Introduction and Motivation

I do not write this story looking for sympathy or sorrow. Instead, as corny as this sounds, I hope to maybe save someone else’s life.

On October 15, 2023, I underwent open chest double bypass surgery. The medical community calls this procedure a Coronary Artery Bypass Graft (CABG), and pronounce this as “Cabbage” vs. saying C-A-B-G. 

The following summarizes how I ended up with a bypass (and in future blog entries, the days in the hospital that followed, and much more!).

Much more importantly, I discuss my good fortune to have detected my blocked Left Atrial Descending heart artery (also known as the Widowmaker) without experiencing any symptoms.

I want to share how I detected this dangerous blockage so that you also know, and can share with your friends and loved ones, in the event one of them (or you!) has a time bomb in their heart like I had! Again, I had no idea I was so close to a major (and likely fatal or permanently debilitating) cardiac event.

Please subscribe to my blog so you can find out when I post updates and new topics to this website. I promise future entries will be much easier to digest; I just wanted to start things off with enough information so that you can be proactive and take action tomorrow!

First, A Shout Out!

I will never be able to express the amount of appreciation I have for the nursing staff at the UNC Rex Heart and Vascular hospital. I wish I could list their first names here, but have decided not to for privacy reasons.

How Does One Know To Go To A Cardiologist?

At age 50, colonoscopies are recommended, and for good reason! Colon cancer is SO AVOIDABLE with regular colonoscopies.

Unfortunately the medical community does not have an analogous protocol to flush out cardiac heart disease (CHD). They rely on you having chest pains or extreme fatigue, neither of which I had. In other words, the ball is in your court regarding detection.

My recent experience has shown there are a few non-invasive tests that can be performed to give a reasonable idea of your heart health. I discuss them in the next section.

How Did I know To Go To A Cardiologist?

This is probably the information folks want to know. Before I was diagnosed with CHD, I considered myself to be in pretty good shape for a 61-year old. I am a non-smoker, averaged only one or two servings of alcohol a week, worked out three times a week, ran once or twice a week, would regularly walk 18 holes of golf, and was constantly on my feet doing chores around the house. My cholesterol was usually in the low 200s, but I was never put on statins. Given no symptoms of heart issues, I was rather confident I was in good health.

Now to the good fortune that I have no doubt saved me from a likely fatal heart attack. The following is the most important thing to take away from this website as far as how I detected my coronary heart disease!

In September 2020, I purchased a KardiaMobile 6L because of its incredible capabilities of providing a six-lead ECG (a.k.a. EKG) along with heart rate reporting. This device analyzes the data recorded and lets you know if you’re in normal sinus rhythm or have some issue with your heart.

I had discussed this device with my friend Phil, and we both concluded this device was cheap insurance against undetected CHD. After every workout and run, I would use my KardiaMobile 6L to check my heart rate and EKG. From September 2020 until early July of 2023, normal sinus rhythm was always reported (except after some of my runs where my heart rate was >120, in which case the expected “Tachycardia” was reported).

However, a couple of readings in July 2023 that reported “Possible AFib” kicked off the data gathering phase with a series of tests to determine what was going on with my heart.

AFib stands for Atrial Fibrillation (AFib), which is a type of arrhythmia, or abnormal heartbeat. AFib is caused by extremely fast and irregular beats from the upper chambers of the heart. A heart in AFib tends to produce blood clots, and these clots represent a significant stroke risk.

You can purchase a KardiaMobile 6L by clicking the link below (I strongly recommend you spend the extra money to get the six-lead version!)

This website contains affiliate links. By clicking such a link and making a purchase, without you incurring any addition cost, I may earn a commission. I would use these proceeds (if any) to pay for upgrades to and ongoing maintenance of this website.

Click this link to purchase a KardiaMobile 6L. You might be glad you did!

Should I Have Known Much Earlier?

