[Kanga]

During a ride last weekend, one of the riders in our club complained of chest pain and tingling in the arms, near the top of a two-hour climb. He was also short of breath and feeling very weak, considering he's a strong rider. I wasn't on the ride, and am just relaying information posted on our club forums to MTBR. But if I had been there, I'd have known immediately what these symptoms meant.

The group kept riding, with our friend still hurting and getting worse. After the group had to wait an unusually long time for him after a two-hour climb (he's usually right there, either with or just behind the fastest riders), he collapsed for a few moments, but then sat up and said he was OK, even though he could hardly breathe. The group turned back, riding downhill, our friend still riding, and went to the nearest ranger station from where they were able to summon paramedics.

He'd had a heart attack, and doctors have since discovered severely clogged coronary arteries. Even though his fitness level was very high, there was still a great deal of blockage within his coronary arteries that had never been picked up on his physicals. I'm guessing that it may have been because he was so fit that they had missed the hidden heart problems, but I'm not a doctor. Had he not been so fit, the doctors tell him, he probably wouldn't have survived.

Since the weekend, we've been doing a lot of discussion on our club forums and a few conclusions have come up that I wanted to share with all the MTBR crew....

First Aid and CPR training - Since mountain biking often takes us out of cell phone coverage and far away from vehicular access, this is one thing that everyone should consider. For those more seriously considering such training, a step up to Wilderness First Aid or even Wilderness First Responder would be even better, since that training spends more time dealing with situations in which we often find ourselves as mountain bikers.

Aspirin - Though some of our group routinely carry first aid kits, none on this particular ride had aspirin, which can lessen the severity of a heart attack or stroke, and even save a life. I'm not sure if any of them would have known what to do with the aspirin, since none had basic first aid or CPR training, and from the reports, it seemed that nobody in the group suspected a heart attack in such a fit individual who was so young (40's) and skinny as a rail.

ID - Keep essential paperwork in your camelback or toolbag: a copy of your ID and Insurance cards, and a list of emergency contacts, doctors, medications, allergies and medical conditions. I just printed mine on the computer and laminated it.

Local Knowledge/GPS/Cell Phone/Radio - Though they had radios, GPS and cell phones, it was knowing the location of the nearest place to summon help (a ranger station) that ultimately determined the outcome of the incident. In other cases, a GPS might be used to give coordinates by radio or cell phone if the victim/patient is unable to be moved.

Solo riding - Had he been riding alone.... well we won't go there, since everyone knows to tell someone where you'll be and when you'll be back and/or take a riding buddy with you.

Our friend is now in the ICU, has undergone angioplasty, and will be off the bike for several months. But they tell us, with his newly opened coronary arteries, he might even come back a stronger and faster rider in the future.

He was lucky, and we're all grateful for the outcome. But it shouldn't have taken such a potentially tragic event to give us all the wake up call we needed.

I hope after reading this a few more riders take the initiative and get trained on the basics. The life you save may be one of your riding buddies.....

 

[slocaus]

He'd had a heart attack, and doctors have since discovered three severely clogged coronary arteries. Even though his fitness level was very high, there was still a great deal of blockage within his coronary arteries that had never been picked up on his physicals. I'm guessing that it may have been because he was so fit that they had missed the hidden heart problems, but I'm not a doctor.

Some blockages do not show up al all. Mine was the LAD and if not for riding, I'd have never known it. It is termed the 'widow maker' with no warnings, just a massive myocardial infarction.

Our friend is now in the ICU, has undergone angioplasty, and will be off the bike for several months. But they tell us, with his newly opened coronary arteries, he might even come back a stronger and faster rider in the future.

Likely he will. I was restricted from lifting over 10 pounds for a week, then was given total freedom to do what I wanted. I had my warning a few months prior, but had not had any exercise for four months. When I went for a ride, I was stronger than before. (My story of the cath lab and stents is in my sig.)

Let your friend know that he has many "heart beats" and "pedal strokes" in his future!

 

[Jisch]

I ride with a guy who is overweight. He does really well on the climbs and can flat out-ride me on the descents. We're somewhat competitive and I'll hammer up any hill to prove I can get to the top before him (its hardly ever a contest).

Recently when riding with a third friend, he suggested that we need to lighten up so this guy can catch his breath and "not have a heart attack". It hit me that if this guy did have a heart attack, I don't know what I'd do. He weighs 240 lbs, most times, its just the two of us out there. No way I could move him any distance and I mean that literally.

