The Beat That My Heart Skips?

For reasons unknown, I've been dealing with periodic chest pain for the past six to seven years. Only once had it ever happend during exercise -- at the top of an 18% climb in a century ride in North Carolina -- and it normally occurs when I'm stressed. I had an EKG done when I lived in NC and the doctor told me I had a heart murmur (that, I knew) and that I might have an over-sized heart.

"Evander Holyfield, the boxer, has the same thing. Nothing to worry about," he said.

Flash forward two years. We were living in Bellevue, WA and I had stopped biking and running for one reason or another, but the chest pain was more regular. I had another EKG done and and this time the doctor actually addressed the reason I was there to begin with -- my chest hurt -- and said that it's probably just heartburn or acid reflux or, perhaps, just muscle spasms in my chest or back. Could be all attributed to stress. I felt good that hs said it could be due to food and/or stress, but then he too said the EKG suggested I might have an over-thickened heart muscle. But he just left it at that. No further study.

It's late 2007, my chest hurt less often and I've noticed that when I would get the familliar chest-in-a-vice feeling, it normally came about 20-30 minutes after eating. Or when I was a day or two out from a deadline and working round-the-clock. No worries, right?

Not until I woke up one morning following Thanksgiving and learned about Major Leaguer Joe Kennedy's sudden death from heart-disease. Then, just a few short days later, I read about professional mountain biker Mike Janelle's sudden heart attack. So I started reading more about the issue of thirty-something athletes and heart disease and what I was seeing was that whenever a susprisingly young athlete suddenly died -- whether in their bed or on a high school basketball court -- they often had an overly thick heart muscle.

This is when the worry began.

Flash forward to last month. The March issue of Men's Journal (great magazine, by the way) arrived and in it was a 3-page article about a regular-guy endurance athlete, my age, who was having some very irregular heart beats and decided to get it checked out. He had the EKG done and stress test, and opted for an angiogram. Fortunately, they found nothing wrong with him, but the article was like an omen to me. I don't want to say it scared me, primarily because I was already a little frightened, but it was like a neon sign had been erected over the phone, flashing the words "Call the Doctor: Schedule an Appointment". And seeing this article about heart disease and endurance athlets made the phone call all the more urgent.

I tore the article out for Kristin to read and when she was done she just gave me the raised-eyebrows look. The look that says so what are you going to do about this?

I went in for a physical on the 23rd -- my first physical in 5 years or so -- and the EKG, once again, showed some abnormally high voltage. This time, however, the doctor sensed my unease and referred me for a stress-ultra test, a combination of ultrasound and stress-EKG test I had read about in the Men's Journal article (they said it was probably overkill, but it would certainly enable the doctors to spot any problems, if they exist). My blood pressure and breathing was normal I also had some bloodwork done that day.

But yesterday was the day for the stress-ultra test. I had 12 large sticky electrodes stuck to my unshaven chest -- good times at the hospital! -- and was asked to lay on my side. The diagnostics person spent a good 5 to 7 minutes performing the ultrasound and, despite the fact that I was there for suspected heart disease, I had to lighten the mood. So when she put the jelly on the wand, I asked her to let me know if I'm having a boy or a girl. She laughed and said, "Surprise! You're having triplets!"

She later told me I was very sono-genic and that my heart takes great pictures. "We finally found my good side!" I couldn't help but laugh.

But, on a serious note, she let me know within two minutes that my heart's size/shape was "perfectly normal" and that I did not have the condition involving the over-thickened heart muscle.

That made my day.

Then it was time to hit the treadmill. I still had 12 different wires hanging off my chest and the blood-presure thingy on my right arm. The treadmill started really slow and although inclination kicked up pretty good, the pace was slow enough for me to just walk. The cardiologist took blood pressure readings every minute but soon just took it off and saying my pressure was fine and there was no reason to continue that part of the test.

Finally, after 8 minutes or so, the treadmill had gotten steep enough and fast enought that I had to actually start jogging. In the meantime we chatted about my cycling and racing and heart-rate training and the EKG machine kept spitting out graphs showing my heart in action. The pace of the treadmill finally got my heart rate up over 190 and after a minute or so at that speed, they had me quickly get off the treadmill and return to the bed for post-stress ultrasound.

I had to exhale and hold my breath several times which quickly brought back memories of drills I used to do in the pool when I would try to swim while blending in self-asphyxiation. I didn't like this anymore than I did those damn hypoxic drills.

The good news: I don't have anything wrong with my heart whatsoever.

I do have a relatively rare trait in that once my heart gets above 170bpm the time-gap between the left ventrical pumping and the right gets slightly exaggerated. The doc called it a rate-related-something-something-blockage. He said the two sides usually beat within 1-2 milliseconds of one another, but above 170bpm, the left side fires about 8-10 milliseconds before the right. He said it's nothing to worry about, he only mentioned it because it's pretty rare.

Nevertheless, he took the ream of EKG graphs to a colleague for a second opinion just to make sure there's nothing he's not seeing. In the meantime I have a clean bill of health and confirmation that my chest pain is definitely either heartburn or chest/back muscle tightening masquerading as heart problems.

All was not rosey, however. My blood work came back with -- surprise! -- high cholesterol levels. I expected this and was prepared defend against a prescription for a statin, but my doctor had a ladder for every wall I raised; he was nothing if not persistent. Finally, I relented and took the prescription for Zocor and agreed to give him 90 days on it. What I really wanted was a second-opinion so I took the scribble to the straight-shooting pharmacist Kristin and I use and he told me that my total (246) wasn't overly high and that, for example, a European doctor wouldn't typically prescribe a statin for anyone with less than a combined score of 300. But, he said, a ratio of 4:1 of bad:good is definitely not good and that I really ought to give the drugs a shot, especially if diet and exercise don't seem to be making any difference. We skipped the diet/exercise riff on account of Kristin and I eating the same things and her having a combined 110 cholesterol and, well, there's really not anymore exercise I can do -- I average 10 to 15 hours a week as it is.

As for why I resisted, the reasons are many. For starters, I despise the idea of possibly having to take a pill every day for the rest of my life. Secondly, I have no known history of heart disease in my family. My grandmother died of a stroke at age 56, but she was as big as a house and smoked like a chimney. I suspect there's a good chance my father will one day succumb to heart trouble, but he too is obese, so even if the high cholesterol is hereditary it's hereditarily not been a problem thus far. Lastly, there's little proof that lowering cholesterol reduces the risk of heart attacks and heart disease. I know it theoretically makes sense and, perhaps, there's just not enough data yet to show a strong correlation and maybe that data is coming, but I still can't help but be untrusting of the rush to prescribe.

But ultimately, none of this matters. All that matters is that so long as I have no side-effects, if taking the pill has no associated harm other than a $10/month co-pay but might mean I can be around longer for Kristin, then it's worth doing. Definitely.