Cardiovascular Changes Medicine Running

Running & Being and Running & Dying (repost 2007)

George Sheehan‘s book “Running & Being” is one that every dedicated runner should read. George, a cardiologist, and one of the early, great running philosophers and gurus has been an inspiration to all old school runners.

Many years back, some people, Jim Fixx included, thought that running marathons would give an immunity to fatal heart disease. While running is certainly excellent for cardiovascular health, this has been found to not be so. The most recent studies seem to demonstrate that long distance running reduces your overall risk from dying from cardiovascular disease but that during running itself your risk is higher than while at rest. I still believe that this is a reason to run and not to avoid running. The overall benefit to reduced risk of cardiovascular disease, high blood pressure, depression, body weight, and many more benefits clearly and strongly outweigh the statistically somewhat increased risk of exercising.

It is important though to note and keep track of your own personal risks. Be aware of your lipid profile, your total cholesterol, your HDLs, LDLs, Triglycerides, and what you must to do make it as good as can be done for you. Be aware of your personal and family history of cardiovascular illness. Have your blood pressure checked, and as you get older have it checked more often. High blood pressure is a serious and by many an underrated, and undetected but major contributor to severe cardiovascular illness. Do not underestimate it or think you may be immune to it because you did not have it for the first 25, 35 or 40 years of your life.

Jim Fixx, author of one of the early and earth shaking popular books on running, died from heart disease while running. Today, Ryan Shay, a promising American runner died in the U.S. Olympic Marathon trials. At this time the cause of death has not been established. It was a very sad thing to learn. He is believed to be the first american elite runner to die during a running event. Earlier this year Alberto Salazar had a severe heart attack and was without a self-sustaining heartbeat for more than 5 minutes. Amby Burfoot recently wrote a great article about Alberto’s heart attack in Runner’s World, in which his personal risk factors were discussed. One of his grandfather’s died at 52 from a heart attack and the other at age 70. He reported that his father had had more than one heart attack. If I recall correctly Alberto was being treated for high blood pressure and an abnormal lipid profile. His lab tests and blood pressure were considered fine while under treatment. Serious heart disease ran in his family. This was pointed out as a risk factor that you can not alter. A few weeks ago I came across another article about Alberto Salazar in a section of the New York Times written by John Brant, an author who has written a book on the famous Salazar – Beardsley Boston Marathon race. Salazar related to Amby Burfoot that his doctor recommended an echocardiogram which would not have demonstrated cardiovascular disease. In the New York Times article something jumped out at me. Alberto, according to this article, had had significant neck and back pain that made him go to visit his physician. Normally, he endures pain stoically. His doctor did a resting electrocardiogram and some lab tests and it seemed normal. He was then given an appointment for some weeks later to have stress electrocardiogram.

“…in Indianapolis, Salazar was unable to sleep, had little appetite and felt perpetually tired. Stabs of pain rose from his neck and back, which he attributed to sitting awkwardly on the plane. As soon as he returned to Portland, his primary-care physician prescribed some tests, which were inconclusive, and referred Salazar to a cardiologist. An EKG stress test was scheduled for early July.”

Unfortunately, before he had that he had his near fatal heart attack. Or as some called it a fatal one that he survived. (Since he lived, even though his heart stopped, I do not call it fatal.). This is another extremely important item for runner’s to note. Do not ignore chest pain, neck pain, left side of the jaw pain, upper back pain and any other pain that makes you think something could be wrong. If you have risk factors or if a possible coronary atherosclerosis is suspected, you don’t need your stress test and or thallium blood flow study next month, you need it now. You should have that test as soon as possible. Salazar had serious signs of heart disease that were perhaps taken a tad less seriously and attended to a little slower than they should have been. His test should have been the following week and not the following month. Another, not quite as good a runner, David Letterman, did get tested early, and had a quintuple bypass. Salazar, was lucky to only need a stent. Happily, both have recovered and are running again.

The Runner’s World article by Amby was excellently written and gripping. Alberto is thoroughly quoted within the article. In trying to figure out why there was a difference in how he related his symptoms before his heart attack to the two authors I was at a bit of a loss. In a close reading though, Alberto clearly wanted to emphasize his spirtual beliefs in both, and perhaps even more so in the earlier interview with Amby. He viewed his heart attack as part of God’s master plan for him. I don’t know why he didn’t mention the symptoms he had. I’d suggest if you do hear a bit of knocking at the door in the form of unusual discomfort, pain, fatigue or dizziness you pay attention quickly.

Since most of you runners are doing all that you can to be healthy, let’s make sure you don’t ignore signs that you need just a little help to keep that ticker working. And don’t put off the stress test, if you need it.