Looking back, I was experiencing issues that would indicate heart disease, specifically a lack of stamina. I have run off and on for several years, including numerous 5Ks and three half marathons. The last few years I have been battling foot issues, but have managed to run a couple of miles every five days or so.

I noticed that my runs were more of a struggle, and I had reverted to a run/walk approach. I simply rationalized this as, “well, I haven’t run a lot lately. I just need to build up my cardio.” I now believe this was a missed clue on my heart issue. I never experienced chest pains of any concern.

Also, my wife had noticed that I was taking more naps than usual. Again, I rationalized that away, this time as “I didn’t sleep well last night. That would explain it.” I suspect this was another missed clue.

Another thing I should have considered are the fact that both my father and mother had heart attacks at the age of 71. Sadly, my father collapsed and died from a heart attack in March of 2000, and my mother had a heart attack (and really miraculous to have survived) followed by triple bypass four months later.

The medical community did not consider 71 as a young age to have a heart attack, and thus did not put me in a higher risk for CHD. I in fact had a stress test in 2001 or so (out of my own paranoia that some light-headedness was a sign of something going on with my heart), but nothing was found. I had also tweaked my diet for a while, but eventually reverted back to my not-so-healthy diet.

Timeline

In an attempt to help understand the sequence of events that occurred, this timeline is provided for reference.

Date	Event
7/10/23	First “Possible AFib” detected by KardiaMobile 6L after 35 minute core and weight workout
7/16/23	Second “Possible AFib” detected by KardiaMobile 6L after a 5K run/walk
7/18/23	Third “Possible AFib” detected by KardiaMobile 6L after a 5K run/walk
7/24/23	First visit to general practitioner
7/26/23	Call to schedule UNC Rex cardiologist appointment (Scheduled for 9/21/23)
8/19/23	Second visit to general practitioner. Referred to WakeMed cardiologist
9/7/23	First visit with WakeMed cardiologist
9/11/23	CT Cardiac Calcium Score test performed at Raleigh Radiology
9/12/23	Second visit with WakeMed cardiologist, this time to discuss CT Cardiac Calcium Score. I am cleared to run in a 5K on 9/17/23
9/17/23	I run in the Carolina Hurricanes 5K
9/18/23	Stress Echocardiogram at WakeMed followed by heart monitor placement on left side of chest
9/19/23	Fourth “Possible AFib” detected by KardiaMobile 6L while sitting on couch and watching TV
9/20/23	WakeMed cardiologist analyzes Stress Echocardiogram and calls to recommend stent
9/21/23	First visit with UNC Rex cardiologist.
9/21/23	When I asked, told by WakeMed cardiologist to avoid vigorous activity.
9/25/23	I mailed off heart monitor for analysis
9/25/23	WakeMed cardiologist analyzed KardiaMobile logs and stated none showed AFib
9/29/23	Heart monitor results available
10/4/23	Coronary CT Angiogram performed at UNC Rex
10/13/23	Cardiac Catheterization performed at UNC Rex
10/15/23	Double bypass surgery performed
Upcoming	To be filled out in future blog entries. Stay tuned!

Assessing The Situation

After three “Possible AFib” readings from the KardiaMobile 6L, I went to my general practitioner (GP) to kick off the investigation. He recorded an EKG, but no AFib was detected. Since I had immediately re-tested with the device and received normal sinus rhythm, we concluded the device had mistakenly returned “Possible AFib.” (I later theorized that the KardiaMobile app on my phone had been updated, and a more conservative assessment of possible AFib was introduced to ensure a peculiar reading was investigated.)

In early August, I had a couple of days where my heart felt “fluttery.” However, the KardiaMobile 6L had returned normal sinus rhythm. I still decided to go see the GP a second time.

Thankfully, without me asking, my GP immediately referred me to a cardiologist at WakeMed. Despite the urgency conveyed by my GP, I had to wait about three weeks before the initial appointment.

