Christopher J. Case - The Haywire Heart: How too much exercise can kill you, and what you can do to protect your heart

Copyright 2017 by Chris Case, John Mandrola, and Lennard Zinn

All rights reserved. Published in the United States of America by VeloPress, a division of Competitor Group, Inc.

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The Library of Congress has cataloged the printed edition of this book as follows: Case, Chris, author. Mandrola, John, author. Zinn, Lennard, author.

The haywire heart: how too much exercise can kill you, and what you can do to protect your heart / Chris Case, Dr. John Mandrola, and Lennard Zinn.

Includes bibliographical references and index.

ISBN 978-1-937715-67-0 (hardcover with jacket: alk. paper)
eISBN 978-1-937716-87-5

AthletesDiseases. HeartDiseases. SportsPhysiological aspects. Sports for older people.

RC1236.H43 C37 2017 | DDC 617.1/027dc23

2016049013

Art direction by Vicki Hopewell

Cover design by Kevin Roberson

Cover photographs by 4x6, Technotr, and Avid Creative, Inc./iStock

Illustrations by Charlie Layton

v. 3.1

A note to readers: Double-tap on illustrations and tables to enlarge them. After art is selected, you may expand or pinch your fingers to zoom in and out.

CONTENTS

CHRIS CASE

The sun shone bright on the upturned Flatirons rock formations above Boulder, Colorado. It was another perfect day in a cycling paradise. Lennard Zinn, a world-renowned technical cycling guru, founder of Zinn Cycles, author of Zinn and the Art of Road Bike Maintenance, longtime member of the VeloNews magazine staff, and former member of the US national cycling team, was riding hard up his beloved Flagstaff Mountain, a popular road that snakes over 4 miles and almost 2,000 feet above the city. It was a ride he had done a thousand times before. But on this day, in July 2013, his life would change forever.

Fifteen minutes into his attempt to set a new Strava king of the mountain (KOM) time for the climb in the 55-plus age group, he felt his heart skip a beat. It was something he had felt before, but only at rest. He looked down at the Garmin computer on his handlebars and noticed that his heart rate had jumped from 155 to 218 beats per minute (bpm) and stayed elevated. He tapped the Garmins screen. Was the connection bad? He felt fine but eventually pulled the plug on the attempt, knowing that the distraction had disrupted any chance at a record.

His heart rate immediately dropped, so he headed down the mountain to establish a different Strava segment KOM. His training plan called for a very hard ride, so he went to another climb and did a set of intervals. His ride completed, he headed home.

Later that day, he called his physician as a precaution. Much to his surprise, after describing the incident, he was told to head to the emergency room immediately. Then things took an even more serious turn: After a series of tests, the ER physician recommended that he be taken via ambulance to the main cardiac unit of the Boulder hospital for an overnight evaluation.

Despite the initial alarm, his doctors simply prescribed rest. That seemed easy enough. So easy, in fact, that even though he trusted the cardiologists and the ER doctor, he ignored the true depth of their warnings. While he obeyed their calls for rest for a short time, he eventually returned to his usual training plan. His only concession was that he did not resist when he was asked to wear a portable telemetric electrocardiogram (ECG) unit that dangled around his neck (a device known as a Holter monitor); it didnt disrupt his routine.

What did disturb life and training were the annoying episodes that started to become more frequent during his intense rides. Now when his heart rate spiked, he experienced what felt like a flopping fish in his chest.

More upsetting was the phone call in the middle of the night from a faraway nurse who had been monitoring the ECG readings from his Holter monitor. She had some shocking news: His heart had stopped for a few seconds. He had to finally admit that something was definitely wrong.

By October, Zinn could do nothing to eliminate the episodes. He made every attempt to reduce the stress in his life, but intense riding and racing always triggered an episode of elevated heart rate and that fish-out-of-water feeling. After further visits to his cardiac electrophysiologist, he received an official diagnosis: multifocal atrial tachycardia.

Thats when Zinn ultimately decided to heed the warning hed been given and quit racing. He also backed off from riding with intensity or duration. In doing so, he felt instantaneously downgraded from thoroughbred to invalid. He altered the very nature of his life, in more ways than one. He was made to face the reality that he could never do what he used to do in the same way that he used to do it. He now became interested in maintaining an activity level to sustain his longevity rather than his fitness or speed.

Life had changed. Forever.

Zinn quickly realized he was not alone. When he began the psychologically arduous process of coming to terms with his life-changing condition, he reached out to friends who had been fabulous athletes in their day and who continued to push themselves well into their 40s and 50s.

The number of friends, colleagues, and former teammates who had had similar or more severe heart issues was alarming. Far from being an outlier, Zinn was one among many.

Thats when I, as the managing editor of VeloNews and a friend and colleague of Zinn, couldnt help but think there was more to this issue than an isolated incident on an iconic climb in a cycling-crazed town. Once I heard the various stories of heart arrhythmias in masters endurance athletes and read the research literature on the subject, it was obvious that this would make for a compelling and important article in the magazine. (An arrhythmia is an irregular heart rhythm caused by a malfunction in the hearts electrical system. Zinns tachycardia is but one example.)

With the help of many, particularly Dr. John Mandrola, we published Cycling to Extremes: Are Endurance Athletes Hurting Their Hearts by Repeatedly Pushing Beyond What Is Normal? in our August 2015 issue. Mandrolas assistance was critical, as he is a cardiac electrophysiologist from Louisville, Kentucky, who frequently writes and lectures on the very subject of endurance athletes and heart health. He has also been a competitive athlete much of his life and has an arrhythmia himself (atrial fibrillation, which is defined as a rapid and irregular heartbeat above 300 beats per minute).

The response from readers and members of the media was staggering. Zinn, in particular, was inundated by letters, e-mails, and phone calls from friends, colleagues, and strangers. The overwhelming majority of the attention came from individuals for whom the article was extremely moving or meaningful, something they could relate to, a story that touched them unlike anything they had read before. In more than one case, the article changed a life.