The Haywire Heart: How too much exercise can kill you, and what you can do to protect your heart

Six weeks ago, I had a vasovagal attack donating plasma at the Red Cross and lost consciousness, so I was taken by ambulance to Caualty at the local hospital. An ECG showed minor changes consistent with an athlete's heart (I'm a retired marathon runner, who is still physically active in a gym).An echocardiogram was advised, which showed severe left atrial dilatation, which I accept is due to damage resulting from excessive training training for marathons (it's well described in the book). So, I was referred to a cardiologist, who noted that I have a resting heart rate of 40 bpm (sinus bradycardia, not heart block), so he advised me to have an artificial pacemaker.This book was very useful in providing alternative advice. My resting heart occasionally drops to 34 bpm (anything above 30 bpm is acceptable as normal in athletes) with no symptoms and a completely normal unchanged blood pressure.Most of the book on arrhythmias doesn't appear to apply to me - I'm never aware of my heart beat or have shortness of breath exercising or at other times. And the chapter advising supplements to me just appears to be junk science.I'm still being investigated. The next step is to have a Holter monitor, which might provide some useful information. Or not.I think the vasovagal attack was due to jet lag (I'd flown from Munich to Perth 2 days earlier - a 17 hour flight with a 6 hour time zone change, so there was probably some tiredness involved). And the Red Cross had recently changed their procedure for plasma donations, not replacing the 900 ml of plasma donated with a litre of saline till the end, so there was probably some low blood volume involved too.I don't think I need to worry much. I'm retired from the heavy marathon training, so that's not a problem. I'm currently doing cardio' workouts in a gym, which are comfortable, to maintain fitness.The book has provided me good reasons for declining a pacemaker.

I have been VERY active my entire life.I am a 60 year old male.I played ice hockey and lacrosse, mobile positions, wing and crease attack and middy respectively from age 8 to 18.I always have been a very avid bodysurfer. I consider myself extreme in this regard, at it 9 out of 12 months, bodysurfing big hurricane surf sometimes up to 8-10 feet, when such surf occurs here on Long Island.This is MAJOR aerobic activity, maybe more so than Tri.I competed in triathlons for 20 years winning my age group in Clydesdale division in every race I entered except one second place finish. In races not offering a Clydesdale division I would finish in top 5th of my age group. I would guess I completed about 60- 75 sprint length tris with never a DNF.I mention this to convey that I was a competitive Triathlete, not merely a event T-shirt collector type participant or a once or twice participant.I was a competitive runner for over 36 years, 6 days a week year round with almost no running injuries and therefore almost no time off.Most months, year round I competed in at least 2 events bike races, ocean swims, runs.Some months I would race three weekends out off the four.About 6 years ago I was diagnosed with atrial flutters and underwent a cardio conversion.This was around the time of major life stress.This was followed up with a atrial flutter ablation about 4 years ago and a atrial fibrillation ablation 3 weeks ago.I stopped competing in running races and Tris about 5 years ago due to other health issues, prostate cancer and other surgeries but I’m still active cycling, swimming and bodysurfing.Just finished the Haywire Heart.The HH is revelatory, dispelling many ideas.Read this fantastic book even if you are not a sufferer of these heart issues if only as a guide to your activity level.Dr. Mandrola explains, in his clear and concise style, complex issues of cardiac and exercise physiology.Perhaps the main takeaway is the explanation that, to your doctor, you are probably a seldom seen anomaly with an activity level they very rarely see and often misunderstand.Dr. Mandrola cites example of Cardiologists and Electrophysiologists failing to interpret data and test results correctly due to biases and lack of specific experience with our rarer test results.The case studies of athletes including that of Ironman god Dave Scott are a wealth of information.Everyone who seriously competes in any endurance sport, especially Tri, will benefit immensely from reading this book.The correlation between stress as result of competing and training and other life stress is eye opening.Kudos to Dr. Mandrola!You have filled a giant void with your effort.Have fun out there but be forewarned!Reply

I have run for 50 years and was diagnosed with 2nd degree heart block and intermittent atrial flutter several years ago. When the flutter kicks in it definitely interferes with exercise: running, hiking, biking -- any aerobic activity. This book was recommended by a neighbor -- a mountain climber and long-distance masters bicycle racer. It was a much appreciated recommendation and provided a good deal of context and background that helped me better understand the nature and potential fixes to my condition.I should say that often the book focused on heart conditions and arrhythmias other than those of direct, personal interest to me. The segment on atrial flutter was relatively brief but quite informative; the book made almost no mention of heart block.The Haywire Heart was a useful and informative read. It seemed well researched, rational, and balanced. Its illustrations were also useful. While I might have quibbled a bit with its organization and coverage, I would definitely recommend it for anyone seeking knowledge and perspective on (aerobic) exercise and risks to heart health.

Básicamente se trata de un compendio de los conocimientos sobre el tema, bastante bien desarrollado, basado en muchas fuentes y con un buen nivel divulgativo.Por otro lado, al puro estilo americano, insiste mucho en casos muy concretos, detallando durante páginas hasta los sentimientos de las personas que se citan como ejemplos, volviéndose algo pesado.La calidad de la gráfica, la impresión y la encuadernación de la versión de tapa blanda es bastante pobre.

I've been an elite masters cyclist in Ontario Canada for several decades and have won National and Provincial Championships on both road and track. Recently I lost a good friend who used to be a fierce competitor and continued to keep himself in excellent condition - he just dropped dead one morning from a heart attack. I also have another close friend who is learning to live with severely impaired heart function. Again, a man who kept himself in pretty good shape. As I think back over the years I realise that there have been several other deaths of masters cyclists from heart problems that I know about. I just never really thought much about it because, like many others, I had a mindset that endurance aerobic activity strengthened a person's heart and cardiovascular system. Not sure how I camp across this book but it has been an eye-opener for me and explains so much that was in the back of my mind, unresolved. I suggest you read the epilogue first before you get into the details of the main body of the book. I'm 75 years old now and my doctor tells me I'm doing just fine so maybe I'll be okay. The book explains that most endurance athletes do not have problems with their hearts, but some do, and it is a significant enough risk that we should all be aware of it. Remember, just because something is good for you does not mean that more of it will be better. I heartily recommend this book to anyone who participates in endurance sport, or has a loved one who does.

Des renseignements précis sur les maladies cardiaques des sportifs et des témoignages captivants, sans compter les conseils utiles. Un très bon livre !

There is apparently an emerging theory (backed up by a growing body of evidence) that excessive high-level exercise can cause abnormal heart rhythms. This fed through into the community in a Velo News article by the authors of this book in 2015.This book explains that theory - beginning with a case study (and with other case studies scattered throughout the work) - going on to explain how the heart works and how exercise affects the heart and how the heart can be damaged (specifically by or contributed to by high level, high volume exercise). The authors acknowledge that the theory is not 'nailed on' and that there is much work to do to understand how arrythmias develop and whether the link with exercise is indisputable.What the work does is identify the issue, explores it, offers some insight and advice about 'best practice' to perhaps avoid damaging your heart 'just in case'.To a degree, I have to say that the book could cause alarm and concern and I recommend also reading the online blog of Dr Larry Cresswell who is a little less alarmist (in my opinion) and whilst he doesn't dismiss the link with exercise, he offers a more conservative view.I thoroughly recommend the book for what the insights it gives, the quality of the writing and the depth.I should emphasise that this is an exceptional work that is perfectly suitable for the lay person; i.e. not requiring any or any detailed medical knowledge.

Devo ancora finirlo, ma non mi pare offra soluzioni concrete per evitre i problemi. Tuttavia apre gli occhi in modo abbastanza divulgativo (e quindi comprensibile ai più) sulle problematiche cardiache degli sport di endurance protratti per tanti anni.