A couple of days after my second GP visit, I requested an appointment with a cardiologist at UNC Rex who basically saved my father-in-law‘s life and is well liked and highly respected by my wife and in-laws. (After a couple of visits, I would conclude that he is most likely the best doctor I have ever had.)

Because I was a new patient at UNC Rex for a high-demand cardiologist, getting an appointment took over seven weeks to schedule. (Pro tip: if you know a good cardiologist, you may want to make an appointment so that you become an existing patient, and thus get higher priority if time is critical.)

WakeMed Cardiologist Visits

Before my initial trip to the WakeMed cardiologist, my friend Ken recommended a couple of non-invasive tests to me to facilitate data gathering:

• Computerized Tomography (CT) Cardiac Calcium Scoring to evaluate the amount of calcified (hard) plaque in your heart vessels; basically looking for hardening of the arteries.
• Lipoprotein (a) test measures the level of lipoprotein (a) in your blood. A high level may mean you are at risk for heart disease.

In my initial WakeMed appointment, I requested that those two tests be performed.

The cardiologist had those scheduled, along with the following:

• A 7-Day Heart Monitor Patch to see if I was indeed having sporadic AFib.
• Stress Echocardiogram to check for the presence of blockages in the coronary arteries.

My WakeMed Test Results

As you will soon see, my test results were cause of great concern to me.

CT Cardiac Calcium Scoring

Overview

Overview Of CT Cardiac Calcium Scoring

CT Cardiac Calcium Scoring is a non-invasive imaging technique that uses a CT scanner to assess the amount of calcified plaque in the coronary arteries. Note that calcification of the arteries is exactly the same as hardening of the arteries.

Currently, insurance companies do not pay for this test. I ended up (gladly) paying $250 for this test. However, I later found out in Raleigh that these tests are $99 at Cardinal Points Imaging. Shop around!

The following table summarizes the calcification level and risk of coronary artery disease based on the cardiac calcium score:

Score	Calcification Level	Risk Of Coronary Artery Disease
0	None detected	Lower
1-10	Minimal Calcification	Low
11-100	Mild Calcification	Low to moderate
101-400	Moderate Calcification	Moderate
Over 400	Extensive Calcification	High

My CT Cardiac Calcium Score

Needless to say, I was quite frightened when my cardiac calcium score came back as 1342.5! Here is a breakdown of each of my arteries that were evaluated:

Artery	Cardiac Calcium Score
Left Main	0
Left Anterior Descending	555
Left Circumflex	155.8
Right Coronary Artery	631.7
Posterior Descending Artery	0

Lipoprotein (a) Level

Overview

The Lipoprotein (a) (a.k.a. Lp (a)) levels are determined via a blood test. Note that Lp (a) is not tested in a standard lipid panel where cholesterol levels are determined, and an explicit request for Lp (a) testing is required.

The following table summarizes Lp (a) levels and associated risk of coronary artery disease:

Lipoprotein (a) Range	Risk Of Coronary Artery Disease
<14 mg/dL (less than 140 nmol/L)	Lower
14-50 mg/dL (140-500 nmol/L)	Increased
> 50 mg/dL (greater than 500 nmol/L	Elevated

My Lipoprotein (a) Level

My Lp (a) level was determined to be 166 nmol/L. Not nearly as concerning as my cardiac calcium score, but still, more elevated than desired.

Stress Echocardiogram

Overview

A Stress Echocardiogram (a.k.a. stress echo) is a diagnostic test that measures the activity of the heart during physical stress. The purpose of a stress echo is to evaluate how well the heart responds to increased demands for blood and oxygen when the body is under stress, typically induced by exercise.

Here is the sequence of events with a stress echocardiogram:

• The patient arrives wearing comfortable clothing and athletic shoes.
• An ECG is recorded and ultrasound images of the heart are captured to record baseline readings of the patient’s heart at rest.
• The patient gets on a treadmill that is gradually elevated in order to increase the patient’s heart rate.
• Once the patient struggles, the patient steps off of the treadmill and immediately gets their ECG recorded and ultrasound images of the patient’s heart at stress are captured.
• The cardiologist analyzes the results and provides guidance to the patient on suggested course of action.