Something to think about I suppose, I should look into some training - I have taken various first aid and CPR classes over the years, but I need a refresher.

John

 

[Kanga]

Slocaus, he'll be glad to hear of your outcome. In retrospect, he'd been slowing down on the climbs over the past few months, but had put it down to stress and age, but now we know better.

Jisch - If you've had CPR classes over the years, the standard of care has been revised and has changed several times. What you learned years ago may be deemed inappropriate by current standards (which doesn't mean you shouldn't use whatever knowledge you have if the need arises). If you're comfortable with the actual administration of CPR, but are rusty on the timing, order, and other standards, there are now online classes that will help get you back up to speed. But IMO they're only appropriate as refreshers, not for first-time CPR classes, and even then, if you can take a real class you're much better off. There's nothing like hands-on practice.

Our friend is in his 40's, 5'7" and less than 140 pounds. Not the size or type you'd expect to have blocked arteries. I spoke to him after posting above. He's been given a stint, and angioplasty, and the doctors were indeed amazed that he made it to the ER after continuing to ride with a heart attack in progress for more than an hour.

 

[slocaus]

Our friend is in his 40's, 5'7" and less than 140 pounds. Not the size or type you'd expect to have blocked arteries.

It is all genetics. If you have the (bad) genetics predisposed for arteriosclerosis, there ain't much you can do. Sad, but true.

That is how my cardiologist explained it to me. Maybe being a vegetarian and taking all of the modern meds, but they will not be subscribed beforehand, and did not exist thirty years ago when my blockages began so subtlety.

 

[Kanga]

Stripes, I used to be in Portland, but am in So Cal now. The only place I know of for WFR training is the Sierra Mountain Center, near Bishop/Mammoth. I did their avalanche 1 training program two winters ago. Their WFR training is a ten-day course that's very intense.

 

[yfdcap]

This is a great thread. I would like to caution not to take aspirin if you suspect you are having a stroke though. If the stroke is a bleeding stroke(ruptured blood vessel)and not a clot it will make it more severe. For a reminder.
Heart attack warning signs are:
Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
Shortness of breath with or without chest discomfort.
Other signs may include breaking out in a cold sweat, nausea or lightheadedness

Signs for Stroke are: Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
Sudden confusion, trouble speaking or understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination
Sudden, severe headache with no known cause

 

[Christine]

It really is a great reminder to people, thanks! Especially in light of all the recent posts about stuff like this.

 

[tahoedirtprincess]

Asprin

My husband had a heart attack a few months ago.

It's not so much about wilderness training or First Aid/CPR, it's about swallowing your pride if you are having symptoms or for the person with you to realize that it could be a heart attack. The WORST part of the heart attack is letting it continue and allow the heart to become oxygen deprived where the muscle starts to die off considerable (aka "damage"). When this happens, this lessens the effectiveness of your heart. One of the big signs? The person is as white as a sheet and they say "I have this discomfort in my chest...." OH BIG SIGN!

He now has a stent and is on a plethora of medications. However, he was able to get back on a bike within a month or so.

Also if you have anyone in your group that is diabetic, keep them in mind as well. Not only because of their sugar to insulin ratio, but because diabetics are more apt to have heart disease as well.

Even I forgot about the asprin. I will be putting that in my camelback tonight. You never know when you might need it and it's not like it's taking up a WHOLE lot of space!
Thanks for the reminder!

 

[Kanga]

This is a great thread. I would like to caution not to take aspirin if you suspect you are having a stroke though. If the stroke is a bleeding stroke(ruptured blood vessel)and not a clot it will make it more severe.

Thanks for that clarification... my understanding is that TIA or CVA's caused by a blood clot account for more than 80% of adult stroke victims (for children, it's typically 50% hemorrhagic).

But since there's no way to know for certain if a stroke is being caused by a blood clot or bleeding without a CT scan or other medical imaging, Aspirin shouldn't be administered in the field, especially if help is not too far away.

From what I've been reading, if the stroke symptoms (numbness, paralysis, etc, as listed above) have subsided and not returned for 1 hour, one can assume a TIA, and administer aspirin to prevent a re-occurrence until professional help arrives. Bleeding strokes generally don't subside on their own. I'm not an expert so do your own research and get proper training!

