[What I have learned by monitoring my own ischemia]

Twenty years ago, I became an "unstable patient", starting with a short episode of precordial discomfort and tiredness, ischemic ECG without enzymes, hypokinetic apex and no other signs. Following a week in bed and a lot of sleep, I went back to my usual lifestyle, refusing to undergo cineangiography or any hydraulic intervention. For ten years, the periodic controls showed no changes and I continued my intense activity under adequate therapy until another more severe episode occurred. Again, during a stressful and psychologically negative period, I experienced more severe precordial discomfort that was accentuated after minor psychological tension, whereas long and intense physical exercise was instead asymptomatic. The hypokinetic area was more extensive--no enzymes again--with a more severe ischemic ECG. My inability to face my psychological stress suggested surgical bypass, given the fact that since the Fifties, any type of intervention--even if nothing is vascularized--would nevertheless block pain and allow me to return to a normal lifestyle (denervation). At that time, cineangiography showed the occlusion of all three main coronary arteries. These occlusions had been there for years without an infarct and were obviously already compensated by adequate collateral circulation, as demonstrated by the normal lifestyle I had led with intense and long-lasting physical exercise. I returned to my regular activity, again mainly under anti-adrenergic stress therapy, and now, another ten years after surgery, I am still waiting for a third episode or something else. What have I learned from studying myself? I've learned that every ischemic patient has his own history and must learn how to face his own risks, the different patterns of so-called ischemic heart disease can not be theorized in a unique etiopathogenesis, the adrenergic system plays a major role in this disease, the "plumbing" vision is supported by reasons which have little to do with the knowledge--as yet incomplete--of the natural history of this disease, and the data obtained in years of research have been confirmed.