One fitness enthusiast's heart attack near miss

A regular runner, swimmer, gym-rat and lifelong non-smoker, I was 56 but fit and healthy - or so I thought. Suddenly, I needed multiple bypass surgery.

Jonathan Gornall, right, has spent a lifetime staying fit, through running, swimming and rowing, but was rushed into multiple bypass surgery when doctors discovered serious signs of atherosclerosis.
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"Shock" is an overused word, as I discovered on the morning of February 26, when I experienced the real thing for the first time.

A regular runner, swimmer, gym-rat and lifelong non-smoker, I was 56 but fit and healthy - or so I thought.

Over a period of days, I had started to notice a mild but increasing discomfort in the centre of my chest just a few minutes into my daily laps of Dubai Marina. I put it down to some kind of low-grade respiratory infection - not uncommon among those who insist on running in the UAE's occasionally particle-rich atmosphere - but my partner finally nagged me into seeing a general practitioner at The Dubai Mall Medical Centre.

And nagging, it seems, can save your life.

X-rays showed nothing wrong with my lungs. Blood tests, however, set alarm bells ringing. My overall cholesterol level was 6.67 millimoles per litre (or mmol/L). That was bad enough - anything between 5.2 and 6.2 is borderline high.

But the worse news was that while my level of "good" cholesterol - HDL, or high-density lipoprotein - was bang in the middle of the acceptable range, my "bad" cholesterol - LDL, or low-density - was at an unacceptably high of 4.62 mmol/L.

It was scant consolation to learn that I couldn't really be blamed; overproduction of LDL is down to genetics, not diet. But the really bad news was just around the corner.

I was referred to Swiss cardiologist Michael Lefkovits, who used electrocardiograms, a treadmill stress test and an ultrasound scan to look closely at my heart and its function. All this revealed little beyond that it seemed healthy and that my resting heart rate - the product of years of exercise - was satisfyingly low.

My marginally high blood pressure, however, was another matter and, taken together with my high cholesterol and chest pain, was enough to justify a closer look. The pain, explained Dr Lefkovits, could be a product of atherosclerosis: the build up of fats and cholesterol into hard plaques that block the coronary arteries.

And so on Sunday, February 26, I checked into The City Hospital in Dubai to undergo an exploratory angiogram. Conducted under local anaesthetic, the procedure isn't the best of fun, but I would soon be looking back on it as a pleasant interlude.

After an iodine-based contrast material has been injected into the bloodstream, a thin tube, or catheter, is fed into the femoral artery in the groin and up and into the aorta and coronary arteries. Thanks to real-time X-rays, the cardiologist and patient alike can monitor its progress - and any obstructions it encounters - on a screen.

Normally, any blockages can be dealt with there and then by angioplasty, in which a small balloon is fed up along the same catheter to the site of the obstruction and then inflated to crush any deposits. Often, a small expandable metal cage - a stent - is also inserted and remains in place, holding open the blood vessel.

But there were to be no balloons for me.

The grim significance of the prematurely terminated session didn't dawn on me until I was back in my hospital room. There, Dr Lefkovits and Dr Beate Wild, the cardiologist from the German Heart Centre who had carried out the aborted angioplasty, did their best to deliver the news gently.

I had several substantial blockages in three coronary arteries. In one or more cases, more than 95 per cent of the artery was closed. There was a real danger that one of these plaques could rupture, cutting off blood supply to the heart and causing a heart attack. To complicate matters, the worst obstructions were dangerously close to the aorta, making stenting or ballooning far too risky.

Which meant I needed multiple bypass surgery - and soon. This was a Sunday. They had already scheduled the surgery for the following day.

I was incredulous. This was never supposed to happen to me. I tried to make a joke about a lifetime of wasted exercise, but my mouth was so dry I couldn't speak. Instead, the colour drained from my face, my heart-rate spiked alarmingly and I threw up.

This was the moment I learnt the true meaning of "shock".

By luck, I found myself in the hands of Dr Andre Wessels, a highly experienced cardiothoracic surgeon from South Africa. In a five-hour operation, he and his team at The City Hospital harvested a long vein from my left leg and an artery from my chest wall to graft from my aorta to points beyond the blockages in my three diseased arteries.

The operation is a tough one and leaves you battered and bruised. It involves sawing open the sternum and spreading the rib cage to allow the surgeons to get to the heart, which is stopped while the grafts are sutured in place. The business of breathing and circulating blood is handed over to a cardiopulmonary bypass machine - for 88 minutes, in my case.

I was kept unconscious for 48 hours, but thanks to intensive physiotherapy and a recovery programme that emphasises mobility over bed-rest, I was able to leave the intensive care unit three days later. Another three days after that I was released back into the wild and was able to fly home to the UK a week after that.

One month after the operation, my various wounds are healing nicely, I am walking miles every day and the muscles that wasted away so quickly in ICU - I lost about 5kg - are slowly rebuilding. I am still suffering various aches and pains and lifting or carrying objects heavier than 2kg remains a no-no, for fear of putting too much strain on the wiring holding together my sternum, but I can expect to be running again in another two months.

And run I will. If I hadn't been so fit, I'm told, my brush with cardiovascular disease might have had an altogether different outcome - and at the very best, I probably would have found myself undergoing bypass surgery a decade earlier.

Atherosclerosis is the number-one killer of men and the reality, demonstrated by autopsy studies of young men who have died of other causes, is that virtually every man over about 35 years of age starts to build up plaques in their coronary arteries. Whether these develop into something serious depends on a range of risk factors - and what you do about them.

A fit non-smoker, I thought I was safe, but I had reckoned without two gifts from my parents - high blood pressure and a high level of LDL cholesterol. Both conditions can be easily and cheaply tested for and controlled by medication but, like the vast majority of men, I stuck my head in the sand and gave neither a moment's thought.

Now I will be on statins to lower my cholesterol and other drugs to manage my hypertension for the rest of my life. That I even have a life is thanks to the doctors I encountered in Dubai. But if I had taken more responsibility for my own health two decades ago and had my cholesterol levels checked, I might never have had to call upon their skills, or learnt the true meaning of the word shock.


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