boxes (clear stress test, patent stents, vegan diet, meds, and watching for any signs/symptoms). Try to live your life and live it well and not worry too much about things unless you have a real reason to be concerned (i.e., chest pain, jaw pain, etc). If you’re not sure, then go to the doc and have it checked to rule out that it’s of cardiac origin. If you do all that, then I’m sure you’ll be fine!

      Hope this helps!
      Kind regards,
      Bill

  30. Dear Dr Bill, I am an army officer and have my regular exercises. I was admitted in the hospital on 15th of Jun this year with severe chest pain. Two days later i had an angiogram which showed 99% block at LAD and another 45% block at RCX. Dr also noticed the 3rd block at RCA which is about 25%. They did place a DLE stent on the LAD and left other two unattended. Today I returned home. I did have high cholestorol and hypertension for the last 8 to 10 years and was under medication (aspirin 75mg, Osartil 50 mg and Rosuvastatin 5mg). My blood sugar level is normal. I have family history related to cardiac problems.

    My cardiologist did not give me any advice on physical activities or rehab program except advising me for taking regular medicine from now on. I am 48. I am worried about the two other blocks those were left unattended by the cardiologist. I am also confused about my lifestyle for future days to come. When and how should I start my exercises, duration and frequency etc. Eagerly waiting for valuable guidelines. Best regards.

    • Hi Colonel Sharif,
      Thank you for writing. As I’m sure you can appreciate, I cannot give specific guidelines since I am not completely aware of your entire medical history. But the general guidelines that I’ve provided in my article are a good start to get you going.

      Regarding your other arteries that are 25% blocked, they generally do not tend to cause any problems until about 75% or higher. Some docs feel that intervening in low grade blockages could pose an unnecessary surgical risk for something that isn’t going to cause you problems right here and now.

      I would suggest you speak with your doctor and have a treadmill stress test done to see what your exercise capacity is. From that, you can work with your doctor to determine a safe level of exercise that you can do on your own. It will also give you both some reassurance that your heart is stable and there are no other issues which could cause problems (such as arrhythmias).

      Regarding timing of your exercise, remember that you are still fresh out of surgery so there is still healing happening on the inside even if you feel well. Once you receive final clearance from your cardiologist (perhaps 2-3 weeks, maybe 4), then you can get back to starting off with low level walking on flat ground to rebuild your fitness.

      To recap, I’d suggest the following:
      1) Get a treadmill stress test done by your cardiologist
      2) Ensure your heart is stable and there are no other issues which could be worsened by exercise
      3) Get final clearance from your doctor
      4) Start off with low level walking as I’ve outlined in my article
      5) Then progress to the higher levels (as I’ve outlined).

      Again, please be advised, I do not provide specific medical advice or guidelines on my website. If you can find an exercise physiologist in your area, then that could be a good avenue to get specific guidelines. Hope this helps give you some direction.

      Kind regards,
      Bill

  31. Hi Bill,
    I had one stent placed four days ago. The blockage was 80%. Another artery at 40% was not stented. No heart attack, just mild discomfort that prompted me to seek help. At 81, I am not into heavy workouts but I do try to do a 1/2 hour on my treadmill every day (3 mph @ 10%) at keep active plus some light weights. Good diet, non smoker etc, but I do feel quite weak. BMI is 27. I am not sure if the weakness could be drug related (ramipril, diltiazem, Plavix, aspirin and Crestor) or a normal result following the procedure. Your thoughts would be appreciated.
    Thank you kindly,
    Barry McIntosh

    PS I did have Afib five years ago but that was cured with ablation and never have returned

    • Hi Barry,
      The good news is that you did not have a heart attack. This means you had a plumbing problem that was caught in time. Regarding feeling weak, I would suggest discussing this with your doctor, as he/she is most familiar with your unique situation. If the medications you are taking are new to you, then it is plausible that they could be making you feel a bit low on energy. The Ramipril is an ACE inhibitor which can lower blood pressure and possibly sap your energy a little bit. But also remember that you are only 4 days post op, and it’s quite normal to feel tired after all that excitement. But again, the bottom line is to maintain good communication with your doctor and work together to find the best approach that makes you feel your best. Hope this helps. Best wishes, Bill

  32. Dr. Bill,

    I stumbled on this trolling for opinions on whether to do a cardio rehab program. After a series of tests, including passing a 12 min stress test, ecko, and nuclear test, my CT Angiogram showed multi vessel CAD.

    No heart attack, damage, just fatigue and some angina pains. Bouts with fluctuating BP, and occasional SOB.

    Got two medicated stents in RCA. Center and Right have 70 % blockages, but doc “measured them and it showed good blood flow. Big family history. I’m still in denial. I’m 62 and the only one who didn’t have “something” wrong.

    In my mind I’m leery of the other 2 blockages and wondering if they could be stented on my “insistence” for peace of mind. They say the LCA provides 2/3 of the goodies.

    I’m also going to take a money hit by doing the program. I thought maybe to do half and drop out just for the education. I went back to work on Day 3 post op and have been walking 20 to 30 min a day ever since.

    Should more stents for the other 2 places being a consideration, or am I just being impatient. Stents on Jun 14th this year.