There are numerous metrics recorded with a stress echocardiogram, too many to discuss here. However, there are two metrics that are relevant for discussion here:

• Ejection Fraction (EF) – a measure of the percentage of blood pumped out of the heart with each contraction.
• Horizontal ST Depression – a value of > 0.5 mm indicates possible myocardial ischemia, which is when blood flow is obstructed by blockage of some degree in a coronary artery. 

The following table summarizes the different degrees of EF:

EF Percentage	Level of Reduction
50-70%	Normal
40-50%	Mildly reduced
30-40%	Moderately reduced
<30%	Severely reduced

Some of the key implications of a severely reduced ejection fraction include:

1. Heart Failure: A severely reduced ejection fraction is often associated with heart failure. Heart failure occurs when the heart is unable to pump blood effectively to meet the body’s needs. It can lead to symptoms such as shortness of breath, fatigue, fluid retention (edema), and exercise intolerance.
2. Increased Mortality Risk: A low ejection fraction is a strong predictor of adverse cardiovascular events and mortality. Individuals with severely reduced ejection fraction have a higher risk of sudden cardiac death and other complications.
3. Impaired Exercise Capacity: Reduced ejection fraction can result in decreased cardiac output, limiting the ability of the heart to supply oxygen-rich blood to the body during physical activity. This can lead to exercise intolerance and reduced quality of life.
4. Arrhythmias: Severe reductions in ejection fraction can disrupt the normal electrical activity of the heart, increasing the risk of arrhythmias (irregular heart rhythms). This can further contribute to the risk of sudden cardiac death.
5. Complications of Heart Failure: Chronic heart failure can lead to complications such as kidney dysfunction, liver congestion, and pulmonary edema. It can also exacerbate other health conditions.
6. Impaired Pumping Function: The heart’s pumping function is compromised when the ejection fraction is severely reduced, affecting the ability of the heart to efficiently circulate blood and maintain adequate perfusion to vital organs.

My Stress ECG Results

For my age, the test was configured such that the target heart rate would be 135 beats per minute (BPM) and the maximum of 152. During the test, my heart rate got to 142 before the technician had me stop. At that point I was really huffing and puffing!

Immediately after I got off the treadmill, the ECG and ultrasound data were gathered.

Fortunately, my EF was 60-65%, which is falls in the normal range.

However, my horizontal ST depression was 1.5mm, which is higher than the acceptable < 5mm.

Heart Monitor

Overview

There are many types of heart monitors, but I was given a Zio XT ambulatory cardiac monitor to wear for seven days. This monitor is simply a data logger and has no means to transmit data or alert anyone if an anomaly is found. 

However, the device has a button that can be pressed if the person wearing the monitor experiences an unusual feeling or pain in the heart. A log book is provided so that the person reporting the condition can “bookmark” when the event occurred, and can write down what physical activity was occurring in the time that led up to the event.

My Heart Monitor Results

After seven days, I removed the patch and mailed the patch to an address in Illinois for analysis (e.g. to look for AFib).

Fortunately and thankfully, the data recorded by the heart monitor showed that my heart exhibited no AFib over the course of those seven days. (Although a few premature atrial contractions were detected, the longest of which was six beats. I will leave that as an exercise for the reader to research what those contractions are.) Later I will discuss a potential reason why my KardiaMobile 6L reported “Possible AFib.”

WakeMed Cardiologist’s Conclusions

Early the next day after the Stress Echocardiogram, the WakeMed cardiologist analyzed the results. Soon after, he called me on the golf course and told me he found a low risk issue. However, he said given my elevated Lipoprotein (a) levels, horrible CT cardiac calcium score, and family history, he recommended that a stent be inserted. He said a scheduler would soon call me to schedule the procedure. Needless to say, the last four holes that day were a blur.

