My name is Kevin, and I’m a 49-year-old editor at Men’s Health. I’m 6-feet tall and 185 pounds, and I exercise regularly. I live healthy and look healthy.
But last month, I found out that I have heart disease.
A doctor unclogged an artery in my heart that might have left me dead or disabled before Christmas.
“I’d say I dodged a bullet,” I told a friend, “but that implies that I saw it coming.”
No, it was more like I was standing with one foot in the street when a city bus narrowly missed me.
I’m sharing my story because you could be at risk, too, and not yet know it. That’s because heart disease can sneak up on you, even when you’re doing most things right.
Seven weeks ago, I felt SOMETHING in my chest. It was not quite pain, not quite pressure. Mostly an awareness, usually on the extreme left side of my chest. Sometimes it would jump to the extreme right side.
Knowing now that I have heart disease, you probably think the symptom should have been obvious to me. But it wasn’t obvious at all.
I first noticed it after a weight workout. I thought I had a strained a chest muscle. It was more annoying than painful.
But a week later, the annoyance was still there, and I had to admit to myself that it wasn’t a muscle tweak. The discomfort was coming from within my chest.
The best way to describe how I felt: You know when the characters in a horror movie suddenly figure out that the maniac’s call is coming from inside the house? Like that.
It shouldn’t have been all that surprising. My family has a long history of heart disease. My dad had quintuple-bypass surgery in 1985, at the age of 44.
My dad’s father died at the age of 42, in 1944. An Irish immigrant driving a Duggan’s bakery truck, he flipped it over on the streets of New York. They pulled his dead body from the truck.
Nobody did autopsies on poor Irish truck drivers back then, so the cause of his death remains a mystery. But we’ve always suspected it was his heart, because that’s been the story on my dad’s side of the family all the way back to Ireland.
And still, I figured that if I did enough good things—stayed active, ate well, managed stress and my weight—that I could stay ahead of this shadow. But here it was.
I called my new GP, and asked him to move up a scheduled checkup by a week.
Things were going fine at my checkup. My blood pressure was a little high but that was understandable because I was nervous. My doctor and I talked about my chest discomfort and he thought it sounded muscular. They would give me an EKG just to be sure, and then I could go home.
Except that, after taking the EKG and disappearing for a second, the nurse came back and asked me to stick around. My doctor wanted to talk with me.
The shadow closed in.
Here’s a quick primer from EKG 101: In a healthy EKG, there are a series of waves, labeled as letters. P marks the contraction of the atria, and is a slight turn upward; QRS is a small-down, big-up, small-down movement that marks the contraction of the ventricle; and the T is a small upward movement that marks the re-set of the heart before it pumps again. The P, R, and T are all supposed to go up.
In mine, several of the leads showed the first two waves going up, then the third sagging downward. That’s an inverted T wave, and the T stands for Trouble. It can be a sign of blockage.
But maybe not. My doctor wasn’t sure what to do. We didn’t have a history together. In fact, this was our first time as doctor and patient. (We knew each other from his treating my 18-year-old son.)
EKGs are not exact science, he explained. In fact, I could have had this abnormality in my heart beat since I was born. “My gut tells me this isn’t something we should ignore,” he said. “Would you mind going to the ER?”
I didn’t, and I did. The doctors drew blood to check for specific inflammation markers and to run a blood panel, and they did another EKG.
The diagnosis: I wasn’t having a heart attack but I needed more tests, specifically a nuclear stress test. Before I left, the ER doc had one last request: “Don’t push it, okay?”
I woke up the morning of the stress test feeling better than I had in two weeks. No pain at all. A ghostly absence of sensation.
The stress test involved injecting a radioactive dye in my bloodstream, then imaging my heart before and after a period of activity on a treadmill.
It was pretty cool and strangely liberating. I’d been experiencing this long enough that my curiosity was now routinely trumping my fear. I was ready to run.
The ER doc had made a point of telling me not to go too hard until that test, especially after I told her I had pushed a 425-pound sled around the gym trying to trigger a reaction that would confirm this was angina. (It didn’t work.)
So the chance to exert myself on a treadmill—under doctor supervision—felt good. I was able to walk fast, then run, for about 9 minutes. I got my heart to 160 beats per minute. No pain.
Maybe this is going to be okay, I thought. I laid down for the after-exercise set of images and went home.
My brand-new cardiologist, Dr. Matthew Levy, called me on my cell that evening. I was shooting baskets in my driveway.
“It doesn’t look good,” he said. “You definitely have a blockage. I need you to come in two days from now to get cathed. We’ll take a look at it, and if the blockage is severe enough, we’ll perform an angioplasty.”
We talked for a few more minutes, then he said. “I don’t know you very well, but you don’t sound surprised.”
I was, and I wasn’t.
Two mornings later, I was on an operating room table in Paoli, Pennsylvania, the object of a cardiac catheterization. I was drugged but not knocked out; it was more dreamy than blotto. While I know that I was half-there, I have no useful memories from the operation or from the couple hours afterward.
