Lifting after a heart attack

[knoted]

Gday Rip.

I'm trying to get some more information about lifting after a heart attack. Specifically if part of the heart muscle is dead. I was hoping you or some of the doctors on here might be able to point me in the right direction.

My cardiologist is concerned about the "isometrics" of powerlifting. He basically means the valsalva and straining to lift a heavy weight. Apparantly that causes a fair bit of blood pressure increase that would increase my chance of having a blowout and dropping dead on the spot. It sounds fairly legit to me, but he's the first cardiologist out of 4 to have a problem with lifting.

I'm not asking for a diagnosis, but here's a quick background if it would be helpful. I had non-hodgkins lymphoma when I was 22 (5 years ago), with some pretty hardcore chemo. Complications included a blood clot in my head, massive internal bleeding needing 4 units of transfusion and the heart attack, caused by a massive blood clot in my LAD artery. The heart attack was the only even to cause any permanent damage, my ejection fraction was 42% at last measure, down from about 60% prior to chemo.

In the last three years (2 years of recovery) I've deployed to Afghanistan with the Australian Army, stopped smoking, put on about 15kg of muscle, I'm a lot fitter and just healthier in general. I've even played a few games of rugby, which I think is pretty much the roughest game I could possibly be playing.

However, my cardiologist thinks I should just do "some light jogging, swimming and cycling". I'm told "it won't matter how big my biceps are when I'm in my 40s."

So far the only reasonable solution I've come up with is to increase my rep range up to 10-15, light enough that I don't have to do a hard valsalva. Well into body builder range, but I'd still be getting a lot of the benefit.

The only specific questions I have is if I were to decrease load down to the 15RM for 12 range would I be reducing my momentary blood pressure by any significant amount? Is there any particular intensity level that greatly increases blood pressure that I should avoid?

Any comments you or your readers provide would be appreciated.

[Mark Rippetoe]

Where specifically is the necrosis?

[thefinalsql]

I had a heart attack in June 2008. Started lifting in June 2009. I do not feel like I have endangered myself by lifting heavy weights.

That being said, that is me. I had a "minor" heart attack, angioplasty, no stints. I am not going to tell someone else it is okay to lift after a heart attack. Every situation is unique.

I did six weeks of cardio rehab which involved treadmill, recumbent bicycle, and very light dumbbells. I think I did not get to even 10 pounds. I was hooked up to EKG, heart rate, and the nurses measured my blood pressure often. I am not sure if you can measure your blood pressure while lifting. But, you could probably measure it immediately prior and after the lift to see what your numbers are.

[rao00010]

Sounds like you had an anterior MI, which means that the front wall of the heart is dead (although the necrosis may not extend through the entire wall, and some of the wall may still be alive). From your description of what you have done since the event, you've been very active, ostensibly without any problems.

A few questions:

1. How was your heart attack treated? Was the LAD opened with angioplasty?
2. Do you have any symptoms at all of heart failure like shortness of breath when lying flat, swelling in your legs, or waking up at night gasping for air?
3. Is there any other heart damage like valve problems?

Sunil

[knoted]

The front wall is the damaged part.
MI was treated with blood thinners only.
I have no symptoms.

The report says "segmental wall motion abnormality in the LAD distribution".

[Mark Rippetoe]

As far as the cardiac stress of the valsalva is concerned, find and read the full text of this paper:

http://www.mendeley.com/research/lef...alva-maneuver/

[knoted]

As far as the cardiac stress of the valsalva is concerned, find and read the full text of this paper:

http://www.mendeley.com/research/lef...alva-maneuver/

Thanks Rip.

Lets see if I've got the gist of it.

The valsalva could actually be protecting the heart from the increased blood pressure by creating an external pressure to cancel it out.
People who lift weights over a long period of time have thicker heart walls.
There doesn't seem to much difference between 80% and 100% 1RM.

The first two seem to be "good things" for someone in my position. However as some of my heart is dead, would that dead section respond to training in the same way? Would it change shape with the valsalva to allow the equaling of pressures? I doubt it would get thicker with increased training but who knows.

The third seems to suggest that I can lift in whatever rep range I want.

[rao00010]

Sorry - one more question - is there any mention of the front wall being thin or aneurysmal? If the wall is of normal thickness, then I don't see any problem with barbell training. Be prudent, follow the recommendations, listen to your body, and you should be fine (this applies to all of us, of course).

Sunil

[Mark Rippetoe]

That's an important question to have answered. The scar will not adapt, but the rest of the ventricular wall can. If the scar is solid and of good integrity, the system can adapt to the added work. The valsalva protects the system from pressure-gradient effects.

[knoted]

I'll have a look through my file on Tuesday after the long long weekend to see what I can find about the anterior wall.

Sunil - Whos recomendations should I follow? Rips (5s) or the cardiologists (10s-15s)? Or were you meaning something different.

Listening to my body and not being too aggressive with increasing load and volume is something I need to pay more attention to if I'm going to make it to 70 I think.