Please everyone, take chest pain seriously
Discussion
Posting here in case it motivates anyone to get something looked at because they have been putting it off; or just not taking it that seriously.
The TLDR is: I’m 43 and reasonably active but had developed angina in June. I’d persisted in cycling to work, doing as much as I could whilst waiting for tests/etc. Last Weds they told me it was 95-99% narrowing in my coronary artery, by Monday I’d had a stent. Afterwards they told me “we call that kind of blockage ‘a Widowmaker’…”. Take chest pain seriously everyone!!!
The longer version, I’m afraid I do rattle on a bit…
I’m reasonably active/fit. I cycle to work everyday, 20mins each way. Typically I’m on Zwift or out on the road most days, a “long” ride at the weekend would be something like 3hrs/50 miles. I run rarely but can turn out 5k in 30mins no problem and have a good cardio base so a few weeks training sees me doing 10k in under an hour no problem. If I want to go hiking then 3/4 hours is no problem. Last September whilst on holiday I walked the final 10k up and down Mont Ventoux (peaks at a smidge under 2000m).
Diet is reasonably good (although clearly portion control a bit lacking as I am 5’11” but hover around 90-92kg in recent years), I don’t smoke and drink fairly moderately. I was diagnosed with asthma in 2017 but it’s been well controlled for several years and in recent years I’ve even done some time trialling on my bike, so it’s hardly a problem nowadays.
In June I was away at a conference and so without bike took my running shoes, having not run since the previous September. I plodded off to do 5k and within a couple of minutes had a nasty ache in the centre of my chest. I pushed on, pain holding steady, and ran the 5k in something like 29:50. A couple of days later I tried again, 8k this time, which I did, but it was uncomfortable again.
The following Monday I cycled to work. Halfway in I pulled over because it hurt rather a lot, again, centre of my chest. Asthma I assumed, prior to the conference I’d had a week of steroid pills after a sinus infection had left me wheezing.
This went on for a few weeks, pushing myself was painful but I could carry on after I’d stopped for a minute or two for it to subside. But it was getting gradually worse. Finally, after cycling into town to pickup some holiday Euros, I decided I’d better see the Dr. This was mid-July.
An ECG, blood test and asthma review later (spread across a couple of weeks) and the Dr rang. “We think you have angina, straight on some medicine for that, plus referral to the Rapid Access Chest Clinic at the hospital”.
A couple of days later I walked my son across a big car park to his summer sports camp and the inevitable chest pain didn’t abate even by lunch time. 111 recommended a trip to A&E, within a couple of hours I’d been told I was definitely not having a heart attack.
I began to worry a bit… However they had given me a GTN spray and I found a) it helped with chest pain when it happened and b) if I took it before riding my bike I didn’t even get symptoms really… One day I used it, got on my turbo trainer and happily got my heart up to 160bpm no problem (pretty high for me, at the high 170s I’m into the ‘seeing stars’ zone).
My appointment letter came through about 10 days later; I was seen in mid-August. “You’ll be unlucky to have heart disease at your age” said the kindly nurse “but we’ll do an ultrasound (echocardiogram) and a CT scan. If we find something, maybe it’ll just be treated with medicine, who knows…”
The holiday cash was then put to good use in a Eurocamp in the Ardennes, I went up the steps and down the water slide with the kids. One day I hiked around the lake; 12km in 2 and a bit hrs.
Back home and in mid-September the ultrasound showed all was OK, then came the CT. A couple of days later I got a call: “it looks like there are blockages, it looks like heart disease is quite progressed, maybe 70% narrowing. The CT is not always accurate though, so we will do an angiogram to see properly”. This couldn’t be quite right could it? Anyway, despite concern beginning to grow, I was still confident that it wasn’t *that* bad, I mean this had been going on since the first week of June. A couple of weeks later and I still hadn’t received a letter, so I rang the department. “We’ve got space on the 23rd October, we’ll see you in the morning”. The following Monday “sorry, we’ll have to postpone; when do you want to move it back to?”. I was annoyed but, again, in my mind if they could afford to push it back then it couldn’t be critical. Still, “ASAP please” I said!