    It has always seemed for many years even my ice hockey days I would always be SOB until I warmed up. Is this because of CAD?

    thx

    • Hi Brian, the decision to stent or not will ultimately be up to your doc and will be based upon the extent of the blockage(s). In my experience, many cardiologists start considering stenting as an option at about the 70% blockage stage. That’s the point where people start experiencing symptoms. The other consideration is whether or not to take a risk with surgery if it can be medically managed without surgery (i.e., there’s nothing routine about routine surgery). As for cardiac rehab, having worked in cardiac rehab, I think you’ll find it helpful, but whether you complete the whole thing is up to you. Not sure if you’re US based, but I know the healthcare system there is irreparably broken re: health insurance coverage and out of pocket expenses. When I worked at a hospital in San Diego, I used to wrestle with insurance companies in a daily basis to get my patients covered. I’m sure it’s no better now. But anyway, if it’s in the budget, I would recommend a cardiac rehab program for sure. As for your SOB, if you had this near the time of your stents, then it is plausible it could have been to do with CAD, but can’t be certain. Hope this helps.

  33. Thanks for your reply. I’m in Massachusetts, USA. I think because I have CAD, I wonder about the efficacy of “busting butt”, but perhaps I should at least try some sessions and then I will know where my threshold is.

    I am of course concerned about the other blockages, and will discuss at my 3 month follow up. I think the US Healthcare system and the “rules” of the insurance companies and payouts drive how much / or how little a doc might do. I know he had a tough time doing just these 2 and you can only stay in there so long with the dye as it will shut down your kidneys!

    I’m mad at myself for not pushing this full work up earlier in my life. Could have been there for YEARS. BUT I also as I stated discovered the walking stress test , even with nuclear proves nothing.

    Had I not had the CT angiogram , or the cath, I would have been just “trying harder” to get in shape…………….was even considering going back to ice hockey in a “fun” league or pick up this winter. So much for that.

    Thanks again for an unbiased opinion. I will be exploring my options in the coming months.

    BTW, am I the only one with difficulties trying to submit posts with the CATCHA codes, keeps coming up with error when there is none

    Brian

    • Hi Brian,
      Yes, you are right about that. Fat balding insurance company bureaucrats with finance degrees are sitting in offices calling the shots about what docs can and cannot do. It’s been a problem for quite some time now. Nevertheless, glad that you were able to get to the bottom of things. If you didn’t have a heart attack then you had what could best be described as a plumbing problem. So you are in the better side of the exchange. Also, the fact that you had symptoms can be a good thing. At least you had warning signs. Not everyone gets clear enough symptoms that they can tell for themselves it’s a heart problem. Or if they do, they sometimes ignore the signs (denial) and end up with half their heart muscle blown out. That’s when the real problems kick in with reduced exercise capacity and, if a large heart attack, mild or moderate congestive heart failure.

      Keep up with your proactive approach and you should be fine in the long run.

      BTW, I’ll look into the captcha code. Have not had any other complaints.

      Best wishes, Bill

  34. Hi Bill,
    I must say thankyou for replying to my previous inquiry. I don’t know how you find the time to reply to everyone. I had 2 stents fitted in January and have made a good recovery. The only thing that really needs some work is my diet. I’m just getting back into working and all the rehab exercise is over. I would like to try a Nutribullet diet but the small print says to consult with your doctor if you are on colesteral reducing drugs and blood thinning medication.
    When I can afford a consultation with you, I will have one, but rather than list all my medications could you tell me why having healthy vegetable and fruit smoothies could mess with my medications.
    Understand your busy but I would appreciate your thoughts.
    Kind regards,
    David Aylott

    • Hi David,
      Thanks for your kind words. It sometimes takes a few days to get around to it, but I do make a good effort to be attentive to people who take the time to comment on my website. Most of these articles are now ranking highly in Google so I take personal pride in being able to help people with good information and fend off a lot of the social media Insta-Muppet “experts” that are confusing everyone with nonsense!

      Regarding your question, in the grand scheme of things, I don’t believe that veggies and fruits should interact with your meds, but these types of juicer products generally have to put a broad disclaimer on it for the litigious subset of the population that wants to sue for stubbing their toe getting out of bed in the morning.

      The thing to remember about juicers in general is that they tend to remove the fibre which can increase the sugar load of the juice. I recommend people eat the whole fruit or vegetable so that the digestive properties are “as nature intended.” Having said that, if you’re drinking a juice with a meal, that will moderate the rise in blood sugar a bit (as opposed to guzzling straight refined juice). If you have any issues with your blood sugars or are at risk of type 2 diabetes, then I’d recommend eating the whole food instead of its juiced version.

      Hope this helps.
      Bill

  35. Hi Dr Bill Sukala This is Deepak and I am almost 60 years old. I had my 1st stent in 2009 and the 2nd one in 2016. I have been drinking alcohol for 40 years. I’m still drinking moderately. Is it going to make my heart worse? Please advise.

    • Hi Deepak,
      As I tell everyone in the comments, I cannot give any medical advice here. First, I would suggest you discuss this with your doctor who is most familiar with your particular health history and any medications you might be prescribed. Alcohol does have effects on your health and it can interact with medications. But as with all things, the devil is in the dose. Obviously if you’re drinking a lot then, yes, there could be possible adverse effects on your heart. If you have other health conditions such as diabetes or high blood lipids, then alcohol is not going to do you any favours. Again, bottom line is that you should have a talk with your cardiologist or general practitioner about your particular health history and if drinking alcohol is going to affect your heart. Kind regards, Bill

  36. Hi Sir, I’ve an angioplasty stene surgery on march 17 this year and I’ve 90/60 bp . This is my 2nd heart attack. I just want to know that when I’m going to do exercise and in future there will be any further heart attack for me or not .

