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Had a Heart Attack today at age ~30. Be safe guys.

ChemBB

ChemBB

Member
Well, it finally happened to me.

Near end of my workout today I start feeling chest tightness & pain, hard to breathe.
Go to emergency room, get told I'm having a heart attack (STEMi).

"A 99% subtotal blockage was found in the second obtuse marginal (OM2) branch of left circumflex (LCx) artery."

Likely from vulnerable plaque rupturing during the workout and the thrombosis that follows narrowing the artery.
Single-vessel disease, no other obstructive disease discovered during angiogram.

Code: 
- Impression: Inferior ST elevation microinfarction with culprit lesion of second obtuse marginal 99 percent subtotal occlusion
- Successful imaging guided primary PCI of second obtuse marginal with 3 x 20 mm Synergy stent
- Normal LVEDP
- No aortic stenosis
- Recommendation
  - Start aspirin 81 mg daily for lifelong
  - Start Brilinta 90 mg twice a day for at least one year
  - Start high intensity statin therapy for goal of less than 55
  - Obtain echocardiogram
  - Cardiac rehabilitation referral

Summary of Echocardiogram w/ contrast performed afterwards:
Code: 
- Mildly dilated left ventricle
- Moderate concentric LV hypertrophy
- Mildly reduced LV systolic function
- EF 45–50% (down from 55% post-op, plausible post-MI myocardial "stunning", expect recovery)
- Hypokinesis of inferoposterior wall
- Mild to moderately enlarged left atrium
- Mild to moderate mitral regurgitation
- Mild tricuspid regurgitation
- Mild pulmonic regurgitation

Stay safe, folks.
 
taco33150 said:
Did you monitor before this?
Click to expand...

Yep, religiously.

Apparently there is no good, non-invasive way to image plaque/lesions in cardiac arteries.

Plaque can occlude up to 70% of an artery without perceivable effects, and only at +90% occlusion do acute symptoms manifest.

What often happens is that "vulnerable plaque", which already occludes a significant portion (60-70%) ruptures. The immune response causes clotting at the rupture sight (thrombosis), which further narrows the artery into heart-attack territory.

Pretty terrifying, especially considering the angiogram saying that the rest of my arteries are clear...

My labwork from the hospital this AM shows LDL and HDL not even that bad...

1758468564271.webp
 
ChemBB said:
Well, it finally happened to me.

Near end of my workout today I start feeling chest tightness & pain, hard to breathe.
Go to emergency room, get told I'm having a heart attack (STEMi).

"A 99% subtotal blockage was found in the second obtuse marginal (OM2) branch of left circumflex (LCx) artery."

Likely from vulnerable plaque rupturing during the workout and the thrombosis that follows narrowing the artery.
Single-vessel disease, no other obstructive disease discovered during angiogram.

Code: 
- Impression: Inferior ST elevation microinfarction with culprit lesion of second obtuse marginal 99 percent subtotal occlusion
- Successful imaging guided primary PCI of second obtuse marginal with 3 x 20 mm Synergy stent
- Normal LVEDP
- No aortic stenosis
- Recommendation
  - Start aspirin 81 mg daily for lifelong
  - Start Brilinta 90 mg twice a day for at least one year
  - Start high intensity statin therapy for goal of less than 55
  - Obtain echocardiogram
  - Cardiac rehabilitation referral

Summary of Echocardiogram w/ contrast performed afterwards:
Code: 
- Mildly dilated left ventricle
- Moderate concentric LV hypertrophy
- Mildly reduced LV systolic function
- EF 45–50% (down from 55% post-op, plausible post-MI myocardial "stunning", expect recovery)
- Hypokinesis of inferoposterior wall
- Mild to moderately enlarged left atrium
- Mild to moderate mitral regurgitation
- Mild tricuspid regurgitation
- Mild pulmonic regurgitation

Stay safe, folks.
Click to expand...
have you ever had a panic attack before? Because one of my biggest fears is ignoring a panic attack which potentially be a heart attack and ive had a few that really scared me.
 
ChemBB said:
Yep, religiously.

Apparently there is no good, non-invasive way to image plaque/lesions in cardiac arteries.

Plaque can occlude up to 70% of an artery without perceivable effects, and only at +90% occlusion do acute symptoms manifest.

What often happens is that "vulnerable plaque", which already occludes a significant portion (60-70%) ruptures. The immune response causes clotting at the rupture sight (thrombosis), which further narrows the artery into heart-attack territory.

Pretty terrifying, especially considering the angiogram saying that the rest of my arteries are clear...

