Skiing After a Heart Attack

I am a local PNW Skier who recently had a heart attack in my mid 30s. My heart attack was caused by genetics and stress, but triggered by exertion as it happened while working out at the gym. A plaque in my artery ruptured and created a clot that blocked blood flow to my heart.

My Dr. Says I am fine and fully recovered and ready to ski again but mentally I am seriously reluctant. I am afraid I have other vulnerable plaques that are ticking time bombs waiting to rupture and that the stress of adrenaline, high altitude, cold weather and exertion involved in skiing will trigger another attack, and that I will be so far from a cardio cath lab that the damage to my heart will be much more severe or that I could just drop dead.

I'm not going to let this stop me from living life but I want to take a measured approach. So, I have questions, especially for the patrollers who I know frequent this board.

How many heart attacks on the slopes happen each year at Crystal, Stevens, Snoqualmie and Baker? What is the survival rate? Do all these resorts have clot buster drugs available and ready to be injected and automatic defibrillators? What is the time average for the various resorts of getting the patient to a cardio cath lab?

If there are any cardiologists reading: How likely is it that I have other vulnerable plaques that may rupture while on the slopes? Is there any way other than standard drug and diet and exercise therapies that can reduce or eliminate my risk of plaque rupture or clotting? Should I stay off the slopes and stay near the hospital for the next 18 years while I start and raise a family and then start skiing again once I've I have lived a full life and wouldn't mind dying so much?

Thanks for any comforting words or information.

That's tough -- I'm sorry you're having to wrestle with it, but I'll bet you get a lot of good information here.

For what it's worth, all of the Snoq ski areas (and Crystal, I'm sure) have AEDs ready to go on the hill. The NSP first aid protocol doesn't allow (or teach) patrollers to do any kind of injection, let alone a blood thinner or clot dissolver -- I don't know if that's available in the aid rooms, but if it is it could only be administered by one of the area MDs.

Lots of your other questions sound like you need to speak in more detail with your doctor, or with a different doc if you're not getting the answers you're looking for...

-  I have a tidbit of info from the Sierras. Los Angeles is the main draw of vacationers who frequent the Sierras. During the ski season, Mammoth Mtn. is real popular. I've lived there, and I know that there are those types of 'things' which occur. For the amount of skier visits, I think the # of situations is very low. The ski area has a pretty high elevation. The town is 8000ft. and the summit is 11,000 ft. One of my unique ski things there is I get to use a water fountain at the Gondola. This really helps as I've skiied for like 4 hours straight doing top-runs. So I get the hydration, and then I get the 5 min. rest period. I think cold weather conditions make your body work more.
    The Mammoth Ski Patrol has a good website. I don't know if they take questions. You might try other mountains for Ski Patrol websites.

If your doctor has cleared you for skiing (presumably with some sort of risk stratification test like a stress echo) and you are on conventional plaque-stabilization therapy (statins, aspirin, or other anti-platelet drugs), there isn't much more that evidence-based medicine can do to further lower risk. There is a risk of another event, and whether or not you ski depends on how comfortable you feel accepting that risk.

If you are mentally reluctant to accept your cardiologist's advice by all means get a second, or a third, opinion. Collect more information. You might also look into a cardiac rehab program. You can exercise on a treadmill or a bicycle while wearing a cardiac monitor with a cardiac nurse a few feet away and a hospital a block away. Work up on the exercise intensity until you substantially exceed any exercise intensity and duration that you think you might experience on the slopes. Seeing how you do in such a monitored situation might give you the information and confidence you need to get out on the slopes.

That's really a tough break...

At Alpental they have an AED in the first aid room. There was discussion to have one at the top of 2 as well, but to my knowledge the first aid room still has the only one on the hill. Each patroller is also required to complete AED and CPR refreshers as part of preparing for the coming season.

I'm no longer active with the patrol, but just checked in with a friend who is and he's not aware of any heart attacks on the hill at Alpental going back to 1999. A Patrol Doc, Patrol Director, or Area Risk Management person could provide more complete data. Also don't know about the drugs.

The time to get a patient to advanced care is dependent on too many variables (location on hill, availability of transport, weather), but its not going to be anything like the response in an urban area.

Have to give the little blurb about not speaking for or being a representative for Snoqualmie Pass areas and the parent companies etc etc..

All the areas have AED's at the bases that can get anywhere by snowmo pretty fast and all patrol is very well trained in their use and recognizing possible cardiac events. However, there is no ALS (paramedic level care; cardiac drugs etc) at the Pass. The closest ALS unit is coming from North Bend or Cle Elum. That said, I have personally only had one cardiac patient (chest pain) in 7 years of volly and part-time patrolling and it was a sedentary person in the lodge with a long history. Not sure on overall stats but I am fairly sure it is very low.

I would hope that following your MD's advice, continuing to be active and getting out more will help you feel more confident about your activities. Knowing limits and gaining strength again will help you be self-limiting when you need to be. Hopefully as you recover physically and mentally we will see you on the slopes and in the BC!