Powerlifting after Angiogram

[Ronin_Z]

Hello Dr. Feigenbaum and Baraki,

I'm a 40 year old male who was recently diagnosed with coronary artery disease. Quite shocking actually. Never smoked or drank. Did workout but not as consistently. But strong family history. I was slightly overweight, but in 2019, I hit a weight of 175lb with a height of 5'8".

Discovered you guys, and in early 2020, started the beginners template and setup proper macros. Lost 40 lbs and gained significant strength by the end of 2020 and continued to maintain the healthy lifestyle. So thank you both for that.

Long story short, I had an CT Calcium score which showed moderate calcifications, and a follow up CTA showed 90% stenosis throughout my right coronary artery. However no symptoms at all. Given my subcontinent ethnicity, my cardiologist stated the lack of symptoms are common.

So he recommended an angiogram.

My concern is resuming weightlifting after the angiogram. I don't have the risk of post infarct ventricular wall rupture in my case, so I'm not worried about the transient hypertension. But the concern is more either the radial or femoral access and if the increased abdominal pressure may cause a hematoma.

There isn't any great info I could find online other than 2 weeks of no exercise, but I assume that means a light cardio or really light weights after those two weeks. Of course, in my case, I would love to go back to my BM template ASAP!

Thanks again guys.

[Austin Baraki]

Up front: we are unable to give you individualized guidance for return to activity after medical procedures via this forum. All of our discussions on these topics are purely informational.

You asked about both radial and femoral access. Is this because they were unable to get radial access, and therefore had to switch to femoral?

Assuming an uncomplicated procedure and no bleeding issues, most patients are returned to normal activity after successful radial access quickly (often 2-4 days). Femoral access is often a little bit longer (say, 5-7 - although like most other post-procedural instructions, this is mostly made up). Two weeks is excessively long for an uncomplicated angiogram, especially since it sounds like there was no intervention needed. It would be reasonable to adjust the load intensity down a bit for your first few sessions back, regardless.

As an aside: based on what you've described here so far it's not clear that you really needed the invasive angiogram given the asymptomatic RCA disease without issues elsewhere, but obviously that is behind you at this point (and there may be aspects of the case that I don't know). Additionally, hopefully they are checking and aggressively managing your blood lipids/ApoB, blood sugar, blood pressure, and have checked a Lipoprotein(a) level as well (we have free content available on all of these topics). It sounds like you are doing great with resistance exercise, but would also make sure you are meeting conditioning recommendations too.

[Ronin_Z]

Up front: we are unable to give you individualized guidance for return to activity after medical procedures via this forum. All of our discussions on these topics are purely informational.

You asked about both radial and femoral access. Is this because they were unable to get radial access, and therefore had to switch to femoral?

Assuming an uncomplicated procedure and no bleeding issues, most patients are returned to normal activity after successful radial access quickly (often 2-4 days). Femoral access is often a little bit longer (say, 5-7 - although like most other post-procedural instructions, this is mostly made up). Two weeks is excessively long for an uncomplicated angiogram, especially since it sounds like there was no intervention needed. It would be reasonable to adjust the load intensity down a bit for your first few sessions back, regardless.

As an aside: based on what you've described here so far it's not clear that you really needed the invasive angiogram given the asymptomatic RCA disease without issues elsewhere, but obviously that is behind you at this point (and there may be aspects of the case that I don't know). Additionally, hopefully they are checking and aggressively managing your blood lipids/ApoB, blood sugar, blood pressure, and have checked a Lipoprotein(a) level as well (we have free content available on all of these topics). It sounds like you are doing great with resistance exercise, but would also make sure you are meeting conditioning recommendations too.

Thank you so much for the quick response Dr. Baraki. I completely understand the disclosure and respect that.

I have not had the procedure yet. It is scheduled for next week. I believe there is a good chance it will require PCI. Unfortunately, have a strong family history of heart disease. My grandfather had an MI at 50, and my father had a triple bypass at 62 with significant 3 vessel disease. He didn't have typical symptoms either. I think that's why they are worried about a silent ischemia.

Started with 10 mg Crestor when my LDL was 141, HDL 45, Total 202 this past month). Had it bumped up to 40 mg after the CTA info. I do follow the conditioning with cardio 30 mins 2-3 times a week accessory lifts.

As far as radial vs femoral, the cardiologist mentioned he usually goes radial but I was concern because my work requires the use of my hand dexterity and was just concerned about that. So I brought up femoral as an option with my cardiologist. But seems like radial is the way to go if I want to limit complications and return to normal activity.

[Austin Baraki]

I have not had the procedure yet. It is scheduled for next week. I believe there is a good chance it will require PCI. Unfortunately, have a strong family history of heart disease. My grandfather had an MI at 50, and my father had a triple bypass at 62 with significant 3 vessel disease. He didn't have typical symptoms either. I think that's why they are worried about a silent ischemia.

I see. Although I'm not a cardiologist, I am involved in the care of these kinds of patients on a regular basis; it's unclear what the indication for PCI would be for incidentally found, asymptomatic (in a patient who actually trains, no less), stable single-vessel disease NOT involving the left main coronary artery. There are also non-invasive ways of evaluating for myocardial ischemia using stress/perfusion imaging, given that concern. I recognize that none of this is answering your original question, but I find it interesting. Perhaps there is something I don't know here.

Started with 10 mg Crestor when my LDL was 141, HDL 45, Total 202 this past month). Had it bumped up to 40 mg after the CTA info. I do follow the conditioning with cardio 30 mins 2-3 times a week accessory lifts.

Understood. Depending on where your lipid panel (ideally apoB) are found to be while on 40 mg, consideration of adding ezetimibe 10 mg may be in order. I would also reiterate a recommendation to ensure your Lp(a) has been checked once.

As far as radial vs femoral, the cardiologist mentioned he usually goes radial but I was concern because my work requires the use of my hand dexterity and was just concerned about that. So I brought up femoral as an option with my cardiologist. But seems like radial is the way to go if I want to limit complications and return to normal activity.

Yes, radial is preferred, in general.