Prelude
The cheerful, week-long UK trip for our elder daughter’s convocation took a sad turn on the final morning with the news of my father’s passing at our Bangalore home. Until then, I was running daily (short distances of 4-10K) through harsh English winter mornings (0 to -8°C) at Oxford and then, London. The return to Bangalore was followed by cremation/funeral rites, driving up/down 500 km each way to Thirunavaya for ashes immersion and more.
Saturday, 27-Jan-24
Nine days after my father’s unexpected demise, I restarted running, to take my mind away by doing something I genuinely enjoy. It was 3-4 km into my run that I could notice a burning sensation on my chest, around Heart Rate (HR) levels of 160. Since November, I have been religiously focusing on staying mostly at Z2 (133-145) or Z3 (146-158), so maybe I was out of practice, I wondered. I mixed up walking with running, but the pain kept coming back - vertically, left of center of my chest, like burning hot air blowing there. I completed my 10K at a moderate 7:10. Perhaps, I had indeed gotten a little rusty.
Wednesday, 31-Jan-24
It was a work-from-home day and I decided to run a little longer to get the target miles for Jan. The first 5K was fast (for my average), but then the burn was back. I walked and ran, slowing down to reduce the pain, eventually completing the plan of 15 KM at a similar pace as Saturday. Something gastric? Is my bronchitis back? The pain however was of a different kind.
Thursday, 1-Feb-24
As a final test, I decided to do hill repeats outside my home late at night - a 300m patch of road with a lovely 10m elevation. Five rounds up/down would give me 3K with a 50m elevation. But right from the first ascent, I wasn’t feeling comfortable. I pushed myself for the 2nd round struggling with pain. 3rd round downhill, I sensed something was seriously off. I stopped the run at 1.5K and walked back home. The pain was intense. Could it be heart perhaps?
Friday, 2-Feb-24
A casual morning call with a childhood friend in the US while driving to the office gave a new perspective. He was fighting fit, perfect weight, vegetarian and a walker (~15K steps daily), but had an attack 2 years back which required three stents. He asked me to call a common friend right away, a renowned cardiologist in Trivandrum, our hometown. The doctor told me to pop an aspirin and book an appointment the same day itself (a cardiologist not a GP, he was quick to add!). Even a 1% chance of heart trouble should be ruled out, he said.
That evening, the cardiologist at the nearby hospital at Electronics City sent me for the three standard tests – TMT, Echo and ECG. All came out clear. In fact, the TMT technician complained that she is unable to hit the target of 85% of max HR because I run regularly! She finally stopped the treadmill at 12 minutes at 81%. That said, I could feel the burning sensation slowly coming back after 10 minutes as the inclines kept increasing (speed was still only 7 kmph).
Saturday, 3-Feb-24
I didn’t want to be in denial, hence I told the doctor my low intensity pain is still there. He said runners’ hearts are well-conditioned and typically clear these three. He suggested a CT angiogram on Monday morning (Sunday being off). The CT angiogram required an HR of sub-70 and minimum 6 hours of fasting, hence we fixed 9am. If HR is above 70, they give a tablet to slow it down for a couple of hours. For chronic cases of high resting HR (say, 100+), they ask the patient to take medicines for 2-3 days prior.
Monday, 5-Feb-24
Like most regular runners, my resting HR is low (56-60 typically) and it was 57 while we tested. At 2pm, I met the doctor with the report and he underlined the problematic section - a potential 60-80% block on Left Anterior Descending Artery (LAD), one of the main arteries supplying blood to the heart muscles. I had coronary artery disease! I could ignore it and put myself in the line of a heart attack any moment or I can get a proper angiogram done for accurate estimates. If <50%, I can start on blood thinners, if >70%, I would need a coronary angioplasty (stent).
After checking with a few “experienced” friends and doctors, I decided to switch to Narayana Hrudayalaya (NH).
Tuesday, 6-Feb-24
The doctor suggested I get admitted immediately and get the angiogram done (and if needed, an angioplasty too). He said if there is an outside chance of something happening overnight, I may live to regret it. The usual reasons given for delaying - getting a 2nd expert opinion, mental preparation, and financial readiness (insurance) – didn’t apply in my case, so I went all-in. At 4pm, they performed the procedure.
Less than an hour later, I was wheeled into the Critical Care Unit (CCU) with two stents in my heart. Fortunately, the block in the main artery (LAD) turned out to be a safer <50%, but they had found two others of 95% and 70%. Thankfully, the wrist route for inserting the guidewire and the balloons/stents worked for me (plan-B was through the thigh) and the anaesthesia was just local.
The only point of discomfort was the main act- when they inflate a balloon at the blocked site to prise open the block, put in the stent and inflate a 2nd balloon to expand the crimped stent to its full size. That one minute felt like my chest was bursting, though by the time the second stent went in, I knew what to expect.
Wednesday 7-Feb-24
The doctor came in the morning, made me walk a little bit, sent me to the ward and I was discharged by evening. I also had a dietician/nutritionist, rehab consultant and a yoga practitioner giving their tips/guidelines at the CCU.
Learnings
Here are my three quick learnings from the entire experience:
Genes trump lifestyle: Both my brother (only sibling) and mother had bypass surgeries. I assumed I had my father’s genes (he passed away at 87 without a single medication), but boy, I was wrong. My active lifestyle (typically 3 runs a week at moderate speeds apart from the treks) didn’t eliminate the risk.
Get proactive: Like Dr. Devi Shetty says, all men over 40 and women over 50 (estrogen helps until menopause) must do a proactive CT angiogram test at least once in 5 years. It’s quick/non-invasive and ensures your 4-cylinder engine (heart) doesn’t become 3-cylinder.
Don’t ignore chest pains – by assuming they’re gastric and will just fade away. If the pain persists, go get tested. The best thing for me was testing BEFORE an attack which helped me to keep 100% of the heart intact.
How was I able to run so well in the UK only to have this block derailing my life just 10 days later? The progression of a block is something no one has been able to accurately pinpoint. Sudden stress – physical or mental - can cause ruptures (lesions) in one’s heart vessels; with platelet pile-up, the block can quickly go up from say, 20-30% to 100%.
My recuperation begins now which includes one week of complete rest, slow walks from week-2, jogging after a month and complete recovery in 6-8 weeks. Running, lake walks with my dog and treks every 4-8 weeks are basically expressions of my abiding love for the outdoors, so I eagerly look forward to restoring normal service from April onwards.
Gopi Krishnan started his running journey after recovering from a crippling road accident in 1995 that left him in crutches for over 6 months. He completed his first marathon in the Bengaluru Marathon in Oct 2022 and the 2nd in Mumbai at TMM in Jan 2023. Continuing the spirit of climbing hills in the countries he has lived in (including Mt. Fuji), he also runs an amateur trek club with over 40 treks under their belt over the last 6+ years. Gopi is a Partner with EY and has over 25 years of experience in the supply chain management/consumer sector consulting space.