BOULDER, Colo. — Dean Schultz and a friend had bicycled up to the amphitheater turnoff on Flagstaff Road one Saturday last May when Schultz felt his chest tighten oddly.
At first, he ignored it.
He was tired, had been tired for weeks, flying between Texas and Denver to care for an ailing relative. He told himself that, at 64, he was getting old. He blamed all the travel for messing up an exercise regimen that included cycling to work and riding up Flagstaff to the Walker Ranch overlook at least once a week.
He wanted to press on. His friend, who knew that Schultz had a history of heart problems, talked him into turning around.
“At first, I dismissed it, but then I thought it could be a twinge of angina,” Schultz said.
And that is how, four days later, Waldean Schultz, a fit and healthy man who had no reason to think that one of his coronary arteries was almost completely blocked by a calcium deposit, found himself undergoing a coronary angioplasty procedure.
For the second time.
“Don't think that you're protected from atherosclerosis because you exercise and eat right,” said Boulder, Colo. cardiologist Jamie Doucet.
Doucet administered that procedure on Schultz last year, installing a polymer stent in Schultz's left anterior descending artery, the artery so commonly blocked that cardiologists have nicknamed it “the widowmaker.”
“I can't tell you how many times I've walked into the ER and found someone having a heart attack, and when I ask about a family history of heart attacks, the guy tells me, 'Yeah, but I exercise,' ” Doucet said. “Children of someone who died from a heart attack may live a different lifestyle than that parent, but it's not enough to overcome their genetic predisposition.”
Read his words again, especially if you're someone who's disciplined about working out regularly — someone who takes the stairs instead of the elevator or ignores the paper cup of sour cream served alongside a baked potato. Even if you don't fit the profile of someone at risk for coronary disease, a family history of heart disease can mean you're vulnerable.
Remember Jim Fixx? The author of “The Complete Book of Running,” which helped propel multitudes to lace up their jogging shoes, was the son of a man who died of a heart attack at age 43 — nine years younger than Fixx, who died while jogging in 1984.
At the time, most people saw Fixx's death as ironic, not predictive. The autopsy found that all three of Fixx's coronary arteries were damaged by arteriosclerosis — arteries so thoroughly blocked that blood trickled instead of flowing.
Like Schultz, Fixx was conscientious about exercising religiously and eating conscientiously. Like Schultz, genetics trumped those best behaviors.
But Schultz learned something from his first encounter with angina in 2007: Pay attention to the symptoms, and see a doctor.
Back then, he'd felt a sudden tightness in his chest as he walked down his driveway to pick up the mail. Twice in the next few days, that strained sensation returned as he sat at his keyboard, and he arranged to see his physician.
Diagnosis: His left anterior descending artery was 80 percent blocked. Treatment: Install a stent. At the time, it was a stainless steel tube with slots, inserted with a balloon catheter that opens the steel mesh stent against the inner wall of the coronary artery. Doucet compares stents to Chinese finger puzzle traps.
After the stent was installed, Schultz figured he was good to go. He monitored his diet. He exercised, faithfully wearing a heart rate monitor to make sure that he didn't exceed 140 beats per minute. (Doucet had warned him that pushing his heart rate higher than that could put additional stress on his heart.)
So Schultz was surprised to learn, on that day last May, the same artery was blocked again — 90 percent this time — with scar tissue. The blockage was revealed in a coronary calcium scan, a procedure designed to look for the calcium deposits that caused Schultz's first angina episode. It also can locate the scar tissue that is often a problem with bare-metal stents, the type used in Schultz's first angioplasty.
“With the bare-metal stent technology, 20 percent of the patients had to be fixed again, sometimes in six months, and if you were diabetic, that number was closer to 40 percent,” Doucet said.
Last May in the procedure on Schultz, Doucet used a polymer drug-eluting stent, which is coated with medicine slowly and continuously released into the artery to discourage scar tissue formation.
“I didn't know that stents could have scar tissue build up around them,” said Judy Schultz, Dean's wife.
“We thought that he'd been taken care of.”
Schultz said the new stent made a dramatic change almost as soon as it was inserted. His chronic exhaustion disappeared. When his wife arrived at the hospital to take him home, she was amused to find Schultz “flirting with the nurses.”
Schultz is back to his Saturday rides up Flagstaff, and to riding his bicycle to and from work.
“He's a new person,” said Judy.
Claire Martin: 303-954-1477, firstname.lastname@example.org or twitter.com/byclairemartin
Forestalling a heart attack
Boulder engineer Waldean Schultz noticed symptoms of angina during his weekly bicycle ride, scheduled a visit with his doctor, and learned one of his coronary arteries was almost completely blocked. A procedure corrected the damage.