I would later find out that my left anterior descending artery, which snakes down the front of my heart, was about 95% blocked. This particular artery is known in heart circles as “the widowmaker.”
A stent was put in place to open the blockage. I was out of the hospital within 24 hours of the procedure, with little to show for it other than a broken night’s sleep and a minuscule incision in my right wrist, where the catheter was inserted.
The site was a little swollen and bruised. That same afternoon, I sat outside on the deck of a local winery, sipping a half-glass of red wine, enjoying the sun, listening to a jazz band, and insisting to friends that I had indeed been a patient in a hospital that morning.
I have a new regimen of three pills—baby aspirin, the blood thinner Effient, and a generic version of the statin Lipitor—that I take daily. I’ve started running again and the biggest issue has been my balky left knee. In fact, I am about a minute-a-mile faster than I’ve been for the past two years.
I don’t know how long I suffered from a significant blockage, but clearly, it had impacted my physical performance. Yet I never noticed it, even though my cardiologist tells me I was days, or weeks—no more than a month or two—from a possibly devastating heart attack.
Now with a stent in place, and the artery clear, I feel like I’m turbo-charged. And pretty damn lucky.
The question, of course, is this: Shouldn’t I have seen this coming?
Medically, the answer is surprisingly equivocal.
How to treat folks like me remains controversial, according to Dr. Spencer Nadolsky, the medical editor of Examine.com, and a practicing physician in Olney, Maryland.
“It really depends,” he says, “because someone with a low risk—a slightly elevated cholesterol level but not a family history, they’re clean, their blood pressure and blood sugar is all fine—they can have slightly higher lipid levels without as much of a risk as someone with those other risk factors. You may have to treat 100 people like that to avoid one heart attack over five years.”
But for someone with higher risk, you may be treating 50 or less people to prevent one heart attack in five years, explains Dr. Nadolsky. “It is one of those things we argue all the time. It’s primary prevention versus secondary prevention.”
Of course, what I’m doing now is secondary prevention. “You’ve already had a coronary issue and now you’re trying to prevent the second event, a heart attack,” says Dr. Nadolsky. “What we find is that statins may be more helpful in secondary prevention than in primary prevention.”
So there’s a medical argument that makes me look less like an idiot. Yes, I had a family history, but my blood panels over the years were borderline.
My cholesterol was right around the 200 mark, with not a lot of the good stuff (HdL). And my triglycerides were high, but not off the charts. Over the years, my doctor would look at the panel, then look up at me, then decide it all bore watchful waiting.
Here’s my recent blood panel, plugged into a popular risk calculator. I filled it out twice: once as I would have before this episode, and the second time knowing I have heart disease.
If I don’t know I have cardiac artery disease, my 10-year risk of heart attack is 6%. But it jumps to more than 20% when I include my current condition. That’s why you need to go to the doctor: to know. (Note that I acknowledged a family history in both examples.)
But here’s where I screwed up: I stopped watching. That’s because my longtime GP—the guy who said we should keep an eye on both my numbers and me—moved away, and for 6 years or so, I didn’t follow up with anyone new.
It’s the most obvious advice one could receive: Find a new GP. But I didn’t. I can say I was busy, that I was occupied by family and career and anything that could keep me from going to the doctor. That I felt fine.
But the truth is, as long as I was feeling good, I didn’t want anyone spoiling my party. So I didn’t look while I stepped in and out of that city street.
I’m not alone. In 2012, more than one-quarter of all guys avoided a checkup with a doctor.
Late this summer, with my 50th birthday just months away, I decided to find a doctor. I made an appointment with a general practitioner who impressed me with his care of my son.
I set up the appointment before I ever felt a twinge in my chest. In my blacker moments, after my chest tingled and before I got to the doctor’s office, I thought, Nice job, Kevin. You invoked this bastard.
Except I know I didn’t. My decision to move up my checkup may have saved my life.
If any of this story resonates with you, start at the beginning. If you don’t have a GP, get one. If you haven’t seen yours in a while, see her or him.
If you have a family history of heart disease, get a baseline EKG by 40, younger if you have other risks factors (obesity, hypertension, generally poor health habits).
Don’t avoid finding out the truth about your health. Because not knowing the truth is far more dangerous.
As I wrote before, I feel pretty damn lucky. Not lucky to have heart disease, of course, but lucky to know I have heart disease—because knowledge gives me choices, and a chance.
“Although having heart disease at a young age indicates a serious predisposition, proper lifestyle and medical management can largely control that risk and is compatible with a normal life span,” says Dr. P.K. Shah, of Cedars-Sinai Hospital in Los Angeles and a member of the Men’s Health advisory board.
Dr. Nadolsky adds: “People with conditions like yours live into their hundreds.”
Only it doesn’t happen by accident. You can’t be stepping in and out of that city street, oblivious to the danger. Something will run you down.
This scare has reinforced for me that my life is a gift. And I’m sharing my story with the intention that it helps me—and you—live a longer, healthier, more aware life.