Mending a Broken Heart

“Genes may load the gun but lifestyle pulls the trigger.” — Dr. Dean Ornish

Opposite: Dave Mackey, always healthy and active, suffered from a heart attack during a 20-mile bike ride through Fort Jackson. Six years later, Dave has achieved what his physicians thought was improbable — a fully recovered heart.

Photography by Robert Clark

Dave Mackey and Nancy, his wife, will always remember Sept. 12, 2009. It was a beautiful Saturday in Columbia where the Mackeys had recently moved one month earlier. Dave, an avid cyclist, decided to take a 20-mile bike ride through Fort Jackson before watching the Carolina-Georgia game that afternoon with his family, but just four miles into his workout, Dave felt “tired and out of gas.” Despite his best efforts to continue, Dave soon realized that he could go no further without resting, and thus decided to take a break in the shade underneath a tree. A combination of heat and fatigue were his only symptoms. However, moments later he was lying down on a sidewalk as several motorists stopped to ask if Dave was okay. After waving off the first few cars, Dave realized he was in trouble and flagged down the next motorist for help. They called an ambulance, and Dave was rushed to the hospital where he learned he was suffering from a heart attack.

Dave felt only a strange sort of fatigue and never experienced the classic symptoms of a heart attack including:

• Pressure, tightness, pain or a squeezing or aching sensation in the chest or arms that may spread to the neck, jaw or back

• Nausea, indigestion, heartburn or abdominal pain

• Shortness of breath

• Cold sweats

• Fatigue

• Lightheadedness 

Dave was not the typical heart attack patient. He was only 53 years old, slender, didn’t smoke and exercised on his bike or in a spin class five days each week. He deemed his diet healthier than most and did not have high blood pressure, although he took a statin for elevated cholesterol. He did, however, have a family history of heart disease as his father died of a heart attack at 59.

Physicians discovered Dave had a blockage of the infamous “Widow Maker,” as cardiologists call the LAD (left anterior descending artery). He received two stents to open up the blocked coronary artery and return blood flow to that part of the heart muscle. During the surgery, Dave’s heart fell into a fatal rhythm twice and had to be shocked back to normal, once while he was wide awake.

During his recovery over the next several days, Dave was given devastating news. Physicians explained that he had suffered significant damage to his heart, which requires constant blood flow and oxygen. He was informed that his ejection fraction, a measure of cardiac function, was dangerously low, only half the normal healthy rate. Dave was in congestive heart failure and faced an increased risk for sudden death.

Dave was further informed that his prognosis was uncertain at best. Physicians explained the damage sustained during his heart attack was severe, and they could not predict the extent to which he would recover, if at all. 

Dave entered a clinical trial that allowed him to wear a LifeVest for the next three months. This personal defibrillator monitored Dave’s heart continuously. If his heart went into a life threatening arrhythmia, the LifeVest would deliver a shock treatment to restore normal rhythm. The trial included the placement of an implantable loop recorder, also known as an insertable cardiac monitor, just under his skin to record the heart’s electrical activity. At any time, he could download data from this recorder to the hospital where medical staff would monitor for irregularities.

Dave also began 12 weeks of cardiac rehabilitation. This included nutrition counseling, supervised exercise and emotional support. Cardiac rehab is a critical element of recovery with the goal being to rehabilitate the heart as well as improve lifestyle choices to reduce the risks associated with heart disease. Dave did improve the function of his heart, elevating his ejection fraction gradually, but the rate was still well below the normal range. Physicians informed Dave and his family that he would most likely have to live with a “broken heart.”  

Heart disease is a lethal killer, the number one cause of mortality in Western civilization, and is responsible for the deaths of more than 500,000 in the United States each year, according to the Centers for Disease Control and Prevention. More than one million Americans have heart attacks annually, and more than three million suffer “silent heart attacks,” which go unnoticed but gradually damage the heart over time.

