Back in February 2014 I suffered the first of I don’t know how many acute cardiac episodes. I say “I don’t know” because these things really aren’t as straightforward as it may seem. I was struck by mild chest pains and a thumping head. I didn’t immediately think heart attack, but rather that I needed food, so I made breakfast before heading off to a scheduled appointment with the dreaded Department of Work and Pensions.
At the time I was under a lot of stress – my mortgage was under severe threat, my business was making no money, with decisions made that I could neither afford nor agree with, and my energy was being leeched by the most toxic ‘friendship’ I had ever experienced. My anxiety was becoming palpable, and my temper was shortening by the day. Something had to give, and I just hadn’t expected it to be my heart. Turning up for the interview, I was quickly overcome by cold sweats and aching forearms. This was not hunger, I realized. Called for my appointment, I was duly treated like mud, and with the pain throbbing in my head, I calmly stood up, announced I was having a heart attack, and walked to my car. Don’t drive to hospital like I did. Call an ambulance. Driving may be quicker, but it certainly isn’t safer. Plus I’d have ended up in a different hospital. Parking up, I stepped into A&E, announced chest pains, and surrendered myself to the mercies of the NHS, who were perplexed.
Sinus rhythm and blood pressure? Normal.
Blood tests were taken and debate was had. It may be a heart attack, but probably not. Then there was the ECG. And then they found the markers. I had had a coronary incident – one of 91 different markers that say a myocardial infarction had taken place, except the entire episode lasted hours. From the initial pain at 8.30am through the the experience overwhelming me at 3am, when I finally drifted off to sleep, I was in pain.
What happened, I later learned, was that a large chunk of arterial plaque had broken off and passed through my left coronary artery and out into my bloodstream, where it scraped and stabbed and forced its way around my body until it finally broke up into particles too small to do me harm. A very bad angina attack, by all accounts. The next day they carried out an angiogram, which complicated matters. They expected to need to fit a stent in the damaged artery, widening it enough that the blood would flow again and I would be sent home. Instead jaws dropped. My arteries were the biggest they had ever seen. They were, the lead consultant said, as big as my head. Hmm. This was where things got mixed up. First I got blase. I was led to believe my arteries were not only too big for a stent to fit, but also too big for any blockage to do me any real harm.
They sent me home.
The head nurse argued it was too soon, but was overruled by the doctor who, in a Holbyesque twist, turned out to be her fella. Cue the theme music. Of course, the nurse was right and the doctor was wrong. Three days later my new meds caused a crash. When the chest pains came, my already low blood pressure dropped to the floor when I did as I was told (i.e. used the GTN spray). In the ambulance they gave me epinephrine and I was like a floppy rag-doll, spaced out and feeling it all slip away as I was raced back into hospital. In the days that followed I learned incident #1 was a heart attack, incident #2 (which, despite being shorter, was much, much worse) was entirely medicine-related, and that many of the people around me were not good for my health.
To this day I don’t know what happened behind my back, but the business partner wanted to break up the business, the toxic ‘friend’ plotted behind my back, and I came out of hospital with fewer friends than I went in with. Of course, I didn’t realize all that at the time – hindsight is wonderful – and as I started to recover I found myself plunged into the darkest days I had ever known.
I was broke, I was breathless, I was unfocused, I was depressed. So low that I was struggling to keep my head above water. Sure, I could put on a brave face, but as if sensing my weakness there were those who circled like sharks, spreading lies and rumours that cost me friendships, hinting that I was somehow abusive. This shocked me. Yes, I was an assertive extrovert, and yes, as my sick heart struggled there was as much shortening of temper as there was shortness of breath, but I was still me. Still desperate to always do the right thing. Still determined to be Mr Nice Guy, and to put the happiness others before my own. It was a desolate place where self worth had no home.
Following cardio rehab my meds were slowly reduced, and six months ago I came off the blood thinners.
Somewhere between then and now the clotting started. Which brings me up to date.
On July 15th, 2015 I was back in hospital. It involved the same chest pains as before. 6.20pm they came on, and I wasn’t asleep and out of pain until twelve hours later. When I woke at 8am they hadn’t seen the notes from my earlier event and they didn’t seem convinced I had been having a heart attack. By 8.30 there was no doubt, and they wheeled me in for an angioplasty while I battled worse pain and discomfort than the preceding day. Again my arteries were too big.
Its called Coronary Artery Ectasia, and basically it means my arteries are stretched. Instead of the 3-4mm diameter of a normal artery, mine are 10mm. Too big to put in a stent. Because of my large right coronary artery the blood-flow into my heart and out of my left is turbulent and slow. This means that clots form near the heart itself, and despite their size two of my left arteries were clogging up with blood clots.
One was pretty much clogged already – probably build-up from the time I stopped taking a blood-thinner. The other was silting up but the blood still flowed. They acted quickly, using balloons (but no stents) to open up the one artery, then withdrawing for a few days to pump me full of blood-thinners before trying again.
That first angioplasty lasted three hours, and I remember every second. 48 hours on and they were in again. Sadly the clogged artery was still thick with coagulated blood, and while they tried to use a stent to force the far end open, they had to withdraw, wait, and see. Now I feel like an epileptic, never certain what the next day might bring. My right coronary artery is still so big that sudden cardiac death might not be likely. My left, while also big, are so prone to clotting that I am instead at high risk of thromboses or embolisms – long, painful attacks that can cause strokes or death – and I don’t have a definite solution in place to prevent this.
CRA is rare, occurring in maybe 4% of coronary patients. 70% of the time it is a by-product of artherosclerosis. 20% of the time it is caused by artery-stretching illnesses like Marfan or Kawasaki Disease. I’m one of the 0.4% the cause of whose CRA is uncertain. It may be caused by Hyperlipidaemia (a genetic cholesterol disease), but when the percentages are so low nothing is certain. Blood-thinners are assumed to be the best treatment, but there just hasn’t been any supporting evidence to prove it one way or another.
Medication for life. That’s fine. Lifestyle change? Well, I went through that, and I can keep it up, but it makes little difference.
This is about blood flow, pure and simple.My greatest risks are ‘exercise-induced angina’ or clot-induced myocardial infarction. In the mean time, the depression seems to have switched off like a button. I say seems to because its less than a week later. I’m still crabby, but I feel like I did a few years ago, and I feel better for it.