    • Hi Srinibash,
      I’m sorry to hear you’ve had a rough time with your heart. No one can guarantee you won’t have another heart attack, but you can certainly take steps to minimise the chances of having any more heart troubles. I cannot give you any specific medical advice, but I can suggest some things you can discuss with your doctor.
      1) I would suggest discussing with you doctor the possibility of having a treadmill stress test done. This will help determine what your unique response to exercise is. With this information, you’ll then be able to figure out a safe workload you can perform when out on your own. Also ask what your blood pressure response is during exercise, as it is somewhat low at rest.
      2) As your doctor if there was any heart damage or wall motion abnormalities. You need to see how your heart is functioning, as this can also help you determine how hard you should be exercising.
      3) Discuss your medications with your doctor and the effects they will have on your ability to exercise. For example, medications like beta-blockers might make you feel a bit more tired and lethargic and that could make exercise feel more difficult.
      4) Discuss your eating habits with a dietitian and get on a path to healthy eating (if you’re not already doing this).

      Hope this helps you.
      Kind regards,
      Bill

  37. Hi Dr Bill I’m a 51 year old female who had a massive heart attack this past January. I had a stent put in my RCA which I was told was 100percent blocked! I also have COPD. Im trying to change my eating habits and I want to start getting more exercise as well,but I’m tired so much of the time and I also get very winded very quickly! I live on the third floor so when I go out and come back in I’m so out of breath coming up the stairs even taking my time. I’m just not sure what to do or how to change all this! I’m also overweight I’m 5-4 and weigh about 185 lbs but I haven’t gotten under 175 lbs in years no matter what I do or dont do! Do you have any suggestions on how I can feel better and help my heart and my lungs at the same time?! I’d appreciate any advice you might have!
    Thanks,
    Your New Fan,Bobbi Jean

    • Hi Bobbi Jean,
      While I cannot give any specific medical advice, here are some options that might point you in the right direction:
      1) Speak to your doctor about your echocardiogram report and ask if there was any heart muscle damage. If so, how much? What is your ejection fraction? If you had a bit of damage, then I would recommend asking for a referral to a hospital-based cardiac rehab program to help you exercise safely and effectively under the watchful eyes of a trained team. This will help you set safe exercise guidelines specific to you.
      2) Regarding reducing body fat (and losing weight), the best answer to this is like a stock market tip: It’s not about TIMING the market. It’s about time IN the market. In other words, you need to be looking at this as a long-term goal rather than thinking you’re going to lose 50 pounds in 2 weeks. In this case, a) you’ll need to get moving and doing exercise (see above comment regarding cardiac rehab); and b) I would strongly recommend visiting a registered dietitian and learning some ways you can improve your eating habits to put you on a slow and steady weight loss trajectory. Please do NOT go out and buy any infomercial products or miracle fat burning or metabolism booster supplements. The only thing you’ll lose is money and you’ll be stuck where you are.
      3) Here are some links on my website which will help put you in the right direction:

      The bottom line is that you need to get some good quality sound health information, get on the right track, and then remain consistent with it for the rest of your life. We’re not talking about “going on a diet” to lose weight and then drop it when you’ve reached your goal. We’re talking about overhauling your life. This can be an overwhelming experience so it must be done in a slow and gradual way. If you’re feeling very distressed about your health, I would also strongly recommend visiting a psychologist who has experience in health coaching and can help you create a systematic and stepwise plan to get your back on track. I’m not going to sit here and tell you it’s easy. There is no magic wand anyone can wave, but if you are prepared to finally say enough is enough, then it’s just about getting on track and staying the course. One day at a time..

      Hope this helps. Best wishes to you
      Kind regards,
      Bill

  38. Hi Dr Bill,

    First of all thank you for posting up this really informative page, and for all your time & effort in replying to our questions. I’ve found it really reassuring.

    I am a 42 year old woman from the UK who really enjoys an active lifestyle. Cholesterol/ weight / blood pressure all good (excellent really) and no family history. In April 2016 I ran my first half marathon and was looking forward to running further. Just a week later I started feeling (what I know now was) angina while running up hills, and although I could warm up into my runs fairly easily, the chest sensations continued during heavy exercise for a couple of weeks. After a visit to a fantastic GP and escalations I was diagnosed with a 70-80% blocked LAD and had a stent fitted in May. The procedure / recovery went well and my exercise tolerance test where they let me exercise to exhaustion was “excellent”.

    Obviously I’m delighted to have been diagnosed and treated, but now, a few months on, I’m looking to the future and what I can/can’t do in terms of exercise. My cardiologist originally said that I could “now do any exercise that I wanted to do” but when I specifically asked if that meant I could run a marathon said no, I should probably limit myself to half an hour of running. He did say there was no evidence either way but that he would be concerned about dehydration on longer exercise sessions. I am now on atorvastatin, aspirin 75mg, clopidgrel, and dilzem (he first thought I had cardiac X syndrome and then decided to keep me on this one).

    I have since been running (30 minutes / 5km at a time) and have taken up personal training with a medically-orientated trainer. I make sure I can talk all the way through my sessions and tend to watch my heart-rate and keep it around 140bpm or lower (I have no idea what my max heart rate is, unfortunately). I feel fantastic during exercise, and haven’t had any angina since the PCI.

    My questions are – is it safe to do this? Is it safe to increase my run to an hour?
    Is there a maximum sustained level of heart-rate that I should be aiming for, or is the ‘talk test’ OK?
    Given that my cholesterol / blood pressure were already good do I need to modify my diet to reduce fat & salt?
    Really, I guess I’m asking how many concessions I have to make!

    Thanks in advance for any advice.

