@BubbleTrubble: When I made my statement I was thinking in the context of patients with elevated troponins but basically an otherwise benign presentation. Many different insults can lead to troponin leakage and therefore a clinical diagnosis of MI. Without having personally examined the OP and knowing whether she had only elevated troponins or some degree of stenosis on cardiac cath to come to her diagnosis I'd be remiss to make much more of an assumption. Any number of situations and/or unknown history could have contributed to the MI. But yes, I have seen many people with a history of MI, especially at 3 months out, that I would consider to have a "healthy" heart.
Jordan.
Without seeing the specific study results from the OP, I too won't make any assumptions on the exact pathology and prognosis. That said, there are a couple thoughts I have:
I have seen cases of demand ischemia in patients with otherwise clean coronary arteries. Especially as we age - and let's be honest, we all do - our ability to tolerate physiological insults diminishes. A couple of my extremely healthy (marathon runner-type) CRNAs have recently discovered cardiac problems as they age. A person in reasonable health with sudden blood loss, lung injury, or physically fighting for their lives can unbalance the oxygen supply/demand equation.
It's possible that the OP experienced laryngospasm or another mode of airway obstruction in the water. Forcefully trying to inhale against that would feel like drowning, and also raise the possibility of negative pressure pulmonary edema. That, on an XRay, would look like heart failure. Combine that with the demand ischemia and troponin leak from the heart's work, and it's easy to assume the event was all pulmonary edema from a primary cardiac process.
Takotsubo cardiomyopathy is classically taught in med schools as being a rare zebra. I've seen a few cases of it. It's a profound cardiac dysfunction that happens in the case of extreme physical or emotional stress. Previously healthy people can have a sudden dysfunction of their cardiac muscle, going from a normal ejection fraction in the 70s down to 20. That may be from circulating evil humors in the blood, or from actual spasm of a coronary artery. That would mimic severe coronary disease clinically.
Any one of the above-described processes would cause a presentation consistent with an MI. The heart catheterization would be "clean." In almost all cases, the echocardiographic picture improves to normal after the acute process has resolved. Those people have a healthy heart after recovering from the initial insult.
I agree with you on it being possible to return to being relatively healthy after an MI. In the case of coronary disease, it's very common to stent the vessels even before they block and cause an MI. I wouldn't say someone with a couple stents has an entirely healthy heart compared with a young athlete. However, a very fit individual with a couple stents, well-preserved cardiac function, and outstanding exercise tolerance can have a comparatively healthy heart. I'd bet on him to be much less likely to have an MI than the 300lb diabetic chain smoker who only exerts himself walking to get the mail. That guy may have a "healthy heart" by EKG, but be ripe for disaster.