I should add that some people are allergic or sensitive to aspirin and should not be given any. That's why having the medical information, including allergies, as I listed in the first post, is also very important.

 

[scheckler]

Now I am scared...

My husband had a heart attack a few months ago.

It's not so much about wilderness training or First Aid/CPR, it's about swallowing your pride if you are having symptoms or for the person with you to realize that it could be a heart attack. The WORST part of the heart attack is letting it continue and allow the heart to become oxygen deprived where the muscle starts to die off considerable (aka "damage"). When this happens, this lessens the effectiveness of your heart. One of the big signs? The person is as white as a sheet and they say "I have this discomfort in my chest...." OH BIG SIGN!

He now has a stent and is on a plethora of medications. However, he was able to get back on a bike within a month or so.

Also if you have anyone in your group that is diabetic, keep them in mind as well. Not only because of their sugar to insulin ratio, but because diabetics are more apt to have heart disease as well.

Even I forgot about the asprin. I will be putting that in my camelback tonight. You never know when you might need it and it's not like it's taking up a WHOLE lot of space!
Thanks for the reminder!

I have had diabetes for 38 years, insulin dependent. I have been riding for years now but do get these weird chest pains, like pressure and sometimes feel that something is just not right. It is very difficult for me to describe the feeling. I have told my doctor about this but she thinks it is something else, not heart related because I exercise every day. Now I am not so sure... thanks for this thread. Time to get a second opinion. Btw, what does one do when one is allergic to asprin?

 

[Kanga]

Tahoedirtprincess, glad to hear your husband is back on the bike. My friend will be very encouraged to hear of other's stories of recovery.

While you're at it with the aspirin, remember some Benadryl. Bee sting allergies can also be fatal, and some people don't know they're allergic, or know, but don't have an epi-pen. The gel tabs are best, since someone with a rapidly closing airway may not be able to get down a pill, and you can break open the gel and absorb the liquid through the lining of the mouth.

You can also use an asthma inhaler to help open airways in the case of anaphylaxis (closing of the airways due to swelling from an allergic reaction).

Let's get safe!

 

[tahoedirtprincess]

I carry an epi-pen, I'm not sure that an asthma inhaler would work correctly, it dilates the bronchii not the throat or tongue that sometimes swells up during an allergic reaction. I always have Benadryl along for the ride as well.

The ER and cardiac rehab folks all have bashed into my head to give asprin. The chance someone is allergic usually is by rash, which is alot less harmless than prolonging the clot. There are all kinds of guidelines for it, the best place to go to is the American Heart Association website. Having been through it myself with my husband, it's still very scary, but the key part is to keep calm. He had chest pain for over 30 minutes before getting to the hospital with no damage to his heart. The short of it is to address it as SOON as they have pain. Which I know is hard, because no one wants to admit they are having a heart attack....

 

[Kanga]

I have had diabetes for 38 years, insulin dependent. I have been riding for years now but do get these weird chest pains, like pressure and sometimes feel that something is just not right. It is very difficult for me to describe the feeling. I have told my doctor about this but she thinks it is something else, not heart related because I exercise every day. Now I am not so sure... thanks for this thread. Time to get a second opinion. Btw, what does one do when one is allergic to asprin?

If your doctor is not a heart specialist, then definitely get a second opinion. The best way to find coronary artery blockage or occlusion is with an angiogram, where dye is injected into the blood and an X-ray taken of your heart. My friend, the patient, is in his 40's with no history of any medical problems. He had a physical less than 6 months ago, and was given the thumbs up, so nobody would have thought to order an angiogram.... now he'll be getting them every year.

 

[Kanga]

I carry an epi-pen, I'm not sure that an asthma inhaler would work correctly, it dilates the bronchii not the throat or tongue that sometimes swells up during an allergic reaction. I always have Benadryl along for the ride as well.(

I believe that some countries the adrenalin inhaler is the standard of care for allergic anaphylaxis, though not in the U.S. where Epi-pens are the standard. If you don't have benadryl or an epi-pen, an asthma inhaler would be my next choice, and while not as effective as the first choices, it may just be enough to keep someone's airways open enough to breath on their own until help arrives. In one of my wilderness first aid training classes years ago, this did come up and was recommended, to the point where the company I worked for required them in all the first aid kits.