    Catherine

    • Hi Catherine,
      Thank you for your comment. You seem to be pretty level-headed about all this and that is a very healthy way to be. As I’m sure you can appreciate from my other comments on this article, I can’t provide any specific guidelines since I’m not familiar with your entire medical history, nor can I give any information that goes against your doc’s recommendations. BUT, I can provide you with some talking points you might which to discuss with him.

      1) provided your PCI was completely normal with no complications, you’re young, you’ve got a history of exercise (including a marathon), then you might wish to plead your case again with your cardiologist. I’ve had some pretty serious cyclists in cardiac rehab, one guy of which had three heart attacks with significant damage to his heart muscle and diagnosed congestive heart failure. Despite all the things wrong with him, he kept on going out and riding his bike for hours and hours with no ill effects. But in his case, the rest of his body was quite fit so that it offset his very sick heart. In your case, you did not have a heart attack, so you do not have any compromised heart function (you had a plumbing problem rather than a heart problem).

      2) Dehydration “could” plausibly be an issue but only if you were not drinking on a regular schedule during your marathon, or if the conditions were quite hot.

      3) If you’re still taking Dilzem then this should slow down your heart rate a bit, making it unlikely that your HR is going to shoot up into the stratosphere. If you’re getting your heart rate up to 140 bpm, then that’s about 78% of your age-predicted max HR (but your actual max HR “could” be higher or lower if it was actually measured). Given your fitness level as you describe it, 140 bpm is not uncharted territory and is unlikely to pose a problem unless you happen to have other arteries plugged up.

      4) Regarding duration, we frequently had patients in cardiac rehab exercising for an hour at a similar percentage of their age-predicted max HR. However, only your cardiologist can officially give the nod on that one.

      5) The talk test is always a good standby aside from heart rate, so I think that’s always a good indicator of how you’re going with the intensity.

      6) Regarding fat and salt, for specific info, I would recommend consulting a university-qualified dietitian to deal specifically with your diet, BUT, I will point out that salt tends to be an issue mainly in salt-sensitive people (not sure if this applies to you). Some people can eat salt by the bucket-load with no ill effects and other people can have a small amount and it bumps up their blood pressure. But that aside, in general, it’s never bad advice to keep salt intake at low to moderate levels as a safeguard. Regarding dietary fat, in and of itself, fat is not necessarily bad, but as with all things, too much of anything isn’t going to do you any good. I would defer to similar recommendations as with salt in that it’s never a bad idea to keep fat intakes at reasonable levels (approximately 30% fat or less and of that 30% less than 10% coming from saturated fat). Fat is a very energy-dense source of nutrition and has a lot of calories packed into a small amount (hence the reason it’s easy to overeat them). Here’s a quick reference link for more info on this: https://www.nutrition.org.uk/nutritionscience/nutrients-food-and-ingredients/fat.html

      The bottom line is that you may wish to speak to your cardiologist again and perhaps discuss having a treadmill stress test done. If you’re pushing yourself to max (or near max) and there is absolutely nothing out of the ordinary happening with your heart, then that at least gives you both reasonable confidence that your ticker is strong (and there are no odd blips on your ECG).

      I would also advise you to pay extra special attention to any other signs or symptoms that may arise. Hopefully this was a one-time thing for you and you’ll never have it happen again. But if for any reason it does, at least you know the symptoms from your first episode. Quick treatment means no heart damage, and that’s very important when it comes to exercise capacity.

      I hope this response gave you somethings to consider and things to discuss with your doc.
      Kind regards,
      Bill

  39. Hi Catherine Your story is very similar to mine. I was 42, very sporty all my life, nothing ever in excess but still ended up with 2 stents in my RCA. Anyway I went and saw the leading sports cardiologist in the UK to get reassurance that I could continue my endurance sporting activities as pre MI. He put me through a thorough stress test, took my HR to 193 and confirmed there were no odd rhythms, also checked my heart function and ejection fraction as best they can with ECG which was all normal so there have been no restrictions applied to me apart from no events that subject you to electric shocks and ice pools ;-). If you want his details and it’s ok with Dr Sukala then I can share here or privately via mail

  40. Hi Dr Bill,

    Thank you so much for your reply and taking the time to advise me.

    Sorry if I didn’t make it clear in my original post, but I did have a treadmill stress test, one month after the PCI (4 months ago). I did 15 minutes of the Bruce protocol and got my heart-rate up to 176bpm without any abnormalities on the ECG. Prior to the procedure I had been asked to stop the stress test early as my ECG on exercise was abnormal. Hopefully this is additional reassurance that things are now running smoothly.

    Thanks also to Rav for his post about his similar situation. It’s good to know that I’m not alone! I’d be really interested to know of other people in this situation and whether it did turn out to be a one-time thing for them, or whether there were other narrowings later. My cardiologist suspected that I may have had a chest infection or something to trigger the lesion since he didn’t expect me to have significant atherosclerosis based on blood tests and lifestyle.

    Thanks again for the advice

    Catherine

  41. Hi Dr Bill
    I have been gym fanatic for since age of 18.Now iam 55.Recently i felt jaw pain during treadmill running and went to see my friend cardiologist who did ETT and stress echo Treadmill showed signs of RCA disease but stress echo was normal with no troponin leak. My TC was 4.1 with HDL of 1.06 and LDL of 2.2.On angiogram there was a very soft 94% occluded RCA which was stented and also mild LAD lesion with 60% lesion in diagonal artery.
    My main issue had been stress for years with poor sleep which i guess has contributed to hypertension and CAD.Hypertension is very well controlled
    Whats my prognosis?Can i play competitive sports like golf?Is athersclerosis reversible?
    Iam only on aspirin , plavix(3-6 months) and ACE inhibitor

    • Hi Vijay,
      Unfortunately, I can’t answer any of those questions since they’re pretty specific and are best answered by your cardiologist who’s most familiar with your individual medical history and circumstances. If you can get into a cardiac rehab that’ll be the best way to get back on track.

