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Dr .Saeed ahmed
Dr .Saeed ahmed, Doctor
Category: Cardiology
Satisfied Customers: 4424
Experience:  MBBS/FCPS(R)/MRCP U.K(R), Senior Registrar Cardiology
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I am a 67 year old male who has been very fit, walking 6 hours

Resolved Question:

I am a 67 year old male who has been very fit, walking 6 hours a week and working out typically 3 times weekly with fairly intense training and exercise heart rate 100-140,duration 25 min, till last week when I had a STEMI and was very fortunate to get 2 eluting stents inserted into LAD coronary artery within an hour of onset. Echo cardiograph confirms moderate ventricular damage with 40% emptying. My BP has always been normal and now is a boring 110/70 with usual meds, Ace inhibitor,beta blocker ,statin, aspirin and Ticagorel. No other artery problems and good valve function.I want to get back to optimum fitness,whatever that may be, and want advice about the time frame which would be reasonable as I want to optimise cardiac function rather than compromise it by overdoing things.Should I observe a maximum heart rate? I am aware that stents can be thrombogenic and wonder if there is a settling in period which requires more care?I feel well . Do you think that any supplements eg coenzyme 10 would be beneficial? I am building up walking distance gradually and am due a stress test in a month or so.
Ian
Submitted: 1 year ago.
Category: Cardiology
Expert:  Dr. Phil, MD replied 1 year ago.
Hello. I'm Dr. Phil, licensed and practicing internist. Excellent service is my goal.
did they set you up with cardiac rehab?
Customer: replied 1 year ago.

Yes I start a rehab programme tomorrow. Sorry about delay but there was a communication breakdown.

Ian

Expert:  Dr. Phil, MD replied 1 year ago.
no problem
what questions do you still have?
Customer: replied 1 year ago.

I have not received your initial reply. Can you please resend?

Thanks,

Ian

Expert:  Dr. Phil, MD replied 1 year ago.
They will teach you this in cardiac rehab.
that is all you need is to go to cardiac rehab.
that is the best way to get back into optimal fitness
Customer: replied 1 year ago.

I am not satisfied with the response as it has not supplied any useful information.

Expert:  Dr. Phil, MD replied 1 year ago.
What else would you like to know?
Expert:  Dr. Phil, MD replied 1 year ago.
can I help further?
Expert:  Dr .Saeed ahmed replied 1 year ago.
Hello,
Thank you for your question.
I will try my best to help you with your questions.
A person with stents in the LAD and heart function of 40% means that you can do your normal daily activity after 1 week of your stent deployment.
Regarding your question about the level of activity it in your case should be symptom dependant. which means you can do activity at levels which do no cause symptoms of chest pain, shortness of breath, fatigue or any other symptoms.
Ideally you should do moderate intensity exercise, which means walking a dog, walking at normal pace on leveled ground.
see following link for some details on moderate intensity exercise.
https://www.nhlbi.nih.gov/health/educational/lose_wt/phy_act.htm
http://www.cdc.gov/nccdphp/dnpa/physical/pdf/PA_Intensity_table_2_1.pdf
No you should not observe max heart rate you should exercise to the levels which do not cause symptoms.
If these are bare metal stents then they settle in with in 4 weeks, if these are drug eluting stents then they need more care for at least 1 year.
No there is no data or studies that have shown the benefit of coenzyme Q10.
Yes it is important that you build your exercise capacity slowly or gradually.
Let me know if you need more details.
Thank you.
Customer: replied 1 year ago.

Thanks for your reply which is informative. It seems to me counterintuitive that an eluting stents should take longer to settle than a bare metal stent. Can you explain why?

In addition are there any alternative preparations or vitamins that are proven to be beneficial in my situation. I am feeling very well and can comfortably walk 3 miles.

Thanks in anticipation,

Ian

Expert:  Dr .Saeed ahmed replied 1 year ago.

Hello,

Ian thank you for your reply,

Because drug eluting stents have coating of medicine which we call anti proliferative agents like evorolimus, zatrolimus E.t.c... These medicine block the growth of endothelium which occurs in bare metal stents within 4 weeks. So by blocking the growth of endothelium surface of stents keeps in contact with blood and its clotting agents more longer. Which is the basic reason for prolong anti platelet or blood thinning medicine in cases of DES(drug eluting stents). So people with DES are prone to late stent throbmosis due to this very reason i have mentioned. So we have to be more careful with DES.

Only natural agent that has shown success in such cases is PUFA agents. which are poly unsaturated fatty acids which are more commonly found in olive oil. While vitamin B, C, A, D and all other agents have not shown any success until now.

I hope this helps. Let me know if you have questions.

Dr .Saeed ahmed, Doctor
Category: Cardiology
Satisfied Customers: 4424
Experience: MBBS/FCPS(R)/MRCP U.K(R), Senior Registrar Cardiology
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