By this point I had throttled back on the cycling, even walking swiftly down to my village playing fields was giving me a mild ache. But I still felt like a fraud, sitting at my desk working/wandering about the office/gardening/going out for a spirited drive in my MX5 all felt absolutely fine.
Last Wednesday I went in for the angiogram. A bit nerve-wracking when they say there’s a risk, albeit small, of the procedure triggering a stroke or heart attack. In the event the most painful bit was the injection of sedative to calm me down a bit (Fentanyl I believe). The Dr was extremely calm, talking me
through progress. And what felt like 20 minutes after I’d first laid down in the “Cath Lab” it was done. Then the Dr leaned over: “we’re going to admit you to hospital, you’ve got a pretty bad blockage. We could send you home but this way you basically jump the queue and get seen ASAP”.
I took this news astonishingly well (presumably the Fentanyl) and then spent several days waiting to hear where I would go. And worrying as to whether a stent would sort it; or if I’d need a heart bypass - which means being properly opened up. Not least when I heard that 8-10 weeks waiting in hospital for the bypass op was fairly normal….
I quite enjoyed the hospital food, had a jovial friend across the walkway (late 50s / 3 stents done already and hoping he would also swerve the open-heart bypass work), and got some reading done (polished off Len Deighton’s “SS-GB” and started on Howard Mark’s biog “Mr Nice”)… The Drs, nurses, healthcare assistants etc were all wonderful: kind, patient, jolly. Absolute angels the lot of them. The only problem I had was with sleep, wired up to a heart monitor for the first few days, an alarm triggered every time I dropped under 50bpm. Which was every time I fell asleep!
Thankfully a slot for surgery was available on Monday this week and by lunchtime I’d had another angiogram, then a balloon pushed in to open the artery (inflated to 12atm) and then a 30mmx3.5mm stent popped into place. Popped probably being an appropriate word, apparently the 18atm pressure they use to reinflate and really shove the stent home is c. 265psi!!! Bypass avoided, excellent! I watched a lot of it happening, on the HUGE TV screen to my left.
By Tuesday morning I was discharged. I’d been moved out into a corridor for my final night to free space for someone who needed to be monitored. I couldn’t have cared less about my new spot by the reception desk, it meant I was out of the woods… The consultant who signed me off talked me through the imagery (all attached to my records, even the video of them doing the actual stent fitting) and informed me that a full blockage in the place i’d had the narrowing was called “a Widowmaker” due to the expected outcome if it were to be fully blocked…
I’ve been told I can return to as active a life as I wish, this leaves me with no other apparent heart problems and no reason not to push my body as far as I wish to.
I can only be hugely grateful for this outcome, which feels like an enormous (and entirely deadly) bullet dodged.
I can also only feel more than a bit sheepish that a) I didn’t escalate things sooner and b) I tried to push on with normal activity in the face of the last few months.
If you’ve read this far, this has been cathartic to write out. And: Ladies, and gentlemen: don’t be like me; take chest pain VERY seriously.
The TLDR is: I’m 43 and reasonably active but had developed angina in June. I’d persisted in cycling to work, doing as much as I could whilst waiting for tests/etc. Last Weds they told me it was 95-99% narrowing in my coronary artery, by Monday I’d had a stent. Afterwards they told me “we call that kind of blockage ‘a Widowmaker’…”. Take chest pain seriously everyone!!!
The longer version, I’m afraid I do rattle on a bit…
I’m reasonably active/fit. I cycle to work everyday, 20mins each way. Typically I’m on Zwift or out on the road most days, a “long” ride at the weekend would be something like 3hrs/50 miles. I run rarely but can turn out 5k in 30mins no problem and have a good cardio base so a few weeks training sees me doing 10k in under an hour no problem. If I want to go hiking then 3/4 hours is no problem. Last September whilst on holiday I walked the final 10k up and down Mont Ventoux (peaks at a smidge under 2000m).
Diet is reasonably good (although clearly portion control a bit lacking as I am 5’11” but hover around 90-92kg in recent years), I don’t smoke and drink fairly moderately. I was diagnosed with asthma in 2017 but it’s been well controlled for several years and in recent years I’ve even done some time trialling on my bike, so it’s hardly a problem nowadays.