  42. Hi Dr

    I am 39 yrs old and regularly play golf every week and up until last November 2015 I was playing 5-a-side football and jogging for around 20 minutes once a fortnight. On 5th November I was playing 5-a-side football and had a pain in the very centre of my chest after 3 minutes running. I stopped and the pain went. This went on for some time every time I ran. Long story short I have just been into Leeds General Infirmary a week ago and a stent has been placed in my artery (MID LAD whatever that is?).
    I want to know if I will be able to resume playing football and jogging. I have continued to play golf throughout all of this with no problems at all thankfully as it is my number one hobby. I am on asprin, atorvastatin, amlodipine, clopidogrel and bisoprolol and have been for a month (leading up to the angioplasty).
    I have had a few strange twinges in my chest during the week following the procedure and had what felt like very mild angina when sat on couch but nothing for the last couple of days and it may just me being paranoid?
    Can I start a slow jog now to test whether I get the pain again? It used to occur after just 2 or 3 minutes of jogging?

    Thank you for your time and I am thankful I have found your page.

  43. Dear Dr Bill Sukala, I am 55 years of age and had a heart attack back in 2005. As a result I had a stent (Texas?) fitted. My medication following this was: Plavix, Lipotor, Ezetrol. Following my Cardiologist’s advice a few years ago I stopped taking Plavix and take Cartia instead. I am also on Methotrexate, Arava and folic acid for Rheumatoid Arthritis (Psoriatic). I believe I am healthy, reasonably fit and have a good diet. Even before my heart attack I believe I was fit and diet was average. My Cholesterol at the time was about 6, now it is over 3. I slowly returned to what I believe was good fitness after starting boxing (for cardio) a few years ago. I now like it very much. Each boxing class starts out by doing rope skipping, learning boxing techniques followed by some light sparring and focus pad workouts. Recently I had a three round (3 min bouts) where we only could punch the body of the opponent. Soon I will be fighting in a full on three round fight – with of course head gear and mouth guard protection. I like learning the technical ability of boxing and will not be doing any further actual fighting in a ring once I compete in the bout above. After my first bout, I was very exhausted and somewhat bruised as well. My GP today said he would rather me play golf. I did check with my Cardiologist some time ago whether boxing was alright to do, and he said yes. But I wasn’t actually boxing in a ring against someone at that time. I do not see the Cardiologist anymore because he feels there was no further need as I was doing everything right and my blood tests and diet were stable. Could you please advise if doing one more three round / three minute fight be pushing my exercise and luck too much, and perhaps do more damage than good? Mainly concerned about being hit in the chest area. Thank you for your time.

    • Hi Kim,
      Based on what you’ve provided, you had your heart attack and stent placement back in 2005. By now, your stent is fixed and is unlikely to go anywhere. As a general rule, being hit in the body is probably not a good thing, but based on my experience in cardiac rehab, I have not come across anyone who’s had any problems boxing after an angioplasty provided they gave it ample time to health and settle in. In your case, you’re 11 years post-op, so that’s good. BUT, as a rule, I always tell people to speak to the cardiologist or the cardiologist’s practice nurse (ring the office) to see what they think. Unfortunately, I cannot give you any specific medical advice, but I’m hopeful this information is helpful.
      Kind regards,
      Bill

  44. Hi Dr Bill
    Sir i am 29years old guy. I recently had angioplasty n a stent in LAD with 100percent blockage. I was very active guy and used to walk alot. It was shocking for me and for everyone in family that this all happened to me. I am taking all my medicines on time. Quit smoking. I am 6ft tall n weigh around 72kg. Doing light exercises as well. Sir i would like to know, am i going on the right track? Will it happen to me again? Can i live normal life or is it me thinking i am abnormal now??? Please help, i lack motivation in my life nowards.

    • Hi Rahul,
      I can imagine this would have come as a massive surprise to you, but it does not mean that it’s the end of the world. If you feel a bit anxious then that is quite normal and expected. If you are making the lifestyle changes such as quitting smoking, that will help you minimise your risk of having another heart attack. The good news is that, based on what you wrote, you did not have a heart attack. So this means you did not have a “heart problem” but instead you had a plumbing problem in one of the arteries that feed blood to your heart (like a clogged pipe). You’re much better off if you did NOT have a heart attack because this can cause heart muscle damage. Consider yourself lucky. I would recommend participating in a cardiac rehabilitation program (if there is one at your hospital) and also visiting a dietitian with a degree in nutrition. That will help you safely exercise and receive reputable information on what to eat to keep healthy for the long haul. If you have a lot of ongoing anxiety, I would strongly recommend visiting a counsellor with experience in working with people who have had medical issues. It’s a sign of strength to reach out for help, not weakness.