A Side Note:

A few days before both the 5K and the Stress Echocardiogram, I mentioned to the WakeMed cardiologist that I was going to run/walk a 5K on the upcoming Sunday. He said that was fine, but suggested I hold off getting the heart rate monitor until the Monday after the 5K, right after my stress echocardiogram.

I later mentioned this sequencing to the UNC Rex cardiologist. He was surprised and said that the monitor should have been attached before the 5K, in order to measure the heart under stress. This is an example of the value of getting a second opinion.

UNC Rex Cardiologist Visit

When the WakeMed cardiologist recommended a stent, the UNC Rex cardiology appointment was only a couple of days away. Since I wanted the opinion of the UNC Rex cardiologist, I pushed off the scheduler from WakeMed.

During my initial visit, the UNC Rex cardiologist recommended a Coronary CT Angiogram in order to get more insight than what the Stress Echo provided. 

I later found that WakeMed does not have the capability to perform Coronary CT Angiograms. This and the fact that I was now seeing my desired cardiologist, I elected to drop the WakeMed cardiologist. (Another factor in the decision was the location of WakeMed as compared to UNC Rex. For me, UNC Rex is much closer and more convenient and the parking seems safer than WakeMed).

Coronary CT Angiogram

Overview

A Coronary CT Angiogram is a medical imaging technique that uses a CT scanner to visualize the coronary arteries. This test provides detailed images of the heart’s blood vessels, allowing for the detection of blockages, stenosis (narrowing), or other abnormalities.

During a coronary CT angiogram, a contrast dye is usually injected into the patient’s bloodstream to enhance the visibility of the coronary arteries on the CT images. This procedure is useful for evaluating the coronary arteries without the need for invasive procedures such as a traditional cardiac catheterization.

At various times during the procedure, over a speaker, a technician will instruct you when to hold your breath and when to breathe. Pro tip: Take an extra half second to hold your breath so that you have taken in enough air to make it through that segment of the procedure!

As far as actions to be taken as a result of this procedure, a 70%+ blockage is the level where something invasive such as stent insertion or bypass surgery to address the blockage. For blockages less than 70%, if warranted, the blockages are addressed with cholesterol statins and changes to diet. 

My Coronary CT Angiogram Test Results

During my procedure, contrast dye was used. I could feel the dye when the technician injected the dye into my system. The associated feeling is probably best described as a sort of a warm feeling in the vessel where the dye is injected. 

Make sure you do your best to hold still once you begin experiencing this feeling. I moved a tiny bit during this portion of the procedure, and the report indicated “Good quality coronary CT angiogram, limited by modest patient motion.“ Oops!

Afterwards, I was instructed to drink a lot of water to help the kidneys flush the dye out of my system.

Unfortunately, the test results indicated that my Widowmaker artery was more than 70% blocked. The other arteries were at a lower level, and thus fell into the “statins and diet” treatment.

UNC Rex Cardiologist’s Conclusions

Unsurprisingly, based on the 70%+ blockage, the UNC Rex cardiologist prescribed a cardiac catheterization to get a more detailed view of the blockage(s). Interestingly enough, my wife and I never recalled him using the words ‘stent’ or ‘bypass’ at this time.

At this point he scheduled a cardiac catheterization on (of course) Friday the 13th of October. As luck would have it, both of our boys were flying into town so that we could go on a weekend family trip to Boone during the peak of fall colors. 

We had to cancel the trip, but on a positive note they were both here to help my wife navigate this situation.

Time For Cardiac Catheterization

Overview

With the Cardiac Catheterization a.k.a. cardiac cath, the cardiologist (at least in my case) puts a catheter in the right side on the top of your groin and goes up in your heart and looks around (a “look see” as the UNC Rex cardiologist described it). If the cardiologist confirms a blockage(s) of more than 70% is present, a cardiac surgeon is called in to insert the stent(s).

If a stent(s) would not adequately rectify the blockage, a bypass would be required. Note that the room where the cardiac cath is performed is not a sterile operating room. Thus, if a bypass were warranted, that procedure would have to be scheduled for a later time. 

