Upon reflection, this latest installment in my (hopefully) continuing series on the twists and turns of coronary heart disease may have begun with a pain in my right shoulder that I first noticed two or three months ago. The right shoulder is the one I had rotator cuff surgery on back in 1997. As the orthopedic surgeon said at the time, once in while you might feel a little twinge there, and if you do it’s probably nothing serious.

Amazingly enough I never felt a twinge of anything in my shoulder, and I began to think that this was the one operation in my life that had been 100 percent successful. Then sometime this spring I began to notice a twinge in the shoulder and then a pain — maybe I slept on it the wrong way. I could mention it to a doctor. Or not.

But the shoulder got me thinking. And the thinking got me to notice another little discomfort: a minor moment of heartburn. Hmmm. Heartburn is exactly what I felt almost five years ago, when this little detour into the world of heart health began, a feeling that led to a thallium stress test, followed by an agiogram at Mercer Medical Center, followed by an ambulance ride to St. Mary Medical Center in Newtown, PA, and the installation of a stent in a 90 percent clogged left anterior descending artery.

So after walking around with it for three or four weeks, I finally met up with my cardiologist at one of my regular bi-annual exams. Reluctantly I reported the heartburn, knowing full well that it would prompt another stress test and knowing also that my six or seven-day a week exercise regime had fallen off to two or three times a week as a result of some back-breaking deadlines in the previous month or two. Sure enough cardiologist Abraham George signed me up for a stress test.

At this point let me give a pass to all the readers out there who exercise regularly, follow a low-fat diet, don’t smoke, have low cholesterol, and enjoy low blood pressure. These first person illness stories are dreadfully personal and predictable (the guy always lives in order to write about it) and you don’t need to read another one. Heart disease only affects about one out of every two people — you won’t get it; the other guy will. You should go now to the article on page 7 of this issue, dealing with retirement planning and long-term care for your 80s and 90s.

Of course that’s what I was thinking as I awaited the dreaded stress test: After four-plus years of exercise, low-fat diet, no smoking, low cholesterol (but high good cholesterol), low blood pressure, plus a daily dose of an anti-coagulent drug, how could it be me again and not the other guy?

At the stress test my brief deviation from the exercise routine is revealed. “I was a little surprised at how quickly you ran out of breath,” Dr. George tells me. But he reserves judgment pending a review of the Xrays. I hit my ellipitcal with a vengeance — 30 minutes a day, up to six miles an hour, with a kick at the end of every session that leaves my heart beating rapidly.

I feel great. If George recommends an angiogram based solely on my shortness of breath on the stress test, I’m going to insist on a re-test. I feel better every day.

After a few days I get a call from the cardiologist’s office: He wants me to review the results in person. Sure enough, George has noticed a “shadow of doubt” on the films from the stress test. He explains that reading a stress test is not a perfect science, but that — given my history — we should take no chances. A much better view is provided by the angiogram, in which a catheter is inserted into the femoral artery in the groin, and threaded up to the heart, where a dye is injected into the bloodstream, producing crystal clear Xray views.

I don’t argue. Three years ago I had sharp pains in my left arm and — given my history — underwent an angiogram. It showed no problems whatsoever. So much for the cliche warning signs of heart problems.

But this time it’s the cardiologist’s guess, not mine, and he guesses correctly. Dr. David Drucker, the angioplasty man, installs a stent — a 3.5 by 20 millimeter, Paclitaxel-eluting stent — into an artery that was 85 percent blocked. It’s the second stent in the same artery.

Later that day, as I’m waiting for the small incision in my groin to heal before I am allowed to get up and walk, a nurse comes in with a little counseling on heart health awareness. Remember, she says, signs of coronary heart disease can be subtle. It could be a pain or tightness in the chest, but not necessarily. It could feel like a case of heartburn (that’s me, I think, brimming with confidence in my ability to read the warning signs so accurately), or a pain or discomfort in the back, or a pain in the shoulder.

Pain in the shoulder? I focus on my right shoulder. I don’t feel even the slightest twinge. My confidence slips a little. Could the shoulder pain have been the first warning sign, one that I totally missed? I still don’t know. A few days later the twinge in the shoulder returns, but not as sharp as it had been.

Maybe I should mention it to the cardiologist. Or not.

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