Heart Attack ~ and Recovery

I suffered a mild heart attack on 18 October 2014 ~

This is my story of how I have managed my recovery.

The only ‘warning’ of the imminence of the heart attack was a feeling of unease; a sort of awareness that I might be starting to feel dizzy – I wasn’t actually feeling dizzy, and there was no revolving sky, or floor coming up to meet me!  I remember squatting, intending to sit on the floor and put my head between my knees to regain my composure.  However, I passed out mid squat and don’t remember anything until regaining consciousness, and thinking that I had dropped off to sleep!  Then, the concern shown by the people around me, the fact that I was having to take deep breaths and was shivering, snapped an awareness in me that something was definitely not right.

The subsequent short hospital stay led to angioplasty and the ballooning of five occlusions.  The most severe, 100%, blockage also needed a stent.  Fortunately for me, 35 year’s worth of exercising had developed increased heart muscle and arterial volume.  These enhancements most likely provided for alternative routes around the obstructions, in time to bring me round, without intervention, before any appreciable damage to my heart or brain could be caused.  Having had no previous history of angina, or acute shortage of breath, and not having experienced angina-like pain leading up to the attack, I became concerned that I might be struck down again, without warning, at any time, any place.

It took a long while: from being allowed to leave my bed for bathroom visits, crossing the road from home to get a paper, building to my first walk of over one mile; the feeling of unease never seemed to be far away, as I worked through my NHS cardiac rehabilitation programme.  Because my confidence was shot, I was happy to adhere to the programme’s generic guidelines, tailored to cater for the worst case scenario, despite me being at the other end of the spectrum.  My goal was to  complete the course and gain a referral to the Heartbeat Cardiac Rehabilitation Exercise course, where I would be guided by a GP and cardiac physiologist, through a treadmill stress test, to determine a safe level for further exercising.

Although I made measured progress and the desired referral, the dreaded ‘white coat syndrome’ struck with extreme venom during my Heartbeat assessment!  My systolic reading burst through 240 – 60 higher than previous ‘white coat’ high readings!  Quite rightly, the test was aborted and a 24 hour blood pressure monitoring collar suggested.  As I had an appointment to visit my heart specialist the next day, it was suggested I mention  that I needed to have a collar fitted, which Heartbeat were prepared to fit and interpret the results from.  He declined the offer and, thus began the real frustration.  First, I had to wait until I was given an appointment to have the collar fitted, then months before the results (which were actually available the day after the test) were typed up and copies showing the satisfactory outcome delivered to myself and my specialist!  It was only then that I could apply for an opening to be retested on the treadmill.

Shortly before the first treadmill test in May 2015, my left knee had become swollen, abruptly blocking my ability to run, and severely hampering any attempt to work towards regaining former training levels.  Even now, more than 12 months later, it is not fully functional!  Fortunately, I was still able to ride my ElliptiGO (a ‘stand-up’ bicycle with ‘treadles’ turning the crank instead of pedals – in an elliptical motion rather similar to an elliptical trainer in a gym).

To see me in action click here: Riding My ElliptiGO

I could do this without pain and, during the frustrating period leading to the treadmill re-test, I was able to hold on to some of my previous fitness by building up endurance.  The ‘GO was connected to the turbo trainer (CycleOps SuperMagneto Pro) in my garage, thus having no hills or wind to worry about!  So, in a controlled manner, I could monitor heart rate and speed, as well as time, distance, cadence and, therefore, progress.

Static Training on the ElliptiGO
Last year (2015), alongside the Heartbeat cardiac rehabilitation exercising, the ElliptiGO ensured that, not only had I maintained a level of fitness, I had even improved over many measures!  I varied the training on the ‘GO to make it more interesting.  Continuous pedalling, without free-wheeling (coasting)  was maintained for all rides, using the maximum resistance setting on the CycleOps, whilst eighth gear, initially, was selected for the ‘GO.  Variety was catered for by switching between long, medium and short ride durations:  As with run training, the long ride was built up slowly, increasing in length by 15 minute increments until I reached 1.5 hours;  medium rides were similar to long rides but with a little more pace; short rides introduced a further variant, in that they could be either recovery or interval rides.

Intervals
The interval ride was made up of a gentle build up through a very slow first minute, through a further four minutes of easing to recovery pace, and then launching into the first repeat.  Here I would raise my pulse to 100 bpm as quickly as possible, before immediately dropping to the highest speed I could maintain and still allow my pulse to drop to 90 bpm.  From there, it was straight into the next repeat, then the next, until the 30 minute ride time was used up.  Interest and enthusiasm was kept up through experimentation, in order to discover what speed was optimal to sustain my form, as I increased the long-ride distance and, to get the maximal number of repeats out of my 30 minute ride.

Cadence
Apart from the interval sessions, all rides were completed at a very leisurely, low cadence.  That is, until I hit on the idea to try to improve my cadence!  This was another way to introduce even more variety into my rides.  My plan was to drop down into seventh gear, yet maintain the same average speed for each ride – less effort because of the gear ratio but more leg speed required.  It felt really strange at first, out of my comfort zone, like I was going so hard that I would not stay below my 100 bpm target HR limit, or last the full 1.5 hours – and the interval efforts were quite manic!  However, after I had been through three cycles of the various ride types, I had grown quite comfortable and moved on down to sixth gear and then, finally to fifth gear and still more or less maintained average pace and average HR.

