Most athletes, especially endurance athletes, are by the nature of the sport very fit, and as a result we tend to also think of ourselves as healthy. This is not always the case, however, as I learned firsthand last year.
I have been training and racing bikes for forty-two years, all the while eating healthfully, maintaining a good weight, and considering myself fit and healthy. With the exception of marginally high cholesterol, every medical indication was excellent. But then breathing pains last season led to a series of tests (I thought initially it was bronchitis) and resulted in a stress test, which resulted in an angiogram, which resulted in finding a 90% blockage in one of my coronary arteries, which resulted in the placement of a stent. Fortunately there was no damage to my heart and I was back to training and racing four months after my procedure.
Endurance sports require a strong and efficient heart to keep up with the aerobic and anaerobic demands, especially at a competitive level; therefore athletes are not only fitter but also typically healthier than the average person. While a strong cardiovascular system is certainly a good thing, it doesn’t preclude us from falling victim to cardiovascular disease and coronary artery disease (CAD). In my situation, needless to say, I was as shocked and surprised as were my doctors. But it demonstrates that none of us are guaranteed clear arteries, despite our great cardiovascular fitness.
In retrospect, I can see several indicators of heart-related issues, but I failed to acknowledge them, partly because I assumed I was too fit to have heart disease. The first indicator was pain in my chest area. Although my doctor said it wasn’t typical angina symptoms, I now know that heart issues can express themselves in a number of ways and radiate in different areas of the chest and arms. The second symptom was noticing my performance had dropped over the past couple of years. I attributed this to my age (I’m 56) and a lack of usual training due to a busy life. I now know my performance was dropping faster than my age was increasing. It was getting harder to keep up on team training rides, and I was getting dropped on hills I never used to get dropped on. My threshold power had also dropped during the past two years. Interestingly, my heart rate did not decrease, maintaining a threshold heart rate of 184 and a maximum well into the 190s despite my condition. Also interestingly, I never experienced a shortness of breath, which is a common symptom for CAD. I attribute this to the fact that I frequently trained in the anaerobic range and I am used to breathing hard so didn’t notice anything unusual.
I would like to use my own experience to provide some points for athletes to consider regarding awareness of heart issues. As athletes we tend to be very in tune with our bodies; we notice every new little twinge, sore muscle, and joint ache. Sometimes we're overly concerned (even obsessed) with these pains when there is really nothing wrong. Most of the time the discomfort goes away with rest and recovery.
Conversely, at the same time we tend to think of ourselves as invincible and above having any serious health issues. We also have a tendency to push ourselves through pain that we should pay attention to. We like to believe we're too fit to have heart disease. I certainly did.
So here are a few things you can do to avoid finding yourself in the same situation I did.
1. Get an annual checkup. We athletes put our bodies through a lot of stress during the season, so we want to make sure everything is working well. But be aware that a typical physical exam will not catch everything. It would not have caught my condition (my EKG was perfect). You might want to ask your doctor whether you should have a stress test done, especially if you're male, middle-aged, and/or have any risk factors for cardiovascular disease. Be sure to explain to your doctor just how hard you work and that you push yourself much harder than a typical patient. You might even bring in a heart rate graph showing how high and how long your heart rate is elevated. Get your cholesterol checked and under control. Mine was "borderline high," which turned out to be too high.
2. Don’t be afraid to keep asking your doctor if you can’t get answers to your satisfaction or find cause of your malady. Go to a different doctor if necessary. After all, no one is more interested in your health than you.
3. Pay close attention to any pain in the chest area. While it could be caused by several things, you should always rule out heart problems.
4. Listen to your coach, friends, and spouse when they suggest you get something checked out. They often look at your situation from a more objective, less biased position than you do yourself.
5. Don’t assume, just because you're a fit athlete, that you're immune from heart disease or other serious ailments. Always check things out when they don’t feel right.
Training and being fit are both wonderful things you've got going for you. If you ever do develop an illness, you'll be better prepared to fight it and will probably return to fitness more quickly because of your physical fitness.
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David Ertl is a USAC Level 1 coach, the author of four cycling training books, a father of twin sons, and a Peaks Coaching Group associate coach. He and his fellow PCG coaches create custom training plans for endurance athletes of all levels of experience. David can be contacted through peakscoachinggroup.com or through firstname.lastname@example.org.