LOS ANGELES — “I think I’m having anxiety,” Leonard Castro told his wife on a day back in September.
Some time in the days running up to Sept. 9, multiple factors that made 46-year-old Leonard a prime candidate for a heart attack converged. His body was groaning: Blood pressure too high. Too much bad cholesterol. Too much sugar in the blood.
Too much weight.
Over the years, the walls in the arteries of his heart had narrowed and stiffened with plaque. The cells in those arteries became inflamed, a medical term perfectly derived from the Latin word inflammare: to set on fire.
Small clots of blood began to plug the arteries. Each time the flow of blood faltered, even for a few seconds, muscle cells died from lack of oxygen.
That was what was happening inside one man’s chest. Simultaneously, lives were upended. A spouse began imagining herself a widow. A father feared he would outlive his son.
A middle-aged man wondered: How could this happen to me? Someone has a heart attack every 34 seconds in the United States. For 785,000 people, it’s a first heart attack. For 470,000, it’s a second or perhaps third attack.
Survival rate on the rise
Fewer people than ever suffer that “big, bad heart attack” that kills them or ruins their health, says Dr. C. Noel Bairey Merz, director of the preventive and rehabilitative cardiac center at Cedars-Sinai Medical Center in Los Angeles. “If you can get to the hospital, the death rate is very low now.” More than 90 percent of heart attack patients who reach the hospital survive, according to a recent study.
And most people who survive heart attacks today are expected to fully recover. But that is not to say their lives don’t change dramatically. They have to.
One minute Castro, an auto parts salesman, was a weekend golfer who changed the oil in his car, mowed his own lawn and trimmed the ivy.
The next minute, he was on disability, could barely walk across his house and needed help using the bathroom.
His wife, Hilda, asked neighbors to keep an eye out so he didn’t do anything stupid and strenuous, like start the lawn mower.
That is a heart attack for those who survive.
“I felt like a dead fish in the water,” he said of those first weeks at home with a healing chest. “I couldn’t bend down. I couldn’t put pressure on the chest. When we brought groceries home, Hilda would bring in the bags. I would carry a loaf of bread or the eggs.”
The Castros were hosting relatives for Labor Day weekend when it happened. On Saturday, Leonard and Hilda’s cousin played golf. He joined a raucous game of volleyball in the pool. He manned the grill, flipping burgers and steaks.
“Kind of lost my breath”
On Sunday, they went to a swap meet. Leonard says that, while standing by the entrance gate, “I kind of lost my breath. It felt like a smog day, when it hurts when you breathe.” Leonard waved off Hilda’s concern.
A heart attack? No way. But, in fact, he had been warned about such a day. Over the years, he had developed into a walking checklist of cardiac risk factors. He was 5 feet, 11 inches and weighed 318 pounds. He took blood pressure medication and had total cholesterol of about 250 — too high. His father had heart disease. Five years ago, Leonard was diagnosed with diabetes.
On Thursday, when Hilda found him lethargic, sweating and pale — still insisting he was OK — she erupted. “We call 911 or I’ll drive you to the emergency room,” she ordered.
Within the hour, an emergency-room doctor told Leonard that he had had a heart attack.
Leonard’s 81-year-old father burst into tears when he saw his son hooked to an electrocardiogram machine. “This shouldn’t be happening to you,” he cried.
Leonard was transferred to St. Joseph Hospital in Orange, Calif., and two days later underwent a quintuple bypass surgery to re-establish blood flow in five completely or partially blocked blood vessels.
Family and friends filled three waiting rooms. Hilda asked them to be strong in front of Leonard. No tears.
He cried once, lying on the gurney just before surgery. He was afraid he would not survive. Hilda cried too. “I was crying because he had to go through this.” Heart disease remains the leading cause of death among Americans despite numerous advances to keep patients alive. But it used to be far worse three decades ago. Heart attack patients were treated very differently from now, Bairey Merz of Cedars- Sinai recalled.
Before the advent of coronary bypass surgery, clot-busting therapies and angioplasty, a procedure to open a clogged artery, survivors were left with heart failure, Bairey Merz says. “They didn’t go back to work. They were weak.” Cardiac rehabilitation also changed, turning into a comprehensive program called secondary prevention that starts right after release from the hospital.
Secondary prevention is Life Overhaul 101. Patients learn about nutrition, exercise, stress reduction and how to manage multiple medications: aspirin, statins, beta-blockers and ACE inhibitors. They are screened for depression and treated if necessary. Smokers are urged to begin cessation classes.
Studies show that the more patients adhere to their program, the better they do.
“If, a year after a heart attack, a patient is taking all of these medications, they have a 90 percent reduction in recurrent risk,” Bairey Merz said. “If they then do some exercise and go to a cardiac rehab program, they basically become immortal.”
Leonard Castro doesn’t feel immortal.
When he awoke from surgery, his chest felt heavy and numb. When he arrived home, he was confined to the upstairs of his house and a schedule of 10 five-minute walks a day.
Later, he would sit in a chair and watch Hilda clean the pool, and he’d simmer with frustration that he couldn’t help.
“I would get up and try to sweep some leaves, and she would get so mad at me,” he recalls.
His worst day occurred a couple of weeks after the heart attack, when he looked up information on quintuple bypass on his home computer. One article said his life expectancy was 15 years.
Since the surgery, he has lost 35 pounds and his blood sugar has improved. He and Hilda, who has lost 10 pounds herself, walk every day. If it’s raining, they grab umbrellas and go anyway.
“I’m still sort of in shock that it happened,” he said. “But every day I go in the bathroom to shave and I look in the mirror and see my scar. I’ll see that scar every day.”
At the first visit with Azer after bypass surgery, the doctor was straightforward.
“You’re young,” he told Leonard. “You have a fresh heart. Now it’s up to you to make the decisions to make this work.” Leonard nodded. Hilda smiled. “A fresh heart,” she said. “I like that.”