My Cardiac Cath Results

When I was wheeled on a gurney into the cath lab, the cardiologist, anesthesiologist, and two nurses were there waiting for me. The cardiologist was seated to my right. After I was given some meds via a breathing to relax me, the cardiologist gave me a couple of anesthetic injections at the catheter’s entry point.

Whenever you hear something like, “I am going to do a local anesthetic injection to ease the pain of the main injection”, you know that the local injection is going to feel like a yellow jacket’s sting. There needs to be another local given for the local anesthetic! 😀

The main injection and catheter insertion were quite painful. Shortly after, I could feel the warm sensation of the contrast dye entering my system.

Right after that, before I knew it, I was awaking up again. I had been placed into “conscious sedation.” Research this term. That type of sedation is quite fascinating!

After waking up, I don’t recall the specific words, but were words to the effect of “Well, you coded on the table, and we had to defibrillate you!” My heart had gotten into a state where it was just quivering, and my pulse had stopped. Yikes!

Apparently I was only in this state a minute or so. The cardio vascular wing of a major hospital is a great place for your heart to stop! After defibrillating me, they resumed the examination. I am thankful for that, as I would not have be thrilled about getting another catheter inserted.

While I was recovering, the cardiologist tracked down my wife to tell her how things went. He said, “Well we had a surprise. I don’t remember the last time this happened.” He then mentioned about me coding. He then speculated that the possible AFibs being reported by the KardiaMobile 6L could be explained by what happened in the cath lab.

The catheterization determined that my left main artery is really narrow, and likely triggered the need for defibrillation. Since the left main artery feeds two of the four main arteries in the heart, a double bypass was deemed necessary.

The Bypass Consultation

The day after the cardiac cath, I was in a hospital room and waiting for a status update from the cardiac surgery team. Sometime mid-afternoon, the cardiac surgeon PA came in.

She said that typically bypass surgeries are not scheduled on the weekend. In addition, there are bypass surgeries queued up starting Monday. Since my vital signs were stable and I was not experiencing symptoms, there was no need to schedule the bypass until the start of the workweek. Since they already had bypass surgeries scheduled the first part of week, she anticipated my procedure would be Tuesday or Wednesday, when they could squeeze it in.

However, less than an hour later, the cardiac surgeon came in and said, “I don’t like what I saw in those images. You might live to this Christmas, but you will not live until next Christmas. How would you like to proceed?” (I think he loves asking how you would like to proceed!)

He actually scheduled the surgery for early Sunday morning. That action really showed us the urgency of the situation.

To wrap up this conversation, the cardiac surgeon said, “Well, I’ll see you tomorrow morning naked on the operating table.” This clearly shows how confident (cocky?) the surgeon was, and that he had a bit of a sense of humor.

The Surgery and Beyond

Well, this is beyond plenty for folks to digest! With this initial website content, I wanted to convey the action you can take now to avoid the precarious situation I was in, where unbeknownst to me, my heart was a ticking time bomb. 

What’s Ahead

I plan on publishing more blog entries (much smaller and easier to consume) that talk about the operation, my experiences with pre op and post op, coming home, and so on.

Now, to close out this first blog entry…

I feel I have met my object of telling folks how they can do a couple of simple things to possibly flush out a serious heart condition.

My goal going forward is to continue describing my experience in the hospital and what to expect, educate folks on cardiac health, and perhaps motivate people to adjust their lifestyles to avoid going through what I am going through.

Subscribers to my blog will be notified when I post new blog entries to my website. The more subscribers I get, the more motivated I will be to crank out new blog entries!

Lastly, I promise not to spam you with numerous emails, nor will I sell your email addresses to anyone.

Stay tuned for updates! Did I mention to subscribe? 🙂

If you have any suggestions, corrections, or questions, please email me at tomandhisheart@gmail.com. Thanks for reading!