One out of every two men and one-third of all women will have heart disease in their lifetime. The economic consequence of heart disease is staggering, costing the United States $300 billion each year. To put this in perspective, this is the equivalent to the expense for the war in Iraq for two and a half years. Dave’s medical bills for his heart attack exceeded $200,000. Yet almost all of the expense for heart disease is spent on treating the symptoms, not on prevention. 

The toll on human suffering, however, cannot be quantified. Losing a loved one, especially when it is unexpected, is one of life’s greatest tragedies. Nancy still has a hard time talking about her husband’s heart attack. Dave’s daughter, Leigh, remembers being afraid to leave him alone, and in the subsequent months any phone call from her family caused her to fear the worst. She always knew her father as strong and fit, but seeing him fight for his life was horrible.

Dave credits his team of physicians, nurses and the cardiac rehab staff with saving his life. He continued to faithfully participate in cardiac rehab, but eventually felt an emotional need to move beyond the hospital setting to “feel normal” again. Recognizing this, Dave’s physician referred him to my wellness center.

After reviewing Dave’s medical history, I told Dave that he could repair his heart. I informed him that comprehensive lifestyle intervention could prevent and even reverse most cases of heart disease, according to Dr. Dean Ornish’s pioneering research. Dr. Ornish conducted studies proving that even advanced cases of heart disease could be reversed. He had become very discouraged at the lack of success in the treatment of heart disease despite the advances in medicine and the enormous financial cost of these treatments. 

As a medical student in 1977, Dr. Ornish observed that after heart surgery to bypass clogged arteries, patients would return to the same lifestyle that contributed to their heart disease in the first place. More often than not, the patients’ bypass grafts would clog up, requiring another bypass, sometimes two or three times. 

Determined to improve clinical outcomes for patients with heart disease, Dr. Ornish conducted randomized controlled studies in which patients with advanced heart disease participated in intensive lifestyle intervention, including consuming a whole food, plant based, high fiber-nutrient dense diet, engaged in moderate aerobic exercise, learned stress management techniques including yoga and had group support. 

Dave was very encouraged by the research but still feared his family history might be too much to overcome. Dave would soon learn two critical facts, namely, lifestyle trumps heredity but the degree of lifestyle changes, especially diet, were crucial.

The Proceedings of the National Academy of Sciences published research demonstrating that lifestyle intervention can even change your genes. Exercise, nutrition and stress management changed the expression of more than 500 genes in men with early stage prostate cancer. Oncogenes associated with breast and prostate cancers as well as genes that increase for heart disease, oxidative stress and inflammation were down regulated –– or “turned off.”

I explained to Dave that the “elephant in the room” was that he must make big changes to recover fully, and that the current dietary recommendations from the American Heart Association were inadequate. Dave would have to make wholesale changes to the way he approached eating.

Dr. Ornish and colleagues used a whole food, plant based, low fat diet (no more than 10 percent) to achieve their dramatic results. The current guidelines from the USDA, AMA and AHA generally do not recommend the degree of change research demonstrates is necessary to reverse or even prevent chronic conditions like heart disease. The reasons for this are complex, but one explanation is that many health care providers simply do not believe patients will comply with “extreme nutritional guidelines.” Needless to say, Dave agreed to the recommendations and was highly motivated to follow a strict regimen to regain his health.

Six years later, Dave has achieved what his physicians thought was improbable. Following the Ornish diet, bicycling regularly, working out in the gym, walking each morning and practicing yoga are all priorities for him, no matter how busy his days are. He has clinical evidence that his heart has fully recovered, his ejection fraction is normal for a healthy adult and his lipid profile is “perfect” per his cardiologist. He has reduced his prescription medications by three and exams show “no damage to his heart.” Dave understands that heart disease doesn’t go away, but he also realizes healthy lifestyle practices will lessen future risk. As importantly, he feels strong, healthy and full of energy.

Dave is extremely grateful for every healthcare professional he encountered. If not for the skilled and compassionate care he received after his heart attack and his strong faith in God, Dave realizes he would not be alive today.

Dave’s daughter says she is “proud to see her father work so hard to recover” from that fateful day in 2009. She is especially proud to see how inspiring and excited her father is when telling others “they too can regain their health.”