      Hope this helps,
      Bill

  45. Hello Dr Bill,
    I have found the information in the letters above to be extremely informative. Thank you for that.
    6 weeks ago I returned from a bike ride (35km and building my fitness through running riding, squash, basketball and touch football to attempt a mountain race consisting of kayaking, running and riding). I suffered chest pain after the ride and my wife drove me to hospital. On the way I suffered a heart attack. In hospital I went into Cardiac arrest and was revived. (3 to 4 minutes down). I was transported by helicopter to a larger hospital and again suffered a heart attack during transport. On arrival at the hospital I was fitted with a stent LAD with 60%mid lesion.
    8 days later I was fitted with 2 more stents, mid LAD 80% lesion, and mid right PDA 80% lesion. An echocardiogram showed an EF of 45 to 50%. My troponin reading on the day of the CA was 92888.
    All in all I am a very lucky 57 year old male to be questioning you today thank you to the prompt intervention of the hospital staff. By the way , I am a fit, nonsmoking,light drinking, BMI 23.5, active person.
    My question is – over time do you think it will be possible to regain my former fitness levels? Play touch and squash? Climb Mt Kiliminjaro? Etc
    Your advice would be much appreciated.
    Also, I am doing cardio rehab but find it a little slow. Do you think it would be worthwhile to approach physiotherapists to design a specific program for rehabilitation, or what other approach would you suggest?
    Again your advice would be much appreciated.
    Last year I had a prostatectomy and recovered my fitness and mind set quite quickly after that.
    Regards
    Greg

    • Hi Greg,
      Thanks for your comment. I’m glad to see that you’re attending a cardiac rehab program so I would encourage you to take full advantage of what’s on offer while there. I know that you’re a fit guy going into this, but sometimes fit people are also difficult patients! I know because I’m one of them! The fact that you’ve had the heart attack and probably a bit of mild cardiac damage (given your ejection fraction) means that you’re going to need to make sure you’re healed and you’ve got the all-clear from your cardiologist before you go back to doing things full throttle.

      I would suggest having a heart to heart talk with your cardiologist (no pun intended) and discuss having a max treadmill stress test before you get back to flogging yourself. This will let you know that your heart is functioning well and you are not having any funky changes on the electrocardiogram (arrhythmias) which might preclude you from doing higher intensity exercise. Your doc can discuss all the pros and cons of the test and what it will and will not tell you. But as an exercise physiologist with experience in cardiac rehab, a treadmill test will at least help you minimise risk. If you’re stable at high intensities during the test then with reasonable confidence, you should be able to handle higher workloads out on your own.

      If you’re still attending cardiac rehab now, I would ask them if they can put you on a telemetry monitoring system whilst exercising. Even if not doing max intensities, it will let them know if you have any arrhythmias during exercise (benign or otherwise). In my experience, we always put the post-heart attack people on telemetry for several sessions to ensure they were “Stable Abel.”

      Regarding a physio for a private program, many of them are good at muscles and bones but don’t have a lot of knowledge or experience with cardiac patients. Some do, but many don’t get much training in that regard. A better bet would be to find a clinical exercise physiologist with specific training in working with clients with cardiac issues. Send me an email through my contact page if you need further assistance.

      Kind regards,
      Bill

  46. Hi Again Dr Bill,
    Thank you for your informative and detailed reply. There are certainly many things there which I will take on board.
    Unfortunately, as I live in a country town(Grafton) the availability of Telemetry equipment is questionable, but I will check.
    One more question if I could? Do you know any exercise physiologists within a couple of hours from Grafton that have cardio rehab experience? I don’t believe there are any locally.
    Thanks again for your support and help.
    Regards
    Greg Eather
    Regards from GREG and his

    • Hi Greg,
      Sorry for the delay. I didn’t see your comment until now. I used to live in the northern rivers area in Lennox and worked as a lecturer of clinical exercise physiology at the uni. I would suggest getting in touch with a friend and colleague of mine there, Sue Broadbent. They have an outpatient clinic at the uni so this may provide you with some additional answers. They have masters students of exercise physiology (supervised) so it could be a good opportunity to get all kinds of tests done. Reach out to Sue here: http://scu.edu.au/staffdirectory/person_detail.php?person=18842 Tell her I told you to get in touch. She’s a very nice person!
      Kind regards,
      Bill

  47. Hi Bill, thanks for your article. I realise I am jumping the gun on this one, as I am having an angiogram in 2 days time and don’t yet know whether an angioplasty will be necessary. I am a 66 year old woman and have not had any heart attacks. Up until now my issues with my heart have only been the rhythm. 12 years ago my heart suddenly started beating slowly and intermittently stopped beating altogether, as a result I now have a pacemaker. Since then I have had one episode where my heart was consistently beating too fast but a change of medication (from Atenolol to Bispronol) seemed to fix that. However, I then started getting some episodes of atrial fibrillation and subsequently some atrial flutter. I did have an ablation procedure a couple of years ago. My Dad died in 1976 at the age of 58 so since then I have made a point of following a healthy lifestyle (he didn’t) including a lot of exercise, more so now I have retired from work and have more time. I gave up competitive running in my 50s but still kayak, cross-country ski, swim laps and hike. So much for the background, now for my question. If I do have to have an angioplasty, can I travel a week later? I booked a small group tour in Costa Rica with a friend which I am reluctant to cancel unless absolutely necessary. There will be opportunities to do some longer, possibly steeper hikes there but these are optional. My concern is mostly around carrying luggage from place to place as I read that heavy lifting is not good. And I will be flying there and back if I go.
    I will of course follow my cardiologist’s directions if I have the procedure, but I would be interested in hearing your opinion. Most of the comments on your page are related to fast and competitive sports but I have always been one for endurance rather than speed.

    Thank you for your assistance,
    Elaine

    • Hi Elaine,
      Sorry for the delay in responding. Your comment ended up in the comment sin bin for some reason. I saved it and am now responding!