 

[scheckler]

Kanga, I really appreciate

If your doctor is not a heart specialist, then definitely get a second opinion. The best way to find coronary artery blockage or occlusion is with an angiogram, where dye is injected into the blood and an X-ray taken of your heart. My friend, the patient, is in his 40's with no history of any medical problems. He had a physical less than 6 months ago, and was given the thumbs up, so nobody would have thought to order an angiogram.... now he'll be getting them every year.

your input I am 43. This feeling does not always occur when I am riding, I am trying to figure out if there is a pattern(if there even is one). I have great insurance so cost should not be an issue. Now I know who to talk to and what to ask... thanks.

 

[HarryCallahan]

What he said!

If your doctor is not a heart specialist, then definitely get a second opinion. The best way to find coronary artery blockage or occlusion is with an angiogram, where dye is injected into the blood and an X-ray taken of your heart. My friend, the patient, is in his 40's with no history of any medical problems. He had a physical less than 6 months ago, and was given the thumbs up, so nobody would have thought to order an angiogram.... now he'll be getting them every year.

Absolutely get another opinion. My dad had a triple bypass a couple years ago. The only symptoms he'd had were some mild tingling when he was lifting weights, and some shortness of breath at altitude when he skiied. My dad is 5'10 and 160 lbs, not a smoker, careful eater. His doctor chalked it up to age (my dad was 69 at the time, and how hard he works out, which is a lot!) My dad finally saw the heart specialist, had some pictures (angiogram) taken, and was not allowed to leave the hospital, as he had 90% blockage in 3 arteries, including a junction between two. He had bypass surgery 2 days later. Two years later, dad is fitter, and has less problems at altitude, though he also takes it a little easier.

 

[AkDave]

This subject hits too close to home....

It is all genetics. If you have the (bad) genetics predisposed for arteriosclerosis, there ain't much you can do. Sad, but true.

That is how my cardiologist explained it to me. Maybe being a vegetarian and taking all of the modern meds, but they will not be subscribed beforehand, and did not exist thirty years ago when my blockages began so subtlety.

My dad died at 63 after many heart attacks.....I'm 61 almost......I've been riding mtbs for close to 20 yrs now. A year ago I had surgery on my back. After a reasonable amount of time I told the neurosurgon (sp) that I still had major pain in my leg. He sent me to a vascular doc and after the prescribed tests I am told I have "atreriosclerosis". I have had the artery opened twice now.....I still don't think it's right. Well, I don't ride off road anymore mostly to the back issues and loss of fitness but I'm putting more and more miles on the road to gain back my cycling fitness. As I ride and go about my daily activities I wonder which artery will clog next.....genitics.....who would of thought.
Dave

 

[Steve030687]

It is great to see everyone start to realize some of the medical emergencies that can arise while out on the bike. One thing that I do see people trying to do is a field diagnosis. Don't sit there and try to figure out if someone is having a stroke or heart attack; just get help ASAP. Carry a cell phone, if you are really out in the middle of nowhere, call first then move if you have to. Your position can be triangulated and help will come to you. Also, we move mighty fast on ATVs. There are tons of symptoms of a heart attack, but the main one is chest pain or tightness. This tightness can radiate to the neck, or especially the left arm. Dial 911 before giving any medication. Some pain may be attributed to Angina Pectoralis, which is more of a chronic condition where the heart cannot get blood fast enough due to smaller diameter arteries. A full blown heart attack is when a little clot gets stuck in the already small artery. Regardless, these two will show the same conditions and CALL 911!!

And as always, wear your helmet!

 

[Steve030687]

Jisch - If you've had CPR classes over the years, the standard of care has been revised and has changed several times. What you learned years ago may be deemed inappropriate by current standards (which doesn't mean you shouldn't use whatever knowledge you have if the need arises). If you're comfortable with the actual administration of CPR, but are rusty on the timing, order, and other standards, there are now online classes that will help get you back up to speed. But IMO they're only appropriate as refreshers, not for first-time CPR classes, and even then, if you can take a real class you're much better off. There's nothing like hands-on practice.

Yes, it is true that the standards have changed effective last June. Don't let your knowledge of the old standard stop you from doing something. Air goes in the mouth and pump on the chest; just don't do them at the same time. If you do that and CALL 911 then you have done your part. Leave the rest to me :thumbsup: