Are Endurance Athletes Heart Healthy?
Pat Ross Colorado Marathon at mile 20 looking very pale compared to his pre-race photos where he is tan.
What is this episode about?
INTRO 0-1:00
Coach Amy is taking a Physical Therapist in Primary Care course about assessing and screening systems for potential health issues. She practices using an otoscope on Liz's ears!
Physical Therapists in Primary Care
In most states, physical Therapists are front-line providers that patients can access directly without a referral. They often see patients more frequently than their doctors, so educating them about screening for serious pathologies is important so they can correctly refer patients to the right healthcare professionals.
Amy's final project is this podcast, which focuses on the fact that endurance athletes are sometimes dismissed by healthcare providers as automatically healthy because they are athletes. That may be true compared to sedentary people, but we still must be aware and get proper screening.
The focus today is specifically on cardiovascular disease in endurance athletes. In The Coach Amy and Coach Liz Show's first guest interview, Amy brings in one of her athletes to discuss his recent experience with discovering his cardiovascular disease. Pat Ross is a 63-year-old white male who has run 36 marathons in 34 states and aims to complete 50 marathons in 50 states.
Athlete Interview
Amy: How did you discover running?
Pat: I ran in High School and then picked it up again in my 20s as a way to stay healthy, knowing that I have a family history of cardiovascular disease. I ran my first marathon in 1993.
Amy: What were your symptoms, and when did you notice them?
Pat: I ran the Colorado marathon in 2018. It was a year tried to focus on health - no drinking, eating healthy, etc. I was hoping for a PR, but it was my worst marathon. I had issues with dehydration and what turned out to be a heart episode. It made me realize running wasn't the only fix for managing my heart health.
My symptoms were pain in my back and through my shoulder. Initially, I rationalized the pain as stemming from running downhill, but I realized about mile 22, it was more serious. In the medical tent, they did an EKG and wanted to take me to the hospital, but after a bag of saline, I felt ok, so I thought my symptoms were just due to dehydration. A few weeks later, I followed up with my doctor and realized it was potentially a heart issue.
Initially, my doctor thought it was fine to keep running, but I continued having the same symptoms as I did during the race. I pushed my doctor to run more tests due to my family history. My dad died before he was 60 of a heart attack, both my brothers have stents, and another one of my siblings has heart valve stuff.
Research shows how longer-distance running can damage the heart (see article link below). That, combined with other family risk factors, means even athletes must be screened. This podcast is to raise awareness about that.
The perception is that, as athletes, we're immune to cardiovascular disease. This is even true in the healthcare industry. Pat's doctor did a stress test, which didn't show anything. However, upon doing an MRI of the heart using nitroglycerin to look at arteries, they found heart plaque. Heart plaque isn't uncommon, especially for people in their 60s, but it can be a risk factor for long-distance running.
Pat's doctor says exercise is still important, but the focus should be adjusted to shorter races like 10Ks instead of marathons.
Pat still has symptoms when he runs today, and because of his family history, his doctor prescribed nitroglycerin to carry with him at all times. If he suspects he’s having a heart attack, Pat is to put the nitroglycerin tab under his tongue (and call 911). He also wears a heart rate monitor while running, and once his heart rate reaches a certain point, he backs off to lower it.
Catching early warning signs of cardiovascular disease and other health conditions is important. Don't assume you are healthy because you're an endurance athlete. Know your family history, get regular screenings, and communicate with your doctor. Ask them to explain your results. If you feel unheard, it’s ok to switch doctors!
Article: Cardiovascular damage resulting from chronic excessive endurance exercise.
Patil HR, O'Keefe JH, Lavie CJ, Magalski A, Vogel RA, McCullough PA. Cardiovascular damage resulting from chronic excessive endurance exercise. Mo Med. 2012 Jul-Aug;109(4):312-21. Erratum in: Mo Med. 2014 Mar-Apr;111(2):135. PMID: 22953596; PMCID: PMC6179786.