My labwork from the hospital this AM shows LDL and HDL not even that bad...

View attachment 349524
Click to expand...
Shit dude ..
 
I would recommend speaking with your cardiologist about using pituvastatin, I know ALOT of them want you max dosing Rosuvastatin and I think you'll have a better time. Advocate.
 
Corsair said:
have you ever had a panic attack before? Because one of my biggest fears is ignoring a panic attack which potentially be a heart attack and ive had a few that really scared me.
Click to expand...
Yes, I'm anxiety-prone and have PTSD, so I've had tons.

Specifically having been a polysubstance drug-addict in the past and using AAS, you always have the fear that this might be a heart attack and you're going to die.

Fortunately, my heart attack felt nothing like a panic attack.
It felt like someone reached into my chest and was squeezing my heart as hard as they could, I couldn't take full breaths and my chest was incredibly tight.

With panic attacks, I've never had that intense heart pain.

I actually walked 10 minutes home from the gym while on the phone with my partner because I wasn't sure if it was serious, lol.

"If I stop talking to you, come look for my body"
keenpen said:
Would a Coronary CT Scan detect this? It's on my list and really affordable even if you have to pay out of pocket.

Glad you're OK! What's the recovery plan?
Click to expand...

I'm not medically knowledgeable enough to give good advice there unfortunately, probably someone else has an idea.

Recovery plan is:
- 2 weeks cardio-only
- Atorvastatin, Aspirin + Ticagrelor (DAPT), Metoprolol, Lorsartan
- Following Echocardio in a few weeks

I don't agree with the Atorvastatin, Metoprolol, or Lorsartan
I'd much rather Pitavastatin, Nebivolol, Telmisartan
Or one of those fancy new PCKS9 inhibitors
Gotta figure out if I can convince them to swap me...
 
Thank god you made it bro.

And *now* post MI, they want you below LDL 55. (typically statin or statin+Ezetimibe aka "double" therapy) Only after a second heart attack is it considered "cost effective* to aim for below 40 (by adding Repatha, aka "triple" therapy) according to the insurance friendly guidelines.

If it were me, I'd hit the cardiologist up for triple therapy now, to minimize risk to the greatest extent, and you're young enough a lot of plaque is soft enough to regress. Most cardiologists have no issue exceeding the guidelines to get LDL even lower. It'll also avoid the need for max intensity statins that have highest side effect risk, and allow slightly less potent, but much more muscle friendly Pitavastatin to be used, with Eze and Repatha more than picking up the slack.

FYI, insurance requirements for Repatha have loosened WAY up this year. It shouldn't be difficult at all to get approved.

If your guy isn't cooperative, I'd do whatever it took to get a "second opinion" regarding post MI treatment from another cardiologist.
 
ChemBB said:
Yes, I'm anxiety-prone and have PTSD, so I've had tons.

Specifically having been a polysubstance drug-addict in the past and using AAS, you always have the fear that this might be a heart attack and you're going to die.

Fortunately, my heart attack felt nothing like a panic attack.
It felt like someone reached into my chest and was squeezing my heart as hard as they could, I couldn't take full breaths and my chest was incredibly tight.

With panic attacks, I've never had that intense heart pain.

I actually walked 10 minutes home from the gym while on the phone with my partner because I wasn't sure if it was serious, lol.

"If I stop talking to you, come look for my body"


I'm not medically knowledgeable enough to give good advice there unfortunately, probably someone else has an idea.

Recovery plan is:
- 2 weeks cardio-only
- Atorvastatin, Aspirin + Ticagrelor (DAPT), Metoprolol, Lorsartan
- Following Echocardio in a few weeks

I don't agree with the Atorvastatin, Metoprolol, or Lorsartan
I'd much rather Pitavastatin, Nebivolol, Telmisartan
Or one of those fancy new PCKS9 inhibitors
Gotta figure out if I can convince them to swap me...
Click to expand...
Thank you for your openness/transparency. I was a former addict in my early-mid twenties. Both with stimulants (and I did a lot back then) and opiates, with some benzos occasionally for come downs or sleep. And I used to smoke cigarettes, I quit a few times for a while. Currently, haven't had a cigarette in 4 years, quit cold turkey. Never was a big smoker. But all these things combined with age (35) and the use of AAS at some point (currently just on trt) definitely makes me more paranoid of the potential of a heart attack.

Thank you for the feedback, ill note that down to watch out for in case I start freaking myself during a panic attack that I might be having a heart attack. Glad your okay and still alive and kicking.
 
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