Tuesday, May 12, 2009

Heart attacks and low cholesterol

Can you have bragging rights cholesterol and still suffer a heart attack? You bet, read on:

My patient sat relaxed and smiling in the exam room. He was here, per my schedule, for 'follow-up."

"So, what's going on?" I asked.

"Well, haven't you heard?" he asked. "I just had a heart attack a week ago Sunday."

There he sat, tan, comfortable, the only visible sign of less than perfect health in his 61 year old self was a little bit more belly than ideal bulging out at his midriff.

"You're kidding, right?"

"Nope," he replied, "to make a long story short, I had a heart attack while reading the morning paper and drinking my coffee. I started having severe chest pain, told my wife that this was the real deal, and within 78 minutes I was on the table getting a stent placed in my heart"

Gad, this guy has perfect blood pressure (110/72) on a low dose of heart-healthy lisinopril, 'walks some' for exercise which is not enough but more than many people, and has an LDL cholesterol of 80 on no meds. His dad had diabetes and died of coronary artery disease at 73.

The cardiologist found a complete blockage of his left anterior descending artery--the so-called 'widow maker-- on catheterization, which means no blood whatsoever was getting to the front wall of his left ventricle prior to stent placement. An echocardiogram after the procedure showed that only a small part of the apex of his heart was damaged.

When I was in med school, this fellow would've gone straight to bypass surgery followed by a prolonged post-op stay in the CCU. Yet here he was, scarcely a week later, already starting a cardiac rehab exercise program.

Two lessons here: prompt access to modern medicine is grand, and none of us can rest assured in our low cholesterol numbers.


Ruth said...

One of our friends had a similar experience. He was so healthy, the surgeon told him he had "cave man" fitness, strength and labs. But he had a blockage and had an angioplasty. Five years later he is still fit and well, but gets regular checkups.

Anonymous said...

Wow. I had a stent fitted in 2007 aged 43, having always had perfect BP and colest's..I did however have a mega hireditary history...father was the same age. Its unclear if I ever did have a heart attack as I had been treated for a chest infection 8 weeks earlier, and it seems the symptoms were possibly those of a heart attack which my GP thought impossible given my age. My blockage was 95%..boy was I lucky that day. It wont surprise you to know I live in the west of Scotland!!

#1 Dinosaur said...

This study showed that even with "low" cholesterol levels, people on statins had better outcomes after stroke than those who weren't. There's probably something more going on than lipid reduction; likely anti-inflammatory properties.

Anonymous said...

So how can you know if there's something going on with your heart if the labs are so great?