      You mentioned you have an upcoming angiogram and are not yet sure if an angioplasty will be necessary. I think first and foremost, you’ll have to take it as it comes. If they perform an angioplasty with or without a stent, obviously the recovery will be a little bit different. As you pointed out, your cardiologist’s advice is the final word since the doc is going to be most familiar with your medical history. I would suggest discussing your intentions for Costa Rica with your doc and get specific guidelines that are relevant to you.

      Speaking from an exercise physiologist’s point of view, provided your angiogram/angioplasty/stent and recovery are all normal with no unforeseen complications, and you’re approved for activities by your cardiologist, then I can’t imagine doing activities of daily living will pose much of a health risk. If you’re lifting baggage but are not struggling and turning red-faced in the process, you should be ok. I think if you’re lifting really heavy bags and are grunting and groaning, then that’s a different story.

      I think one of the things that people tend to forget is that routine surgery is still surgery and there is still healing happening on the inside (and perhaps at the catheter insertion site presumably at the femoral artery). For all normal light lifting, you should be ok, but it’s still prudent to ask one of the young stallions in your group tour if they can do the heavy lifting for you (as required) until you’re fully healed.

      Again, I need to be clear, I am not providing medical advice or giving you information that is a substitute for that of your cardiologist. Discuss your concerns with your doc and I think you’ll get the answers you seek that are specific to your situation.

      Hope this helps,
      Bill

  48. Dear Dr.Sukala
    I follow you as runner from Turkey.I am 52 years old male. I had a heart spasm last week and they placed a stent .I run 10-15 km. everyday for 10 years.I also run marathons.I am very dissapointed and I dont want to quit running.I am waiting for your advices and a program that is suitable for me. Thanks
    Ozgur Kosar

    • Hi Ozgur,
      Thank you for your comment. First off, you are still in a recovery phase so you still have some healing occurring inside your heart. You should discuss your recovery plan with your cardiologist who will be most familiar with your complete medical history. If there is a cardiac rehabilitation program available to you, I would also recommend participating in it so you can exercise under supervised conditions to ensure you transition smoothly back into your training program.

      I do not provide full exercise programs over the internet, as this would be negligent on my part for not knowing your entire medical history. I would recommend you speak to your cardiologist to discuss having a treadmill stress test (after you’ve healed) to ensure that your heart is stable and there are no signs or symptoms (or changes on the electrocardiogram) that could pose a problem.

      If you can find an exercise physiologist or personal trainer with experience working with cardiac clients, then they can help you there in person to transition you back into your running routine. Hope this helps.

      Kind regards,
      Bill

  49. Hi

    I’m 63, female and had 2 drug-eluting stents fitted a couple of days ago. My angina symptoms were in my jaw and between shoulder blades and for over 2 years had been put down to my arthritis by my rheumatologist! I was taken into hospital with severe pain and diagnosed with unstable angina. There are no vacancies at rehab at the moment but I will go once called. I’m limited in what I can do due to arthritis but thought I would begin with gentle walking. I’m really not fit and wondered how long I should walk for. I must admit I’m worried about having another angina attack if I overdo it. Or is there something else you can suggest? I aim to go back to work after a week, although only part-time for the first couple of weeks.

    • Hi Jennifer,
      Thank you very much for taking the time to leave a comment. While I’m not happy to hear you had angina (ouch!), I am happy to learn that you were able to get a proper diagnosis and treatment. If you have a documented history of other aches and pains, then it’s not uncommon for these sorts of things to be chalked up to arthritis pain. I’ve seen it before on a number of occasions. But onto the here and now, let’s see if we can get you on the right path.

      Here’s some good news. Based on the info you’ve provided, it looks like you only had a plumbing problem (the arteries) as opposed to a heart problem. If you have a heart attack with damage to your heart muscle, then that is an entirely different landscape from a recovery standpoint. So hopefully that helps put you at ease.

      Remember that you’re still pretty fresh out of surgery and there IS still healing happening on the inside. Even if you feel well, remember not to push it too hard (as I mentioned in my article). The key is to keep your heart rate and blood pressure from climbing too high while your stents are settling in.

      Regarding cardiac rehab, I strongly support your participation in a guided program once a spot opens up. It will give you a lot of peace of mind and will allow you to sound off to the cardiac rehab staff regarding any questions or concerns that are specific to your individual situation.

      As for what you can do in the meantime, I would suggest speaking to your cardiologist and/or the practice nurse at the clinic to ensure that you’re medically stable (i.e., no medical reasons which would preclude you from safely walking around your neighbourhood on your own). Provided they deem you stable and low risk, then going out for walks as I’ve outlined in my article would be very helpful in getting you back on track and feeling strong again.

      Regarding another angina attack, if the docs were able to treat all affected arteries, then it’s unlikely you’ll have angina again (and assuming the two stents they put in were a success). You do need to be aware of how you’re feeling while walking. It’s not uncommon to be a little bit leery getting back into it, always fearful of the angina setting in again.

      As for going back to work, depending on what kind of work you’re doing, perhaps it’s best to speak with your doc and get approval. If it’s desk work, then probably no issue, but if anything physical that requires any lifting or exertion, then maybe best to check just for good measure.

      Hope this helps.
      Kind regards, Bill

  50. Hi Dr. Sukala,
    I had angioplasty and a bio absorb stent placed in my LAD 5 1/2 weeks ago. I did not have a heart attack so I have no heart damage. Last spring and halfway through the summer I was able to be very active. I ran a couple of half marathons and in July did a short triathlon. Around August I was unable to do cardio anymore because of chest pain, however, I continued to lift weights up until the stent was placed. I am now back to doing cardio and just this week I started lifting light weights again. Right now I can do from 20-40 minutes of cardio at a time depending upon intensity.
    I live in Nebraska and it gets cold in the winter. I have been told that I shouldn’t shovel snow this winter and I shouldn’t run outside this winter. But do you think I can go ahead and shovel some light snow and do some easy outside runs if I wear a face mask and don’t overdo it? Also, if you think that is a possibility is there a particular kind of mask you would recommend?

