I apologize for being away for so long. I got extremely busy with teaching first aid & CPR classes and have been working long hours 7 days a week trying to get all the classes completed so I have not had an opportunity to dive in months now.
Apparently I worked a little too hard and it finally caught up to me. On September 10th I suffered a massive heart attack also known as a STEMI (ST-elevation myocardial infarction) while loading our CPR training equipment for classes the next day.
Since I did not have the typical symptoms it went unrecognized for about 7 to 8 hours before I finally recognized one of the common symptoms, profuse sweating. I then added up the other minor “unrelated” symptoms that I had been having all day and knew immediately what was happening.
It was a very hot day and the humidity was unusually high. We had just received a new cargo van from the dealership and I was preparing it for the next days classes by loading 10 sets of CPR manikins, 5 dog CPR manikins, airway training manikins, oxygen tanks, and other training equipment into it.
Somewhere around noon I noticed that the temperature inside the back of the van had reached 125 degrees while I was working inside it, so when I started feeling slightly nauseous I assumed it was from the heat and that I was getting dehydrated. When I stopped to cool off in the shade the nausea would stop, but when I started working again in the heat it came back.
This continued for several hours and then I noticed a slight tingling in the fingers of both hands. Since this was not a familiar symptom I continued to work getting the equipment loaded and organized in the van.
About 7:00 in the evening I started noticing that my chest was getting a little tight. I had asthma as a child and it felt as though I was having a very mild asthma attack due to the humidity. Actually an extremely mild case, one that I would not even need to use an inhaler to treat. Since the symptoms were so mild and I was almost finished with getting the van ready I continued to work.
A few minutes later I noticed a pain in the middle of my back right between my shoulder blades that felt just like I had to stretch and pop my back. Since I had been doing a lot of lifting and bending all day I had expected some back discomfort, so it was not a shock to me. I tried unsuccessfully for several minutes to relieve the pain by stretching and shrugging my shoulders to get my back to pop, but the pain just would not go away.
Then the one symptom that I recognized started. It had started to cool off outside but all of the sudden I began to sweat profusely. Almost at once my clothes were dripping with sweat. It was almost like I was standing inside a shower.
I immediately recognized this fatal symptom as a heart attack and immediately reached for the first aid kit to retrieve the 81 mg chewable aspirin that was kept inside. I chewed two of them quickly and let them dissolve in my mouth and under my tongue as I teach in the first aid classes. I also grabbed an oxygen training kit and placed myself on high-flow oxygen (15 liters /min) with a non-rebreather mask. I then called 911 for an ambulance.
When the ambulance arrived I was hooked up to an EKG to monitor the electrical activity of my heart and the Paramedics immediately recognized a significant elevation of the S and T waves on the monitor signifying a STEMI heart attack with complete blockage of at least one of the arteries supplying the blood flow to the heart causing significant damage to the heart. A normal heart attack does not show any change to the EKG however a STEMI heart attack affects a very large portion of the heart and will affect an EKG reading.
Instead of staying on-scene to stabilize me as they normally would have I was immediately rushed to the emergency department for treatment. Blood tests were performed to measure the amount of damage to the heart by looking for chemical markers in the blood.
Troponin is a protein found on the blood that relates to contraction of the heart muscle. Its level in the bloodstream are used to detect heart muscle damage. Troponin levels are normally between 0.0 and 0.10 µg/mL. On my first test the result was .98 µg/mL which showed that a massive heart attack had occurred and that extensive heart muscle damage had resulted from it.
I was rushed into the cardiac catheterization laboratory to evaluate the status of my heart, arteries and the amount of heart damage. They found that my heart had about 50% productivity right now, which means that I was only able to pump half the amount of blood that I should be pumping.
One of the arteries was completely blocked so an angioplasty was performed where they basically run a wire with a balloon on the end of it from your groin up inside your arteries until they come to your heart where the blockage is at. Then the balloon is inflated to breakup the blockage in the artery. A stent was placed in the artery to prevent it from collapsing.
The cardiologist performing the procedure also noted that a second artery had a 90% blockage in it, and a third had a 50% blockage in it. Unfortunately since one artery was completely blocked and this was an emergency procedure they could not risk performing an angioplasty on the other two arteries and I would have to come back after I healed to have them done and have two more stents put in those arteries. I was kept in the hospital for observation and had to wear an EKG transmitter so they could monitor me all the time.
On Friday the 13th I was finally released from the hospital and was glad to get back home. I had classes scheduled all week that I needed to get ready for, the first of which was the next morning when I had a class of 7 students for CPR certification. Wanting to take it easy after the heart attack I had the students carry the equipment in for the class so I did not have to exert myself, however during the class I did have some minor chest pain with sweating which was quickly relieved by placing a nitroglycerin tablet under my tongue.
The next week went about the same, a couple very minor incidents of chest pain on exertion relieved with nitroglycerin. On Friday I had a 1-on-1 class to teach and had to park farther away from the building than I would have liked (about a block). I walked to the apartment building pulling the CPR manikins behind in their wheeled case.
Upon reaching the apartment and starting the class I began to feel chest pain, felt nauseous and started sweating profusely once again. I placed a nitroglycerin tablet under my tongue and the symptoms were relieved, but came back in a few minutes so I took another one. When the symptoms started coming back again I postponed the class and called for an ambulance. Back to the hospital that I had only escaped from one week before.
3 nitroglycerin tablets later and after receiving high-flow oxygen again the symptoms left just about the time the ambulance was getting me to the hospital. After 6 hours in the Emergency Department I was sent to the Telemetry floor to wear the portable EKG transmitter once again.
The Emergency Department doctors were stumped because my Troponin levels did not rise from 0.2 like they expected which would signify another heart attack. They stated that I could take 6 to 8 hours for the levels to increase in the blood, so I would be admitted so that could continue testing me. I agreed to stay for them to run 3 more tests to verify if the Troponin levels were increasing or not. If they increased I would stay in the hospital, if they did not I would sign myself out AMA (Against Medical Advice) and go back home.
At 1:00 in the morning the results finally came back from the third test, my Troponin levels were still at 0.2 and showed no indication of any further damage to my heart. Since the Troponin levels did not rise, they could not classify this episode as a heart attack because there was no evidence of a heart attack. Since there was no indication of further damage to the heart and I already had a followup appointment scheduled for Monday with the cardiologist I kept my word and signed myself out of the hospital against their advice. I could not see any benefit of staying cooped up in the hospital all weekend when by the test results, clearly I did not have another heart attack.
It will be awhile before I am able to dive again, and I will have to limit my activities to boat dives as shore dives will be too demanding and exhausting for me, at least for now.