  . . . more detail and stats here 

At my second treadmill test, ‘White coat syndrome’ struck again, but the high reading proved to be yet another anomaly.  My BP had actually dropped on reaching the first measuring point during the test.  The remainder of the test served to show my exercise tolerance as being sufficient for me to not need target heart rate guidance.  I was free to continue to use RPE (Rate of Perceived Exertion) to monitor either steady, slightly testing, or recovery segments, during my exercise sessions.  This didn’t mean that I launched myself into proper training again – far from it!  The cardiac rehabilitation training at Heartbeat didn’t change much as I used the same approach of a general 10 minute warm-up, followed by 10 minute sessions on individual apparatus, where I built up my effort through each 10 minute period, then had a couple of minutes slow walk round the gym before moving on.  I also alternated between whole body, upper body and treadmill based machines.  On the full body and treadmill exercises, my HR could peak at 130-140 bpm but, as this equated to my chosen ‘working hard’ RPE –  and for less than a minute, it was of no concern.  Because of my ongoing knee problem, I’d only been managing two runs a week during the year and then – fell, trail and cross-country races gradually unwound any recovery, bringing my efforts to yet another dead stop, so there was no danger of over-training on that score!

That brings me to this year, 2016.  Before I go any further, let me explain the Heart Rate training zones I have set up on each of my Garmins.  I use the following method, from Runners’ World, to work out the zones.

The Target Heart Rate Zones are scaled percentages of Working Heart Rates

Working Heart Rate is Maximum Heart Rate minus Resting Heart Rate

Maximum Heart Rate is:     ~ for men: 216 – 0.93 * age    ~ for women: 200 – 0.67 * age

Target HR  (RW Method)			Garmin Zones  (Input by Me)
Easy	60% Effort		Warm-up – (Z1)
	– 110 bpm   (Oct’s 2015/16)		– 100 to 110
Slow	60 to 65%		Easy – (Z2)
	– 110 to 115 (Oct’s 2015/16)		– 110 to 115
Steady	65 to 75%		Aerobic – (Z3)
	– 115 to 125 (Oct’s 2015/16)		– 115 to 125
Brisk	85%		Threshold – (Z4)
	– 136             (Oct’s 2015/16)		– 125 to 136
Fast	85 to 95%		Maximum – (Z5)
	– 136 to 146 (Oct’s 2015/16)		– 136 to 152

From the values entered in the zones above, it is easy to see how cautious I have been while training during my recovery.  In fact, probably more than 90% of training during the first year was done at a level even lower than the ‘Easy’ or ‘Warm-up’ zone!

The Second Year
2016: training with the ElliptiGO on the CycleOps in the garage continues, having resumed in October last year; building on that, I had covered over a thousand trainer miles this year by April, with a longest ride of 63 miles.  Good Friday saw me saw me back out on the road with an 80 mile ride.  Training at Heartbeat was still playing an essential part in my life, supplementing my ElliptiGO workouts.  Eighteen months after my heart attack, my confidence had been largely restored, although I still believed that I was taking too much medication; that medication having taken the place of exercise in maintaining my healthy lifestyle and, along with a damaged knee, having  prevented me from re-establishing my former exercise regime.

I had a setback while out walking with my wife Margaret, which caused anxiety, shaking my confidence one again.  Although running/cycling never lead to sudden unease in my breathing, stairs and hills when walking sometime do!  And so to the walk with Margaret; my breathing had shortened and as I slowed, Margaret noticed and asked if I was OK; I became anxious at Margaret’s concern and the unease escalated as we climbed the remainder of the walk back to the car!  As soon as the car, with Margaret driving, was turned towards home, I was back to normal!!  Never-the-less, the following day I visited the doctor then, following an examination, it was decided that I should attend for ECG, chest x-ray and blood tests.  The initial review of the results led to the withdrawal of my beta blocker, the chest x-ray showed up clear, although further blood tests confirmed a history of me being close to anemic, together with borderline production of white platelets.  This blood composition had remained stable, not showing any signs of deterioration (further diet and alcohol/caffeine adjustment may help). My  doctor wrote to my cardiologist and to a blood specialist to verify stopping the beta blocker and that no specialist blood tests were needed.  For my part, I agreed to continue to monitor my blood pressure for improvement whist I adjust my diet and step up my exercise level.  On my latest visit to see my doctor gave me the feed-back from her letters, in that the specialists had endorsed her recommendations.  The beta blocker has been removed from my repeat prescription but, as my blood pressure is still not down to an optimal level despite being on maximum dosage of three medications, she is trying me on a minimum dosage of a fourth together with a request for a 24 hour ECG monitor.  With the results of that to come, evaluation and adjustment of the new medication and ongoing blood testing, I am being well monitored!

It has been a long process, but my knee slowly improved and I was able to bend it fully once more.  From a tentative few minutes running on a treadmill, I have slowly been able to build to several five-minute sessions during each Heartbeat visit.  I have also gradually increased the incline on the treadmill to further strengthen my knees.  This prepared me for a low-level return to parkrun and then to take place in the monthly interclub road races, leading to a more severe test of my knees with the first Harrock Hill and Badger Trail races.  Finally, as I close this post, I am able to reflect that, even at a low level my running is improving measurably and progress is still being maintained.

And, finally . . .

View from the ElliptiGO

~ oOo ~