    Thanks,

    • Hi Jim,
      It sounds like you’re on track regarding your recovery. For the first month or two, it’s true you’ll need to be more cautious. There are general recommendations but individual recovery can vary from person to person slightly depending on their condition, how complicated the surgery was, pre-surgery level of fitness, etc. The main reason they tell you not to shovel show is that it can get heavy and jack up your blood pressure. While you’re in recovery, this can be an issue so they generally tell people not to overdo it (particularly if the snow is wet/soggy snow). If you’re nearly 6 weeks post op, you’re medically stable, and you’re already doing 20 to 40 minutes of cardio, then this is a good sign that you’re on the right path. I would recommend you speak to your doc about resistance training and, if given the green light, then ask if shovelling light snow would be an issue. As I’m sure you can appreciate, I can’t give any specific advice since I don’t know each commenter’s full medical history. Hope this helps give you some direction though. Cheers, Bill

  51. Hi Doc
    I an 55 years old male, I had 3 stents put in 6 months ago, no issues with the op
    But I get a bit of pain when I lay on my left side, when I go to bed, or when I raise my left are above my head when laying down, or when I am just sitting still watching TV
    I do not get an pain when I am active/ working, is this normal?
    Cheers
    Steve

    • Hi Steven,
      Hard to say exactly what’s causing this, but I would recommend discussing it with your cardiologist or practice nurse. I’ve heard of this in other people as well but can’t say for certain it’s cause and effect or coincidence. Feel free to stop back here and post another comment after you speak to your doc, so others might benefit from this information as well. Kind regards,Bill

  52. I had a stent placed on 21st of December. I have just been released to full activity !!!! I am 61 in good shape and an avid cyclist. I ride 150 miles a week before the stent. I ride with a group and we ride training rides in an ” A ” group pace (30 miles we will finish at 19.2avg mph) , My question is I am taking Brilinta 2 times a day with 1 aspirin. My PCP doctor is scared taking that much if I fall I could bleed out if I landed on my head ? when can I cut back on the thinners so I can ride ?

    • Hi Ken,
      Thank you for your comment. You certainly sound like a very fit person. Provided you did not have a heart attack and only had a stent placed, then this means that you only had a “plumbing problem” rather than a heart problem (i.e., heart muscle damage). It might be worth discussing with your cardiologist the possibility of having a treadmill (or cycling) stress test done to see how your ticker and hemodynamics are after the stent placement. I often tell athletes like yourself to discuss this with their docs since you are pushing the higher intensities. It will give you some peace of mind.

      As for Brilinta and aspirin, yes, they are blood thinners and there is an elevated bleed risk if you fall. That is true. I would discuss the risks versus benefits with your doc. You’re 61. How many years have you been a cyclist and how many nasty falls have you had where you banged your head? You seem to be a well-trained athlete so I’d imagine you’re not in the habit of falling off your bike every ride. If you are cycling with a group, then if, God forbid, you did fall and bang your head, you’d at least have people there who could attend to you on the spot, as opposed to cycling on your own and ending up face down on the side of the road. Lots of factors and meta-factors worth considering and discussing with your cardiologist.

      I can’t tell you when you can cut back on your thinners since I am qualified as an exercise physiologist and not a cardiologist. Moreover, even if I was a cardiologist, I still couldn’t provide you with any medical advice since you’re not my patient and I’m not familiar with your entire medical history. But definitely a question worth discussing with your doc just the same. Hope this information was helpful for you.

      Kind regards,
      Bill

  53. Hi Bill
    Thank you again for your 2 previous replies to my questions.
    I did try and email Dr Broadfoot, sp? but at this stage I have had no reply. Ian still looking for an exercise physiologist that has telemetry equipment as close to Grafton as possible. Possibly somewhere in the Gold Coast ?
    Any suggestions?
    I am to do a nuclear stress test on March 2nd, so hopefully this will give me more direction.
    One last question. Does your clinic, assuming you have one, work on exercise physiology with telemetry equipment and do you or some else see patients?
    Regards
    Greg Eather

    • Hi Greg,
      Thanks for getting back to me. Dr Broadbent has just recently taken up a position at University of Sunshine Coast so is no longer at SCU (which would explain why she’s been hard to reach!). Nevertheless, the telemetry equipment is still available at SCU and you can try to set something up through a colleague of mine Sonja Coetzee (http://scu.edu.au/staffdirectory/person_detail.php?person=19344). Here email and phone number are listed there.

      I’m not too sure about who on the Gold Coast is doing training and testing with telemetry, but you can get in touch with Jack at Making Strides in Burleigh Heads and he might know who is doing that sort of thing there (info {at} makingstrides.com.au 07 5520 0036).

      I have telemetry equipment here in Sydney but am working on private consulting contracts at the moment so am not currently seeing new patients. However, if that changes and you’re in Sydney, I’d be happy to see you here at that time. But best bet for now would be to contact Sonja and see if they can get you into the SCU clinic.

      Cheers,
      Bill

  54. Thank you so much Dr. Bill for this article. It was very informative.

    I was searching for some guidelines to help my fiancee who had a major attack in Oct2016, & 1drug eluting stent implanted. The cause, as mentioned in the report is the rise of homocysteine level.
    Thank you, once again 🙂

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