Question from Werner R.: I am 49 years old and have been in very good shape so far. During an MTB marathon, I suffered a severe anterior wall myocardial infarction. About two hours later, three stents were inserted. After a week, I was able to leave the clinic for rehab. The doctor's report showed moderate damage to the pumping capacity (ejection fraction around 35 per cent, normal is around 55 per cent). Can cardiac output be restored to the original level? How should recovery training be organised? I am aware that I will probably not be able to reach the peak heart rate range in the future, but I would like to cycle as intensively and as much as possible again - i.e. road cycling and mountain biking at an ambitious hobby level.
Dr Robert Eifler: A heart attack occurs as a result of coronary heart disease. As a rule, all coronary arteries are affected to a greater or lesser extent. Stents only keep the most severely affected sections of the vessel open acutely and locally. In order to improve the chances of recovery and to prevent the vessels from narrowing further, the following aspects are paramount: treating the risk factors of high blood pressure, lowering cholesterol levels (LDL below 100 milligrams per decilitre of blood), not smoking and avoiding obesity. Of course, endurance sport also helps in the first instance. But you should only exercise at a moderate, aerobic level! This requires ergometric checks, which can be used to determine suitable heart rate ranges. Ultrasound examinations (echocardiography) provide information about the heart's pumping capacity. This is often limited, particularly in the case of anterior wall infarction.
At best, it can be stabilised with low-dose ACE inhibitors. Warning signs of a (new) heart attack are a frightening feeling of pressure behind the breastbone, unusual breathlessness on exertion, acute left-sided armpit pain (often acute stomach pain in women) or sudden loss of performance, to name just the most important.
Intensive cycling training, for example mountain biking in mountainous terrain, is not recommended after a severe anterior wall infarction. You should avoid competitions or competition-like situations. Always ride with a heart rate monitor that sounds an alarm when you leave the recommended heart rate range in order to avoid dangerous moments as far as possible.