In June I was away at a conference and so without bike took my running shoes, having not run since the previous September. I plodded off to do 5k and within a couple of minutes had a nasty ache in the centre of my chest. I pushed on, pain holding steady, and ran the 5k in something like 29:50. A couple of days later I tried again, 8k this time, which I did, but it was uncomfortable again.
The following Monday I cycled to work. Halfway in I pulled over because it hurt rather a lot, again, centre of my chest. Asthma I assumed, prior to the conference I’d had a week of steroid pills after a sinus infection had left me wheezing.
This went on for a few weeks, pushing myself was painful but I could carry on after I’d stopped for a minute or two for it to subside. But it was getting gradually worse. Finally, after cycling into town to pickup some holiday Euros, I decided I’d better see the Dr. This was mid-July.
An ECG, blood test and asthma review later (spread across a couple of weeks) and the Dr rang. “We think you have angina, straight on some medicine for that, plus referral to the Rapid Access Chest Clinic at the hospital”.
A couple of days later I walked my son across a big car park to his summer sports camp and the inevitable chest pain didn’t abate even by lunch time. 111 recommended a trip to A&E, within a couple of hours I’d been told I was definitely not having a heart attack.
I began to worry a bit… However they had given me a GTN spray and I found a) it helped with chest pain when it happened and b) if I took it before riding my bike I didn’t even get symptoms really… One day I used it, got on my turbo trainer and happily got my heart up to 160bpm no problem (pretty high for me, at the high 170s I’m into the ‘seeing stars’ zone).
My appointment letter came through about 10 days later; I was seen in mid-August. “You’ll be unlucky to have heart disease at your age” said the kindly nurse “but we’ll do an ultrasound (echocardiogram) and a CT scan. If we find something, maybe it’ll just be treated with medicine, who knows…”
The holiday cash was then put to good use in a Eurocamp in the Ardennes, I went up the steps and down the water slide with the kids. One day I hiked around the lake; 12km in 2 and a bit hrs.
Back home and in mid-September the ultrasound showed all was OK, then came the CT. A couple of days later I got a call: “it looks like there are blockages, it looks like heart disease is quite progressed, maybe 70% narrowing. The CT is not always accurate though, so we will do an angiogram to see properly”. This couldn’t be quite right could it? Anyway, despite concern beginning to grow, I was still confident that it wasn’t *that* bad, I mean this had been going on since the first week of June. A couple of weeks later and I still hadn’t received a letter, so I rang the department. “We’ve got space on the 23rd October, we’ll see you in the morning”. The following Monday “sorry, we’ll have to postpone; when do you want to move it back to?”. I was annoyed but, again, in my mind if they could afford to push it back then it couldn’t be critical. Still, “ASAP please” I said!
By this point I had throttled back on the cycling, even walking swiftly down to my village playing fields was giving me a mild ache. But I still felt like a fraud, sitting at my desk working/wandering about the office/gardening/going out for a spirited drive in my MX5 all felt absolutely fine.
Last Wednesday I went in for the angiogram. A bit nerve-wracking when they say there’s a risk, albeit small, of the procedure triggering a stroke or heart attack. In the event the most painful bit was the injection of sedative to calm me down a bit (Fentanyl I believe). The Dr was extremely calm, talking me
through progress. And what felt like 20 minutes after I’d first laid down in the “Cath Lab” it was done. Then the Dr leaned over: “we’re going to admit you to hospital, you’ve got a pretty bad blockage. We could send you home but this way you basically jump the queue and get seen ASAP”.
I took this news astonishingly well (presumably the Fentanyl) and then spent several days waiting to hear where I would go. And worrying as to whether a stent would sort it; or if I’d need a heart bypass - which means being properly opened up. Not least when I heard that 8-10 weeks waiting in hospital for the bypass op was fairly normal….
I quite enjoyed the hospital food, had a jovial friend across the walkway (late 50s / 3 stents done already and hoping he would also swerve the open-heart bypass work), and got some reading done (polished off Len Deighton’s “SS-GB” and started on Howard Mark’s biog “Mr Nice”)… The Drs, nurses, healthcare assistants etc were all wonderful: kind, patient, jolly. Absolute angels the lot of them. The only problem I had was with sleep, wired up to a heart monitor for the first few days, an alarm triggered every time I dropped under 50bpm. Which was every time I fell asleep!
