Despite my self-diagnosis, I felt guilty. The pains would surely go away, and I’d have wasted Dr. Janevski’s valuable time.
Nevertheless, I spent the entire next day at the hospital, undergoing tests. The treadmill stress test did not go well. After only a minute, I experienced the now-familiar chest pain. The medics quickly turned off the machine.
At 4 o’clock, results in hand, Dr. Janevski delivered the news. The worst of it came from comparing printouts of two old electrocardiograms – he was 80-per-cent certain I had already suffered a minor heart attack, some time in the period from 2007 to 2009.
For a moment, I was in shock. “Wouldn’t I have known I was having a heart attack?”
“Not necessarily,” he replied, adding that the cardiograms would have had to be read by a proper cardiologist, to draw the right conclusion.
Only then did I remember. In May, 2007, on a boat cruise on the Dnieper River in Ukraine, I had, just after breakfast, inexplicably broken out in a profuse, beading sweat. There was discomfort and mild pain in my mid-back. I went to the boat’s infirmary, where they applied liniment and told me to rest. No one suggested that I might have had a heart attack, and it didn’t occur to me, then or afterward.
I rested for a few hours and, that night, felt well enough to attend the trip’s final party and even perform, singing a satirical song.
I had been very fortunate, Dr. Janevski explained. The heart attack had not affected a major artery, and the organ’s blood vessels had made a route adaptation around the plaque. But other, more serious blockages were probable.
Moreover, however fit or well-nourished I considered myself, I had no control over the key determinant of my cardiac health. My father suffered his first heart attack at 48, and died of another one at 73. Four of his siblings also succumbed to coronary disease.
Against the dominion of DNA, regular exercise and good diet are simply not enough. They are not irrelevant – my gym diligence, Dr. Janevski said, may explain why I survived on the Dnieper. But there is no escape from family history. In percentage terms, it’s 80 for the genes, 20 for all the other risk factors.
And there was an additional complication – a case of polymyalgia rheumatica (PMR), an inflammatory auto-immune disorder for which I had been treated the year before the boat trip. Research has yet to establish a firm link between PMR and heart attacks, but my doctors believe that there is some connection.
Regardless, it was time for the next step – an angiogram to determine just how bad the problem was.
When it comes to pinpointing cardiac blockages, the angiogram – essentially a motion picture of the heart, complete with close-ups of veins, arteries and chambers – is the gold standard.
The half-hour procedure (devised in the 1920s by Antonio Egaz Moniz, the same Portuguese physician who invented the lobotomy) uses fluoroscopy, a technique that allows doctors to see the lumen (the interior wall) of the heart’s blood vessels. A tiny catheter is inserted into the body and guided to the coronary arteries. Then, a radiographic dye containing iodine is injected into these arteries.
The amazing part is that, lightly anesthetized, the patient can watch on a bedside monitor (albeit in black and white) as the film is being shot.
‘We could send you home, but I recommend you stay’
I spent two, anxiety-filled weeks waiting for the angiogram. Afterward, surgeon Alan Barolet leaned on my gurney rail and reported, in a hushed tone: “I’m afraid you have a significant blockage.”
“Really?” I replied, as though he were given to making jokes about heart disease.
“Three, actually,” he said. “One at 99 per cent. Two at 70 per cent.”
Gulp. Virtually total. Even under the fog of the anesthesia, my attention was riveted.
“Can they be stented?” The stent procedure – in which blocked vessels propped open during angioplasty are reinforced with mesh – was, I knew, less invasive and less risky than bypass surgery.
“Possibly,” Dr. Barolet said. “But we think that’s likely not the best approach in your case. A stent will repave part of the road. A bypass is an opportunity to build you a new highway.”