Thankfully a slot for surgery was available on Monday this week and by lunchtime I’d had another angiogram, then a balloon pushed in to open the artery (inflated to 12atm) and then a 30mmx3.5mm stent popped into place. Popped probably being an appropriate word, apparently the 18atm pressure they use to reinflate and really shove the stent home is c. 265psi!!! Bypass avoided, excellent! I watched a lot of it happening, on the HUGE TV screen to my left.
By Tuesday morning I was discharged. I’d been moved out into a corridor for my final night to free space for someone who needed to be monitored. I couldn’t have cared less about my new spot by the reception desk, it meant I was out of the woods… The consultant who signed me off talked me through the imagery (all attached to my records, even the video of them doing the actual stent fitting) and informed me that a full blockage in the place i’d had the narrowing was called “a Widowmaker” due to the expected outcome if it were to be fully blocked…
I’ve been told I can return to as active a life as I wish, this leaves me with no other apparent heart problems and no reason not to push my body as far as I wish to.
I can only be hugely grateful for this outcome, which feels like an enormous (and entirely deadly) bullet dodged.
I can also only feel more than a bit sheepish that a) I didn’t escalate things sooner and b) I tried to push on with normal activity in the face of the last few months.
If you’ve read this far, this has been cathartic to write out. And: Ladies, and gentlemen: don’t be like me; take chest pain VERY seriously.
Very similar story for me.
I'm curious why the doctor was more confident you had angina after the blood tests. Did the resting ECG show a blockage? It sounds like you were comfortable at rest and no heart damage? I was told due to my age it probably wasn't angina base don the ECG and my age, and it was only because I deteriorated a bit and I went back in, that it got caught.
Also curious why they didn't put the stent in right away in the first Cath lab. I thought angiograms 'came with the option' in most cases.
Cardiac anxiety is a very real possibility at this age, so look after your head as well as your body.
I'm curious why the doctor was more confident you had angina after the blood tests. Did the resting ECG show a blockage? It sounds like you were comfortable at rest and no heart damage? I was told due to my age it probably wasn't angina base don the ECG and my age, and it was only because I deteriorated a bit and I went back in, that it got caught.
Also curious why they didn't put the stent in right away in the first Cath lab. I thought angiograms 'came with the option' in most cases.
Cardiac anxiety is a very real possibility at this age, so look after your head as well as your body.
No idea on the first bit, and I thought it’d all blow over at that point to be honest, so didn’t ask much/take it that seriously.
Stent wasn’t an option at Colchester (my nearest hospital) - they only do angio for diagnosis, hence I had to wait for Basildon or Ipswich (and ended up with Ipswich and a trip up and down the A12 in an ambulance on Monday). Apparently the Colchester Cath Lab will close at some point anyway.
Stent wasn’t an option at Colchester (my nearest hospital) - they only do angio for diagnosis, hence I had to wait for Basildon or Ipswich (and ended up with Ipswich and a trip up and down the A12 in an ambulance on Monday). Apparently the Colchester Cath Lab will close at some point anyway.
Good post.
Two of my friends (51 and 52 years old) was recently fitted with double stent. One had to go private to get the required scan as he had chest pain warning, whereas the other had no warning and suffered a heart attack (he had the widow maker type but he got lucky as the ambulance got him to hospital within the golden hour). According to one of the consultant, heart attacks tend to affect guys around the 50 years mark so if you didn't have a heart attack by then, it was a good sign!
Two of my friends (51 and 52 years old) was recently fitted with double stent. One had to go private to get the required scan as he had chest pain warning, whereas the other had no warning and suffered a heart attack (he had the widow maker type but he got lucky as the ambulance got him to hospital within the golden hour). According to one of the consultant, heart attacks tend to affect guys around the 50 years mark so if you didn't have a heart attack by then, it was a good sign!
Fair, my grandad (mums side) had angina and my dad (non smoker, light drinker, not athletic as such but often out walking/gardening etc) had a heart attack at in his later 50s so its certainly on my mind as I near the end of my 30s with a desk job, not a lot of time to exercise, and a young family.
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